title: Identifying and describing patients' learning experiences towards self-management of bipolar disorders: a phenomenological study.
abstract: Existing evidence suggest that patient education in promoting self-management strategies of bipolar disorder (BD) is effective. However, results across the full range of service users with BD vary. Learning experiences of service users look to be a crucial factor to take into account when designing, delivering, and evaluating effective interventions that promote self-management in chronic illness. What learning activities service users actually undertake themselves when self-managing BD that might explain varying success rates, and guide future self-management educational programmes has not been examined. Unlike previous studies that suggest that outcomes in self-management depend on individual learning activities, the current study found that learning to self-manage BD takes place in a social network that functions as a learning environment in which it is saved for service users to make mistakes and to learn from these mistakes. Especially, coping with the dormant fear of a recurrent episode and acknowledging the limitations of an individual approach are important factors that facilitate this learning process. Practitioners who provide patient education in order to promote self-management of BD should tailor future interventions that facilitate learning by reflecting on the own experiences of service users. Community psychiatric nurses should keep an open discussion with service users and caregivers, facilitate the use of a network, and re-label problems into learning situations where both play an active role in building mutual trust, thereby enhancing self-management of BD.
  Existing evidence suggest that self-management education of bipolar disorder (BD) is effective. However, why outcomes differ across the full range of service users has not been examined. This study describes learning experiences of service users in self-managing BD that provide a possible explanation for this varying effectiveness. We have conducted a phenomenological study via face-to-face, in-depth interviews, guided by a topic list, along service users with BD I or II (n = 16) in three specialised community care clinics across the Netherlands. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7. Unlike existing studies, which suggest that individual abilities of service users determine outcomes in self-management of BD, the current study found that self-management of BD is a learning process that takes place in a collaborative network. We identified five categories: acknowledgment of having BD, processing the information load, illness management, reflecting on living with BD, and self-management of BD. The success of self-management depends on the acknowledgment of individual limitations in learning to cope with BD and willingness to use a social network as a back-up instead. Especially, the dormant fear of a recurrent episode is a hampering factor in this learning process.
authors.affiliation: Saxion University of Applied Sciences, Expertise Centre for Health, Social Care and Technology, Deventer, The Netherlands.|Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, The Netherlands.|KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium.
authors.forename: S C G H
authors.initials: SC
authors.lastname: Van den Heuvel
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Dimence, SCBS Bipolar Disorders, Institute for Mental Healthcare, Deventer, The Netherlands.|GGZ-VS, Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands.|University Centre of Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Services, Ghent University, Ghent, Belgium.
authors.forename: P J J
authors.initials: PJ
authors.lastname: Goossens
authors.affiliation: Saxion University of Applied Sciences, Expertise Centre for Educational Innovations, Enschede, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Terlouw
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Van Achterberg
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.|Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: L
authors.initials: L
authors.lastname: Schoonhoven
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012648:Self Care; D055815:Young Adult
keywords: bipolar disorders; community mental health services; learning experiences; phenomenology; qualitative research; self-management