title: Towards a conceptual consensus of continuity in mental healthcare: focused literature search and theory analysis.
abstract: OBJECTIVE
  While continuity of care is an important component in the provision of mental health services, a universally accepted definition is missing. There is a need to identify areas of consensus and discrepancy in continuity theory and provide a foundation for advancing measurement capabilities. The purpose of this study was to systematically identify and examine scholarship on continuity in mental healthcare.
  
  
  METHODS
  Using a focused literature review modelled on the Joanna Briggs Methodology for systematic reviews, MEDLINE, CINAHL, Embase, PsycINFO and Health STAR were searched from 1950 to 2011 for articles on the theoretical nature of continuity in mental healthcare. Included conceptualisations were subject to a theory analysis to critically examine similarities and differences. Next, a content analysis on the extracted data was used to identify a global understanding and set of theoretically defined concepts for the whole. Finally, the identified global concepts were compared with the original documents and to items identified on existing quantitative measurement tools to assess areas of consensus and discrepancy.
  
  
  RESULTS
  Seven documents describing the conceptualisation of continuity in mental healthcare were identified. From these, a deductive theoretical summary is proposed and theoretical consensus exists to support nine global concepts of continuity in mental healthcare. These global concepts include Longitudinality, Input & Individuality, Comprehensiveness, Flexible Consistency, Stability & Relationship, Accessibility, Information & Sharing, Realities, and Responsibility/Accountability. The original theories proposed by Dr Bachrach and colleagues and Dr Joyce and colleagues, as well as the ACSS-MH measurement tool, provide the best coverage of the proposed concepts.
  
  
  CONCLUSIONS
  Consensus exists across conceptualisations of continuity in mental healthcare, yet it is obscured by inconsistent use of language. Existing tools capture many of the associated concepts and elements, but none do so entirely. Further tool development and psychometric testing is needed. This study provides the foundational work required to advance research priorities in this area.
authors.affiliation: School of Nursing, Queen's University, Kingston, Ontario. 2ad2@queensu.ca
authors.forename: Amanda
authors.initials: A
authors.lastname: Digel Vandyk
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: VanDenKerkhof
authors.forename: Amanda
authors.initials: A
authors.lastname: Ross-White
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Harrison
mesh_terms: D003210:Concept Formation; D032921:Consensus; D003266:Continuity of Patient Care / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*