Community-based Group Research Articles

Consumer Perceptions of a Shingles Infograph Intervention and Vaccination Plans in Community Pharmacy Settings.

Background: Cost and lack of knowledge are key barriers to improving shingles vaccination rates in community pharmacies. A health literacy (HL) tailored infograph intervention addressing these barriers can enhance consumer interest in shingles vaccinations. Objectives: The objectives were to: 1) design a health literacy tailored shingles infograph addressing cost and knowledge about vaccination barriers, 2) determine consumer perceptions of infograph usefulness, and 3) determine factors associated with shingles vaccination plans. Methods: An infograph addressing the study objectives, and a 22-item self-administered questionnaire assessing shingles vaccine awareness, HL, infograph usefulness, and vaccination plans were designed. The infograph was pilot tested with pharmacists and two community-based focus groups. Inclusion criteria consisted of age-eligible consumers at one chain and three independent community pharmacies. Consenting participants first reviewed the infograph and then completed the survey. Descriptive statistics and multivariable logistic regression analyses were performed. Results: Of the 422 eligible consumers approached, 112 participated in the study, with 55.4% from the chain pharmacies. Participants were female (56%), white (94%), between 50-70 years old (77%), had adequate HL (96%) and aware of the shingles vaccine (87%). While only 8% of the respondents considered vaccinating on the survey date, 46% considered it in the future, and 29% planned to in the next six months. The infograph was useful (90%) in recognizing vaccination need, was readable (95.5%), and understandable (96%). Consumers who found the infograph useful were significantly more likely to have vaccination plans (OR= 4.06, CI: 1.37 - 11.9, p=0.016). Conclusion: A shingles vaccine infograph focused on key barriers to vaccination was well-received and useful in promoting consumers' vaccination plans.

A community-based peer-support group intervention “Paths to EvERyday life” (PEER) added to service as usual for adults with vulnerability to mental health difficulties – a study protocol for a randomized controlled trial

BackgroundThe number of people struggling with vulnerability to mental health difficulties is increasing worldwide, and there is a need for new interventions, to prevent more people from developing serious mental illnesses. In recent years, peer support has been suggested as a key element in creating person-centered interventions in mental health services. However, the evidence for peer support is not yet established. We aim to investigate the effect of a 10-week peer-support intervention “Paths to EvERyday life” (PEER) added to service as usual (SAU) versus SAU alone in a Danish municipality setting.MethodsA two-armed, investigator-initiated, multi-municipal, parallel-group superiority trial to investigate the effectiveness of the PEER intervention added to SAU compared to SAU alone. A total of 284 participants will be recruited from the municipal social services in the participating municipalities and by self-referrals and randomly assigned to (1) the PEER intervention added to SAU or (2) SAU. The primary outcome is a self-assessed personal recovery (Questionnaire about the process of recovery (QPR-15)) at end of the intervention. The secondary outcomes are self-assessed empowerment (Empowerment Scale Rogers (ESR)), quality of life (The Manchester Short Assessment of Quality of life (MANSA)), and functioning (Work and Social Adjustment Scale (WSAS)).DiscussionThis trial will test a new community-based peer-support intervention, and if the intervention proves to be effective, the goal is that future integration of this intervention will improve individual recovery and mental health and reduce the societal burden of individuals seeking municipal social support and/or mental health services.Trial registrationClinicalTrials.gov NCT04639167. Registered on Nov. 19, 2020.

Leveraging mHealth usage logs to inform health worker performance in a Resource-Limited setting: Case example of mUzima use for a chronic disease program in Western Kenya

Health systems in low- and middle-income countries (LMICs) can be strengthened when quality information on health worker performance is readily available. With increasing adoption of mobile health (mHealth) technologies in LMICs, there is an opportunity to improve work-performance and supportive supervision of workers. The objective of this study was to evaluate usefulness of mHealth usage logs (paradata) to inform health worker performance. This study was conducted at a chronic disease program in Kenya. It involved 23 health providers serving 89 facilities and 24 community-based groups. Study participants, who already used an mHealth application (mUzima) during clinical care, were consented and equipped with an enhanced version of the application that captured usage logs. Three months of log data were used to determine work performance metrics, including: (a) number of patients seen; (b) days worked; (c) work hours; and (d) length of patient encounters. Pearson correlation coefficient for days worked per participant as derived from logs as well as from records in the Electronic Medical Record system showed a strong positive correlation between the two data sources (r(11) = .92, p < .0005), indicating mUzima logs could be relied upon for analyses. Over the study period, only 13 (56.3%) participants used mUzima in 2,497 clinical encounters. 563 (22.5%) of encounters were entered outside of regular work hours, with five health providers working on weekends. On average, 14.5 (range 1-53) patients were seen per day by providers. mHealth-derived usage logs can reliably inform work patterns and augment supervision mechanisms made particularly challenging during the COVID-19 pandemic. Derived metrics highlight variabilities in work performance between providers. Log data also highlight areas of suboptimal use, of the application, such as for retrospective data entry for an application meant for use during the patient encounter to best leverage built-in clinical decision support functionality.

The Yin and Yang of Equity-Centered Philanthropy

Foundations face two competing imperatives when they commit to advancing equity. On the one hand, they are counseled to support and follow the lead of community-based groups that are on the front lines of social change. On the other hand, they are also being challenged to use their power and influence to act boldly to change inequitable structures, policies, and institutions. These two orientations, yin and yang, can take a foundation in different directions and thus cause confusion and internal conflict.

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2-4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8-9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries.

82. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

82. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review

Feasibility of physical activity promotion in eyecare and sight loss services to improve the health of adults with sight loss: a survey

Purpose (1) To identify if adults with uncorrectable sight loss would increase their physical activity (PA) following advice from general healthcare, eyecare or sight loss service professionals. (2) To identify what resources could be provided alongside advice from a professional to facilitate PA. Materials and methods Survey data from 100 UK adults with uncorrectable sight loss were analysed. Adjusted logistic regression models were used to examine the association between participant characteristics, and the likelihood that participants would increase PA if advised to by different professionals. Results Most of our sample would increase their PA if advised to by a general practitioner (GP) (n = 78), ophthalmologist or optometrist (n = 70) or a low vision rehabilitation officer (n = 75). Thirty-one participants would increase their PA if advised to by a dispensing optician. Participants with a history of anxiety and depression were less likely to report they would increase their PA based on advice from a GP (p = 0.002). Sight loss specific and community-based PA groups, exercise specialist support, a sighted guide, and a travel plan, were considered by most participants to be useful facilitators of PA. Conclusion The results suggest eyecare and sight loss service professionals could facilitate increases in PA among adults with sight loss. Implications for rehabilitation Physical activity levels among populations with sight loss are critically low, and inactivity increases the risk of chronic conditions and premature mortality within these populations. GPs, optometrists, ophthalmologists, or low vision rehabilitation officers could play a pivotal role in increasing physical activity levels among people with sight loss, by providing physical activity advice during consultations. Professionals advising people about physical activity should have the knowledge, and opportunity, to refer people with sight loss to accessible physical activity groups or services.

Stakeholders’ perspectives on “miracle examination centres” in Nigeria

PurposeThe purpose of this study is to describe the nature and operations of schools commonly regarded as “Miracle Examination Centres (MECs)” in Nigeria, through the lens of stakeholders in education. This study also assessed stakeholders’ perspectives on the possible solutions to the problem of MECs.Design/methodology/approachThe study design was a stakeholders’ approach involving 39 key actors within the examination system from northern and southern Nigeria. The stakeholders comprised people from the Ministries of Education (MoE), Examination Councils (EC), school owners and teachers, security agencies and Civil Society Organisations (CSOs) who were invited to interact, interrogate and debate the subject of MECs in Nigeria. Using thematic analysis, recurrent themes were identified from the data and used for a narrative synthesis of the findings.FindingsMECs may attempt to circumvent quality assurance and regulatory requirements and may find support from prominent leaders and members of the communities through a wider informal economy. Interventions against MECs might only yield incremental results and must involve various groups like CSOs, anti-corruption agencies, EC and faith- and community-based groups. These interventions will be even more effective if the MoE will strengthen its integrity and improve its monitoring and regulatory functions without political interference.Originality/valueThis paper revealed that improving examination integrity and building a solid and reliable secondary educational level in Nigeria will be achieved through the combination of horizontal and vertical approaches that involve local actors and those in authority.

A controlled evaluation of the effect of social prescribing programs on loneliness for adults in Queensland, Australia (protocol)

BackgroundIn social prescribing, link workers support individuals whose persistent health problems are exacerbated by loneliness by connecting them to community-based social activities. This approach is well established in the UK and is gaining attention in Australia. However, a major limitation of research to date has been a lack of theoretically informed and rigorous evaluations of social prescribing. We will address these points in this study, applying a social identity framework to examine the effects of group-based social prescribing (SP) activity compared to primary care treatment as usual (TAU).MethodsNinety participants experiencing loneliness recruited from primary care services and community centres across five sites in Southeast Queensland will be assigned to one of two conditions (SP, TAU) and assessed at two timepoints (baseline, + 8 weeks). Individuals will be aged 18 years and over, have sufficient English language skills to provide consent, and at the time of recruitment they will not be experiencing acute symptoms or social issues that require urgent intervention. Primary outcomes are loneliness, mental well-being, and health service use (total number of GP, hospital, and allied health visits in the past 3 months). Secondary outcomes will assess social group processes, including number of important social groups, new group identification, multiple identity compatibility, and group-based support and emotion regulation.DiscussionThis study will provide comprehensive data about the extent to which, and how, social prescribing to community-based group activities may help people to feel less lonely, more socially integrated, and healthy over the first 8 weeks. If effective, this social identity-informed model of social prescribing can be disseminated in communities across Australia.Trial registrationANZCTR, Registered 8 June 2022 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000801718.aspx

Analysis of changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention

Objective: To analyze the changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention. Methods: From August to November 2014, a 3-month community-based self-management intervention study of type 2 diabetes patients was implemented in Fangshan District, Beijing. 510 patients were recruited through posters, household inquiries and telephone notification and then were randomly divided into intervention group (260 patients) and control group (250 patients). Finally, 500 patients completed the study, including 259 in the intervention group and 241 in the control group. Self-efficacy score was measured through face-to-face interview at different time points, including pre-intervention, post-intervention, 2 years after the intervention and 5 years after the intervention, respectively. A two-level random coefficient model was fitted to analyze the long-term trend of self-efficacy and its relationship with group intervention. Results: Individual-level educational attainment, disease duration as well as their treatment plans had a positive correlation with self-efficacy of type 2 diabetic patients while gender and age did not affect their self-efficacy. Patients with junior middle school education, senior high school education and university and above education had 4.66 (P<0.05), 6.40 (P<0.05) and 11.02 (P<0.05) points higher than those with primary education, respectively. The self-efficacy of diabetic patients increased by 0.23 (P<0.05) for each additional course year. The effect of treatment plan on self-efficacy was mainly reflected in the self-efficacy of taking medication or insulin injection as prescribed and blood glucose monitoring. After controlling for the confounding factors, i.e., gender, age, disease duration, educational attainment, and treatment plan, self-efficacy scores at the post-intervention increased in both groups compared to those at the pre-intervention. The intervention group had 7.95 points higher than the control group (P<0.05). After the intervention, the self-efficacy scores of both groups decreased year by year while the intervention group declined faster, with 5.41 points (P<0.05) at 2 years after the intervention and 8.94 points (P<0.05) at 5 years after the intervention. Conclusion: Community-based self-management group intervention could improve the self-efficacy of type 2 diabetic patients while the self-efficacy decreases year by year in the absence of follow-up intervention.

Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review

BackgroundPhysical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes.MethodsFive electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological s) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation.ResultsIn total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity.ConclusionsGroup-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Quantification and characterization of plastics in near-shore surface waters of Atlantic Canada

Plastics are a ubiquitous pollutant in the marine environment. Despite growing concerns, quantitative and qualitative data on microplastics in aquatic and marine environments of Atlantic Canada is just emerging. Surface water plastics were measured and categorized by morphology (thread, microfibre, fragment, foam, film, pellet, and microbead) in two locations in Nova Scotia and one in Newfoundland and Labrador, Canada. All sites within the three locations contained plastic with an average abundance of 9669 items/km2. Most plastics (68 %) were sized as microplastics (0.425–5 mm), and plastic fragments were the most common morphological type. Polyethylene accounted for a third (30 %) of all particles found across all three locations, followed by polypropylene (23 %). Results can inform future research for community-based environmental groups, government, and academia.

Examining telehealth use among primary care patients, providers, and clinics during the COVID-19 pandemic

BackgroundAt the onset of COVID-19, there was a rapid expansion of telehealth (video/telephone) visits to maintain delivery of primary care (PC) services at the Veterans Health Administration (VA). This study examines patient, provider, and site-level characteristics of any virtual and video-based care in PC.MethodsInterrupted time series (ITS) design was conducted using VA administrative/clinical, electronic healthcare data, 12-months before and 12-months after COVID-19 onset (set at March 2020) at the VA Greater Los Angeles Healthcare System (GLA), between 2019 and 2021. Patients with at least one visit to a VA PC clinic at GLA (n = 547,730 visits) were included in the analysis. The two main outcomes for this study were 1) any telehealth (versus in-person), as well as 2) video-based care (versus telephone). For the ITS analysis, segmented logistic regression on repeated monthly observations of any telehealth and video-based care was used.ResultsPercent telehealth and video use increased from 13.9 to 63.1%, and 0.3 to 11.3%, respectively, before to after COVID-19 onset. According to adjusted percentages, GLA community-based clinics (37.7%, versus 29.8% in hospital-based clinics, p < .001), social workers/pharmacists/dietitians (53.7%, versus 34.0% for PC clinicians, p < .001), and minority groups, non-Hispanic African Americans (36.3%) and Hispanics (34.4%, versus 35.3% for Whites, p < .001) were more likely to use telephone than video. Conversely, mental health providers (43.3%) compared to PC clinicians (15.3%), and women (for all age groups, except 75+) compared to men, were more likely to use video than telephone (all p’s < .001).ConclusionsSince telehealth care provision is likely to continue after COVID-19, additional research is needed to identify which PC outpatient services are better suited for telephone (e.g., case management) versus video-based care (e.g., integrated mental health visits). Additionally, it is important to understand how all clinics can systematically increase access to both telephone- and video-based PC services, while ensuring equitable care for all patient populations.

An exploration of identity change in post-detoxification alcohol dependent individuals

PurposeDependent alcohol use is a severe addictive disorder with significant enduring consequences for health and social functioning. This study aims to inductively explore the process of identity change for alcohol dependent people progressing through a “pre-habilitation” intervention, alcohol detoxification and post-detoxification recovery support.Design/methodology/approachQualitative study as a part of a process evaluation situated within a UK feasibility trial of a group-based intervention in preparation for structured alcohol detoxification. Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported data on experiences of treatment provision as part of the feasibility trial. Thematic analysis of transcripts and iterative categorisation of identity-related themes and concepts was conducted with verification of analysis undertaken by a second coder.FindingsIdentity change was revealed in participant narratives around the meta themes of external (social-identity) and internal (self-identity) concepts. External influences impacting social identity were key, having influenced initiation into alcohol use, influencing acceptance of the stigmatised “alcoholic” label and then being central to the treatment journey. Internal influences on self-identity also impacted on the process of identity change. In recovery, there was hope in discovering a new “normal” identity or rediscovering normality.Originality/valueAnalysis demonstrates that moving from regular alcohol use to problematic use is a journey of identity change that is influenced at the macro (cultural), meso (group) and micro (relational) social levels. Throughout the treatment journey, social influences in gaining a new non-drinker identity are key. Findings suggest a need for long-term support through treatment and community-based groups specifically to foster positive identity change that may not have been addressed previously.

Automated patient self-scheduling: case study.

This case study assesses the uptake, user characteristics, and outcomes of automated self-scheduling in a community-based physician group affiliated with an academic health system. We analyzed 1995909 appointments booked between January 1, 2019, and June 30, 2021 at more than 30 practice sites. Over the study period, uptake of self-scheduling increased from 4% to 15% of kept appointments. Younger, commercially insured patients were more likely to be users. Missed appointments were lower and cancelations were higher for self-scheduled patients. An examination of characteristics, benefits, and usage of automated self-scheduling provides insight to those organizations contemplating the implementation or expansion of similar consumer-facing digital self-scheduling platforms.

Electronic health records analytics to identify cancer patients with metabolic syndrome.

e18649 Background: Metabolic syndrome, defined as the presence of at least 3 of 5 clinical factors including hypertension, elevated triglyceride levels, low high-density lipoprotein level, insulin resistance, and central obesity, increases the risk of heart disease, fatty liver, and multiple cancers. Metabolic syndrome in cancer patients has been associated with poor cancer-specific and overall survival. Lifestyle modification in patients with metabolic syndrome may reduce the risk of poor outcomes. In this quality improvement project, we aimed to determine the prevalence of metabolic syndrome among cancer patients and survivors seen in an outpatient general internal medicine (GIM) clinic and to determine the feasibility of using electronic health records (EHR) analytics to systematically identify such patients and refer them to lifestyle interventions and liver imaging. Methods: Study period was January-December 2021. During this period, an EHR algorithm was used to identify patients with metabolic syndrome based on the presence of ICD-10 diagnoses of metabolic conditions (diabetes, hypertension, lipid disease, and obesity). This algorithm was used to direct data from patient visits into an interactive dashboard to track metabolic syndrome prevalence and continuously monitor referrals to interventions. In September 2021, a best practice alert based on the EHR algorithm was created to identify patients with metabolic syndrome and prompt providers to refer them to nutrition counseling, liver ultrasound with elastography, and/or a community-based active-living support group for cancer survivors. GIM clinic nurses also reviewed medications and utilized an EPIC SmartPhrase that incorporated laboratory values (e.g., glucose, A1c, and lipids), blood pressure, and body mass index to confirm whether patients actually met the criteria for metabolic syndrome, and if so, they notified medical providers who then ordered the interventions. Patients confirmed to have metabolic syndrome received educational materials about lifestyle modifications. Data extracted from the dashboard were analyzed using Minitab 17 statistical software. Results: Among 1133 patients seen in the GIM clinic during 2021, 609 (54%) had metabolic syndrome. A total of 1045 patients (92%) had hypertension, 802 (71%) had hyperlipidemia, 571 (50%) had obesity, and 483 (43%) had diabetes. Among the 609 patients with metabolic syndrome, 148 (24%) were referred to liver ultrasound with elastography, 124 (20%) to nutrition counseling, and 21 (3%) to the support group. Beginning September 1, the best practice alert was triggered for 1131 clinical encounters meeting criteria for metabolic syndrome. Conclusions: The prevalence of metabolic syndrome among cancer patients seen in a GIM clinic was high. EHR analytics can lead to systematic identification and referral of patients with metabolic syndrome to lifestyle interventions and liver imaging.

Singing for Wellbeing: Formulating a Model for Community Group Singing Interventions.

Research into the benefits of community-based group singing, pertaining to positive wellbeing and Quality of Life is lacking. Additionally, no preferred theoretical framework exists for community singing-based interventions. For the present study, six members of a UK community choir were interviewed using a semi-structured interview approach. Interpretative phenomenological analysis (IPA) was employed. Analysis produced superordinate themes of: Social Factors with key elements such as social bonds and group identity; Psychological Factors, highlighting self-efficacy, self-identity and positive emotions and Psychological Motivations for Joining the Group, including autonomy, change of life circumstance and seeking a new challenge. The style/method of the group, teaching, music and group leader, were shown to have an influence on perceived benefits of the singing group. A key product of this study beyond the evidenced benefits of group singing is the development of an intervention model that optimises wellbeing outcomes in community singing groups underpinned by psychological theory, findings from the wider literature and the results of this study.

Examining the powers decentralized to community resource management areas in Ghana

Decentralizing forest control to community-based groups is a widely promoted form of governance around the world. Community Resource Management Areas (CREMAs) in Ghana, a form of forest decentralization, is a relatively recent government strategy to reduce forest loss, promote restoration, and improve local control and participation in resource management. This paper examines the powers devolved to CREMAs in Ghana, using a political ecology lens. Using a variety of qualitative research methods, the paper found that CREMAs receive limited powers from the State and these powers mainly restrict local access to resources, an action the State has often failed at. The results also suggest that CREMAs impose responsibility on local people without accompanying resources and often at the expense of security and safety of local volunteer enforcers. The findings also highlight the lack of coherence between forest decentralization and exiting political decentralization processes; the incoherence between the different institutional regulations for CREMAs; and tensions between new and traditional forms of local resource governance. The study suggests that critical approaches to evaluating the performance of decentralized regimes could be a useful approach to understanding the drivers of vulnerability among local resource users, dependents, and their institutions.

Making all the right moves: Clinician-led development and pilot of an evaluative toolkit for a community-based school readiness group program

Introduction Children often present to occupational therapy with delays in pre-school occupations, with underlying skill deficits. If unaddressed, deficits may affect adjustment to school, jeopardising educational progress. Although evidence supports group-based interventions, evaluation can be time-intensive and expensive. We developed and piloted an evaluative toolkit to measure and report outcomes for short school readiness groups. Method We sought measures that were inexpensive, reliable and responsive to change in key domains. Skills and pre-school occupations were measured in children [ n = 58; mean = 5 years] before and after our school starters group program. Parents rated their children’s skills, school readiness and level of school-related anxiety. Results Our resource-efficient, multi-measure, skills-based evaluative toolkit reliably recorded changes in children’s performance in our school readiness program. Measures were adapted for groups. Children demonstrated improvements in skills important for successful school transition pre-post program; including static and dynamic balance, pencil grasp/control, pre-writing/drawing skills and name writing. Parents’ confidence in their child’s readiness for school increased, while school-related-anxiety decreased. Conclusion The evaluative toolkit proved responsive to change and showed excellent inter-rater reliability. Measures were practicable for groups, easy to administer and score, and engaged parents in their child’s progress. In our six-session School Starters group, important pre-school skills were improved in participating children.

Patient acceptability of group transdiagnostic cognitive behavior therapy for the treatment of anxiety disorders in community-based care: a qualitative study

ABSTRACT Objective Cognitive-behaviour therapy (CBT) is a research-supported treatment for anxiety disorders. Transdiagnostic CBT protocols have been recently developed to manage multiple anxiety disorders. The efficacy of transdiagnostic CBT is directly dependent on acceptability as perceived by patients and health care providers. In this study, we sought to examine the acceptability of transdiagnostic CBT from the patient perspective within the context of a community-based group delivery for mixed anxiety disorders. Method An embedded qualitative study was conducted as part of a pragmatic randomized clinical trial of group transdiagnostic CBT for anxiety disorders. Semi-structured interviews were conducted based on a meta-framework of the concept of acceptability. Acceptability of the therapy was examined with a thematic analysis of interview verbatims. Results Seventeen patients were interviewed. Patients’ perception of acceptability of tCBT was classified into eight themes: 1) therapy features; 2) intervention components; 3) group format; 4) group cohesiveness; 5) co-therapists with different expertise; 6) quality of therapeutic alliance; 7) perceived effectiveness; and 8) access to the therapy. Conclusion The acceptability of transdiagnostic group CBT for patients was generally perceived as adequate in community-based therapy. Recommendations to enhance acceptability of the group therapy were related to group size, group dynamics and exposure. KEY POINTS What is already known about this topic (1) Transdiagnostic group CBT is an effective treatment for anxiety disorders. (2) Studies generally report good acceptability for CBT, but dropout rates suggest a potential area for improvement. (3) To date, few studies have examined the comprehensive concept of acceptability of CBT from the patients’ perspective. What this paper adds (1) A qualitative study was conducted with a meta-framework of the concept of acceptability in the context of a community-based therapy. (2) The acceptability of transdiagnostic group CBT for patients was generally perceived as adequate. (3) Recommendations to enhance acceptability emerged from participants’ experiences concerning the topics of group size, group dynamics and exposure.