Table 4 Research Question 3: Structured healthcare approaches to managing psychological distress.
Domains and themes | Quotes |
|---|---|
Beliefs about consequences Participants’ perceptions and expectations about their health conditions and the treatments offered | |
Expectations, mental health care | “Look they [psychologists] were very good, I mean, you can talk to them, and they listen to you and everything. But it doesn’t change the situation that you’ve got”. (Fiona, P10) “Rubbish [laughs]. Yeah, I don’t know, I was expecting something that she didn’t deliver. She got onto a subject which had nothing to do with it, and just harped on that. You know, I went three times, and yeah, she’s just harped on this one subject. And you know, that wasn’t the problem….I thought, she’s uh, I think she’s turning me against them [psychologists].” (Sam, P7) |
Stigma | “Cos they’d be looking at you a nutter if you were going to be seeing a psychiatrist. Yeah, no. No, psychologists do their job, you know, perhaps sometimes if people, when they’re struggling and especially young people, if they’re struggling over something, if they go to psychologists first, I think it would be better for them.” (Kathy, P3) |
Sharing illness experience | “Because I just don’t like talking about it. Why talk about it? It is what it is. It happened and it’s all there is about it. There’s nothing I can do about it now.” (Irene, P8). |
Expectations, medication effects | “I don’t like taking tablets to be quite honest, because once you take them - and you’ve got to wean yourself off, I have a lot of bad trouble. So I don’t want to be poppin’ this in and that in.” (Barbara, P2) “I don’t know that, that anything can help. Because it’s, I’ve got COPD and heart failure and I just got to live with it. You know, taking medications is not going to- medication for anxiety or depression is not going to fix the COPD or the heart failure. Do you get what I mean?” (Fiona, P10) |
Social influences The impact of social factors on participants’ attitudes and perceptions of structured management approaches for psychological distress, offered by health professionals | |
Perceptions of illness and illness treatments | “She thought he was sillier than me. Well, some psychiatrists, they do say that, don’t they? That they get a bit, you know, that the ones that have terrible cases to deal with, and they deal with them all the time, that they get a bit…odd. I’m trying to be polite here. You know, that’s what my sister said. He was as silly as what I was, and she said, and he calls himself a professor! [Laughs].” (Kathy, P3) “He prescribed morphine too. I said I don’t want to take morphine. And it looks like I’m at the end of the, you know… I get a bit scared, you know. Just to take morphine. Valium it’s all right. A lot of people take Valium.” (Antonella, P6) ““You don’t go crying like a little sissy to a doctor about things. [Laughs] My grandfather would roll over in his grave if I did that.” (Derrick, P4) |
Environmental context and resources The impact of external factors such as availability and accessibility of healthcare services and healthcare professionals on access to treatments | |
Treatments offered, respiratory | “He [General Practitioner] must’ve clicked onto it then. And that’s when he put me on the [inhalers]….that I’m on. And then he also, he’s also put me onto um,…my other one, it’s for asthma.” (Kathy, P3) “You do sit-to-stand and you do lots of like little weights for your upper body….It was actually through HARP [hospital admission reduction program] that I did them. But then after I stopped doing that with them, I actually joined a gym and I used to use the treadmill and do a few exercises.” (Pauline P9) |
Treatments offered, mental health | “Just talking to the doctor. And, like, I’ve been seeing the same doctor for 26 years. And he said, look, you don’t seem to be 100%. You know, you seem to be down, and so he prescribed me on those tablets.” (Sam, P7) “That’s the medication they gave me after I jacked up. After I went crook at ‘em. And they finally gave me mirtazapine, 15 milligram….And then I told them to take, to put it to 30….Which they finally did and now I’m still feeling better on that.” (Derrick, P4) “I mean, a few times, the local doctor has said, what about an antidepressant? And I’ve said no. Because as I said, years and years ago, I found they didn’t do anything. And I don’t like taking tablets unless I really have to.” (Fiona, P10) “In the hospital….when I had the psychologist with us, he was just a psychologist to teach people how to deal with pain without taking pills. That was his job, was to teach people to deal with pain without taking medication.” (Cathy, P3) |
Input, health professionals | “If her GP thought she needed it, she’d be the first one to put her hand up and get someone to help her.” (Brett, C2) “I used to get that [counselling] at my AA meetings. We’d get up and talk about things or anything worrying you or upsetting you. And then you’d get a person who’d help you out and that; which they did. You’d have a sponsor. I didn’t have one, cos I asked everybody. But yeah, I did that through AA.” (Allen, P1) “The [General Practitioner] usually… he’ll ask, you know, a question or so… how’s your this going? How’s that going? Oh you don’t look too happy today… so he picks up on it. So yeah, he’s been reasonably good about it.” (Neil, P11) “What I need, or what I think I need, is somebody… that’s actually walked in my shoes, but that’s not quite right either because everybody’s got a different version even if you all read the same book! You’ve got 50 different versions, so… that’s why I find I can listen to what people are saying and not necessarily do I agree and know that it will work for me, I’ve just got to pick out what I think will work for me. And if it does, it does. And if it doesn’t, well at least I tried.” (Phyllis, P12) |
Facilitators | “Like my local doctor. If I’m not well, or anything, she will see me at any time, she’s put a note on my file that if I ring up that she will fit me in. Whereas otherwise you have to wait three or four weeks to see her. And my cardiologist, if you ring him, he always rings you back within half an hour. It’s amazing.” (Fiona, P10) “I said I’m not even sure what puffers I’m supposed to take anymore. So she’s written down what I’m supposed to take. She did a new action plan.” (Irene, P8) “Like I don’t have to go and wait in the doctor’s surgery if I’m unwell. She just calls in here. She’s good. She does house calls….And a lot of doctors don’t do house calls.” (Pauline, P9) |
Barriers, service accessibility | “I don’t think doctors are communicating with each other, because my doctor was trying to listen to my lungs. And he was saying something,…your lungs aren’t getting enough capacity or something. Something’s going on here. And I thought, why aren’t the doctors communicating?…He’s trying to do tests that the respiratory team should have already let him know what’s going on.”(Irene, P8) “She wanted me to go to…Where they do this, therapy for the lung. But they sent me a letter and they told me they fully booked. They can’t take me, I have to… But I don’t know if they put me on the waiting list or not.”(Antonella, P6) “They can only have you for so long….Because of funding, and they turn around and say, look, you know, sorry but I can’t see you anymore because the funding has stopped” (Neil, P11) “I remember once I went and I was on a mental health plan, and I thought it wasn’t going to cost me anything. And I finished up costing me $190. And at that stage, when you’ve got three kids, you don’t have a spare $190.” (Fiona, P10) |
Barriers, therapies misaligned with patient preferences | “Yeah, they were psychologists and yes… and people that knew what they were talking about, but I just got sick and tired of the phone ringing all the time! Every second day or whatever to help me. To try and help me. But in the finish, I got fed up because each one was asking the same question over and over again. I’m repeating myself all the time and that wasn’t helping me. That was making me more depressed.” (Barbara, P2) |
Memory, attention and decision processes Participants’ cognitive function and decision-making processes regarding treatment | |
Information retention and recall | “I don’t know, everything happened so fast. And I ended up with all these puffers and so unsure of what I was supposed to take.” (Irene, P8) “See things don’t stay in my head…that’s the only thing that frustrates me, that things don’t stay in my head.” (Cynthia, P13) |
Decision-making | “Having to do my will and having to do, you know, power of attorney, make a decision whether I don’t, whether I want to “do not resuscitate”. Filling forms about my medical care. It’s just really, it’s frightened me, and I’m scared.” (Irene, P8) |
Cognitive overload/fatigue | “I just can’t be bothered to be quite honest…you tell these people and they ring up and everyone’s asking the same questions over and over again. And I just get exhausted. I had it a while back. Each one was trying to help me, ringing up, asking the same questions and I was fed up in the finish.” (Barbara, P2) |
Competing demands and priorities | “I didn’t try. So far, I got too much mucking around between doctors and nurses, up and down. And I fed up now.” (Mario, P5) “At the moment, I just haven’t got the time. As I said, I’ve got appointments, they’re cancelled, I’m waiting for them too”. (Barbara, P2) |
