Objective: Individuals suffering from severe mental illnesses represent one of America’s most vulnerable and disenfranchised populations. An estimated 11.4 million adults or 5.7 percent of the total population have some form of “severe” mental illness (SMI). As a group, persons with SMI suffer higher rates of undiagnosed or undetected physical illnesses than the general population. Undoubtedly, those with SMI can benefit from the entire spectrum of health promotion and disease prevention strategies. The purpose was to examine whether the theoretically proposed variables identified in Lauver’s Care Seeking Behavior (CSB) model were sufficient to explain careseeking behaviors of persons with SMI. Design: A descriptive correlational design was used. Population: A purposeful sample of 85 SMI clients enrolled in an Outpatient Community-based Adult Day Treatment Program was recruited. Study participants met the following criteria: (1) Had a primary DSM-IV diagnosis of a severe mental illness (excluding personality disorder or organic mental disorder), (2) not overtly psychotic or unable to focus on and respond to the questions asked in and interview format, (3) no prior history of a positive TB skin test, and (4) ability to communicate in English or through a translator. Individuals with severe mental illness are often at increased risk of contracting TB because of periods of institutionalization in long-term psychiatric facilities or correctional institutions, prior history of drug or alcohol problems, or living in congregate housing. Other factors contributing to their potential increased risk for TB include poverty, lack of access to medical care and screening, high rates of coexisting substance abuse and HIV related conditions, and homelessness Concepts studied: Lauver’s CSB model focuses on secondary prevention or health behaviors aimed at early detection and prompt treatment of diseases or disorders, often when the individual is asymptomatic or has few noticeable symptoms. As its main construct, the CSB model asserts that psychosocial variables (affect, health beliefs, habit and social norms) and facilitating conditions (barriers) directly determine the likelihood of engaging in careseeking behavior. Methods: Participation in tuberculosis (TB) skin testing was chosen as the secondary preventive health behavior for examining the CSB model. Based on Lauver’s prior work and the SMI literature, a Careseeking Behavior (CSB) Questionnaire was developed to be used as a prospective tool measuring those variables. The Tension-Anxiety scale of the Profile of Mood States (POM) was used to measure affect regarding TB skin testing. To obtain a measure of habit, participants were asked to report the number of TB skin tests they had received in the past five years. Items reflecting beliefs about TB screening, sources of social influence, facilitating conditions (barriers), perceived consequences of contracting TB, and one's likelihood of having come in contact with someone who had TB (perceived susceptibility) were included in the questionnaire. A nurse researcher in an interview format, administered the CSB questionnaire in a quiet room. After completing the initial questionnaire, those agreeing to participate in skin testing received a Mantoux skin test. Participants were instructed to return in 48 to 72 hours for the skin test to be read. Findings: Of those participants having a skin test placed, an overwhelming majority (95%) returned to have the skin test read within the required 48-72 hours. Logistic Regression found that the model chi-square for the joint effects of model variables was very significant,(X2 (3)=53.43, p=.000)indicating that some of the CSB model variables significantly predicted participation in TB testing. Social norms, health beliefs and facilitating conditions (barriers) were all associated with careseeking behavior. Social norms had a positive independent association with participation. There was a negative interaction between facilitating conditions (barriers) and utility beliefs on participation in TB testing. For study participants with one or more barriers, higher utility beliefs were related to TB testing. For participants with no barriers, there was no significant relationship between utility beliefs and TB participation. Conclusions: Findings from this study support the need to tailor prevention interventions using the CSB model components that enhance careseeking behavior. Implications: Findings from this study strongly support the implementation of on-site wellness screening clinics at community mental health centers. Actively enrolled SMI clients had high compliance rates when engaging in health screening. Analysis of the data show strong support for enhancing social norms and health beliefs while minimizing barriers associated with screening. More work is needed to measure perceived barriers of SMI clients not willing to under screening and to determine whether or not general health habits influence careseeking behavior.
Back to Depression and Stress in Vulnerable Populations
Back to The Advancing Nursing Practice Excellence: State of the Science