Validation of the icf core sets for schizophrenia from the expert perspective
- Autores: Laura Nuño Gómez
- Directores de la Tesis: Emilio Rojo Rodés (dir. tes.), M. Teresa Barrios Cerrejón (codir. tes.), Juan Antonio Amador Campos (tut. tes.)
- Lectura: En la Universitat de Barcelona ( España ) en 2020
- Idioma: inglés
- Tribunal Calificador de la Tesis: Rafael Penadés Rubio (presid.), Susana Ochoa Güerre (secret.), Albert Batalla Cases (voc.)
- Programa de doctorado: Programa de Doctorado en Psicología Clínica y de la Salud por la Universidad de Barcelona
- Materias:
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- Resumen
Schizophrenia has long been considered a chronic mental illness predestined to irreversible progressive deterioration. However, in recent decades scientific evidence has shown that recovery in people with schizophrenia is possible and should therefore be a priority in their treatment. In that sense, the recovery model has gained strength and transformed the view of mental illness. This approach moves the therapeutic goal from symptomatic remission to the recovery of satisfactory and proper functioning. In view of this, an integrated and interdisciplinary care system is needed where professionals from different fields who treat people diagnosed with the condition work together to address not only their symptoms, but also the difficulties they present in their daily functioning, their personal characteristics and the environmental factors that affect them.
This change in the therapeutic approach highlights the need for a tool that can assess the full spectrum of difficulties in functioning that a person may have and all the contextual variables involved and that facilitates the coordination and joint work between all the professions involved in the recovery process. The International Classification of Functioning, Disability and Health (ICF) covers all these requirements. Since it has more than 1400 categories, ICF Core Sets (ICF-CSs) linked to certain health states have been developed. The ICF-CSs consist of a list of the most relevant ICF categories for the description of the functioning and disability of people living with a given health condition. In the case of schizophrenia, two versions of ICF-CSs have been developed: the brief and the comprehensive.
In order to apply the ICF-CSs in clinical practice, they must be validated through different sources of evidence. In this context, the present thesis aims to evaluate the content validity of the ICF-CSs for schizophrenia from the perspective of experts in the treatment of this population, as well as to identify the potential repercussions of this health condition in the functioning of people diagnosed with this disorder. To achieve this, six three-round Delphi studies were conducted with expert panels from different professional backgrounds which have shown a significant role in the treatment of people with schizophrenia (i.e., psychiatry, psychology, nursing, occupational therapy, social work and physiotherapy). Each of these studies identifies functioning difficulties from the perspective of one of these professional areas and analyzes whether the identified aspects are represented in the ICF-CSs for schizophrenia. Once the results of the six Delphi studies were obtained, all the data were integrated to conclude the expert perspective and to evaluate the content validity of the ICF-CSs globally.
In total, 790 experts (352 psychiatrists, 175 psychologists, 101 nurses, 92 occupational therapists, 57 social workers and 13 physiotherapists) from 85 different countries covering the 6 demographic WHO regions (i.e., Africa, Americas, South-east Asia, Europe, Eastern Mediterranean and Western Pacific) participated in the first round of the different Delphi studies. Globally, 113 ICF categories and 31 Personal factors reached consensus (75% or more of the experts of a profession considered them relevant) by at least one professional perspective. Of these, 90 ICF categories and 28 personal factors reached expert consensus (they reached consensus from four or more professional perspectives). One hundred percent of the categories in the brief version of the ICF-CS for schizophrenia reached consensus from all professional perspectives considered. Regarding the comprehensive version, 89.7% of its categories (87 categories) reached expert consensus.
Overall, the present thesis provides important support for the worldwide content validity of the ICF-CSs for schizophrenia from the expert perspective. The results highlight the relevance, in the evaluation and treatment of people with schizophrenia, of assessing functioning by considering the body functions, participation in activities, environmental aspects and personal factors that experts have identified. All this suggests that the ICF and these ICF-CSs provide an effective framework from which to evaluate and describe functioning in people with schizophrenia and therefore may be a useful tool in the comprehensive treatment of this population.
