Dyadic Intervention Research Articles

The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care.

Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.

Occupational therapy interventions for adult informal carers and implications for intervention design, delivery and evaluation: A systematic review

Introduction Informal carers provide vital support for patients, reducing strain on health and social care services. However, caring can detrimentally affect carers’ health and wellbeing, thus policy advocates for improved carer support. Objective: to establish the published international evidence base regarding interventions for carers delivered by occupational therapists. Method English language studies published January 2010–January 2021 were identified against predetermined inclusion/exclusion criteria via searches of MEDLINE, EMBASE, CINAHL, PsychINFO, OTSeeker, Scopus, Web of Science and the Cochrane Library. Supplemental strategies: database alerts, hand-searching, searching of included papers’ reference lists and citations, and contacting key authors. Two reviewers completed critical appraisal and produced a textual narrative synthesis of data using a convergent integrated method. Results 38 papers were included, reporting 21 interventions. Most were dyadic, home-based interventions for carers of people living with dementia. Common intervention components included: assessment and goal-setting, skill training, education, coping strategies, equipment provision, environmental adaptation and signposting. Interventions improved outcomes for carers, however, intervention design and evaluation require careful consideration to maximise carer benefits and capture intervention effects. Conclusion Occupational therapist delivered carer interventions enhance support and improve carer outcomes. Intervention and evaluation designs should include careful selection of outcome measures, avoidance of increased carer burden in dyadic interventions and acknowledgement of known barriers and facilitators to both carer and therapist intervention engagement.

Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases.

Neurodegenerative diseases (NDDs) are increasingly prevalent and radically alter the lives of individuals and their informal care partners (together called a dyad). As symptoms progress, dyads are at risk for elevated emotional distress and declines in relationship functioning and quality of life. Psychosocial interventions delivered to dyads early after diagnosis have successfully prevented chronic emotional distress across several chronic illnesses including cancer and acute brain injury. Dyads with NDD could benefit from such interventions, however, they are limited. Because NDDs have symptom profiles that are distinct from other chronic illnesses, they require a unique framework and interventions. Given the limited dyadic interventions and unified symptoms across NDDs, a transdiagnostic framework may help to enhance scalability and efficiency. To address this problem, we developed a transdiagnostic framework that cuts across NDD physical and emotional diagnoses to inform cost-effective and sustainable NDD dyadic interventions. To develop this framework, we conducted: (1) a narrative review on dyadic adjustment and existent dyadic interventions for those with NDDs, and (2) integrated findings to develop our NDD transdiagnostic framework for dyadic interventions early after diagnosis. Findings revealed no existent dyadic interventions for NDDs delivered shortly after diagnosis. Among available interventions, all were delivered later in disease progression, thereby focusing on dyadic challenges at more advanced stages. In addition, although research emphasized the influence of individual, dyadic, and contextual factors on dyads' early adjustment to NDDs, no conceptual model has been developed. Informed by theory and current research, we introduce an NDD transdiagnostic framework for couples' early biopsychosocial adjustment. This framework includes NDD specific: contextual factors, illness-related factors, individual and dyadic stressors, adaptive coping strategies, and dyads' resources. Our NDD transdiagnostic framework can be used to inform early dyadic psychosocial interventions that cut across all NDDs. This approach has important implications for implementation and scalability.

Music and Psychology & Social Connections Program: Protocol for a Novel Intervention for Dyads Affected by Younger-Onset Dementia.

Psychosocial interventions targeting the specific needs of people affected by younger-onset dementia are lacking. Younger-onset dementia refers to dementia where symptom onset occurs at less than 65 years old. Because of its occurrence in middle age, the impact on spouses is particularly marked and dyadic-based interventions are recommended. Music And Psychology & Social Connections (MAPS) is a novel online intervention, informed by the theory of adaptive coping by Bannon et al. (2021) for dyads affected by younger-onset dementia. MAPS combines therapeutic songwriting, cognitive behaviour therapy, and a private social networking group that focuses on the dyads. This will be a randomised controlled trial with a waitlist control. The primary aims are to assess whether MAPS improves depressive, anxiety, and stress symptoms in caregivers, with secondary aims to assess whether MAPS improves depressive symptoms in people with younger-onset dementia. The trial also aims to assess dyadic social connectedness; caregiver coping skills; and neuropsychiatric symptoms in people with younger-onset dementia. We will recruit 60 dyads to participate in a group-based weekly online program for 8 weeks facilitated by a credentialed music therapist and psychologist. Sessions 1 and 8 will include both caregivers and people with younger-onset dementia and Sessions 2–7 will involve separate group sessions for caregivers and those with dementia. There will be focus groups for qualitative feedback. Due to its online administration, MAPS has the potential to reach many dyads affected by younger-onset dementia.

Emotional distress in neuro-ICU survivor-caregiver dyads: The recovering together randomized clinical trial.

Emotional distress is common in both survivors and their informal caregivers following admission to a neuroscience intensive care unit (Neuro-ICU) and can negatively affect their individual recovery and quality of life. Neuro-ICU survivor-caregiver dyads can influence each other's emotional distress over time, but whether such influence emerges during dyadic treatment remains unknown. The present study involved secondary data analysis of Neuro-ICU dyads enrolled in a randomized clinical trial of a dyadic resiliency intervention, Recovering Together (RT), versus a health education attention placebo control to test dyadic similarities in emotional distress before and after treatment. Data were collected from 58 dyads following Neuro-ICU admission. Emotional distress (depression, anxiety, and posttraumatic stress) was assessed at baseline, 6 weeks (postintervention), and 12 weeks later. Nonindependence within survivor-caregiver dyads was examined (i.e., correlations between cross-sectional symptoms and changes in symptoms over time); mutual influence of emotional functioning over time (i.e., "partner effects") was examined using cross-lagged path analyses. There were strong, positive cross-sectional correlations between survivor and caregiver distress at postintervention and follow-up and between changes in survivor and caregiver distress from baseline to postintervention and postintervention to follow-up. There were no partner effects. Neuro-ICU survivors and their informal caregivers show similar changes in emotional distress after treatment. These findings highlight the potential benefits of intervening on both survivor and caregiver distress following Neuro-ICU admission. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

"I Guess I'm On Alert All The Time": Dyadic Symptom Appraisal In Heart Failure With And Without An LVAD

Background Symptom monitoring is an essential component of heart failure (HF) self-care for HF patients with and without a left ventricular assist device (LVAD). Attention to HF symptoms by the caregiving dyad is important for prompt recognition and response. The purpose of this analysis was to characterize patient and caregiver agreement within dyads on appraisals of patient HF symptoms, and explore dyadic agreement across dyads, comparing LVAD and non-LVAD experiences. Methods This was a post-hoc analysis of a mixed-methods descriptive study of HF caregiving in dyads with and without an LVAD. We recruited HF patients and their caregivers from outpatient HF and LVAD clinics at Johns Hopkins Hospital. We administered surveys and qualitative interviews with each dyad. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS; higher scores = higher burden). We used raw difference scores to quantify the magnitude and direction of agreement within dyads. Dyads with difference scores of <|5| were considered in agreement. Dyads with difference scores ≥|5| were grouped based on the direction of agreement ([+] caregiver scored patient symptoms higher; [-] patient scored their symptoms higher). We integrated these appraisal patterns with qualitative quotations relevant to symptom appraisal. Results We enrolled 10 LVAD and 12 non-LVAD dyads. There were 7 dyads with agreement and 15 dyads with disagreement of which 6 had [+] agreement scores and 9 had [-] agreement scores. Qualitative data analysis revealed a theme common to both types of dyad relevant to symptom appraisal: “monitoring/vigilance”. However, the monitoring/vigilance described differed between LVAD and non-LVAD dyads (figure). In LVAD dyads, vigilance related to monitoring of the LVAD while non-LVAD dyads described monitoring symptoms and signs of disease progression. Dyads with agreement spoke less about monitoring/vigilance than dyads with disagreement. Dyads with higher caregiver rating of symptoms spoke of specific actions they take to monitor the patient's symptoms. Dyads with higher patient rating of symptoms described monitoring and vigilance in ways that were similar to stress. Conclusions Although quantitative comparisons were not powered to detect statistical significance, this study showed differences in HF symptom appraisal agreement and symptom monitoring behaviors between LVAD and non-LVAD dyads. Additional investigation may suggest targets for dyadic interventions to improve symptom burden, appraisal, and management. Symptom monitoring is an essential component of heart failure (HF) self-care for HF patients with and without a left ventricular assist device (LVAD). Attention to HF symptoms by the caregiving dyad is important for prompt recognition and response. The purpose of this analysis was to characterize patient and caregiver agreement within dyads on appraisals of patient HF symptoms, and explore dyadic agreement across dyads, comparing LVAD and non-LVAD experiences. This was a post-hoc analysis of a mixed-methods descriptive study of HF caregiving in dyads with and without an LVAD. We recruited HF patients and their caregivers from outpatient HF and LVAD clinics at Johns Hopkins Hospital. We administered surveys and qualitative interviews with each dyad. Symptom burden was measured using the Heart Failure Somatic Perception Scale (HFSPS; higher scores = higher burden). We used raw difference scores to quantify the magnitude and direction of agreement within dyads. Dyads with difference scores of <|5| were considered in agreement. Dyads with difference scores ≥|5| were grouped based on the direction of agreement ([+] caregiver scored patient symptoms higher; [-] patient scored their symptoms higher). We integrated these appraisal patterns with qualitative quotations relevant to symptom appraisal. We enrolled 10 LVAD and 12 non-LVAD dyads. There were 7 dyads with agreement and 15 dyads with disagreement of which 6 had [+] agreement scores and 9 had [-] agreement scores. Qualitative data analysis revealed a theme common to both types of dyad relevant to symptom appraisal: “monitoring/vigilance”. However, the monitoring/vigilance described differed between LVAD and non-LVAD dyads (figure). In LVAD dyads, vigilance related to monitoring of the LVAD while non-LVAD dyads described monitoring symptoms and signs of disease progression. Dyads with agreement spoke less about monitoring/vigilance than dyads with disagreement. Dyads with higher caregiver rating of symptoms spoke of specific actions they take to monitor the patient's symptoms. Dyads with higher patient rating of symptoms described monitoring and vigilance in ways that were similar to stress. Although quantitative comparisons were not powered to detect statistical significance, this study showed differences in HF symptom appraisal agreement and symptom monitoring behaviors between LVAD and non-LVAD dyads. Additional investigation may suggest targets for dyadic interventions to improve symptom burden, appraisal, and management.

Patient Self-Care and Caregiver Contribution to Patient Self-Care of Chronic Conditions: What Is Dyadic and What It Is Not

ObjectivesSelf-care of chronic conditions involves both patients and their informal caregivers and therefore might be considered as a dyadic phenomenon. Nevertheless, empirical evidence supporting a dyadic construct is unavailable. This study aimed to explore the existence of a dyadic construct in self-care maintenance, monitoring, and management in patients affected by chronic conditions and their informal caregivers. MethodsThis study used a cross-sectional design. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory, which measure patient self-care and informal caregivers’ contribution to self-care maintenance, monitoring and management. Exploratory Structural Equation Modeling was performed to verify the existence of dyadic latent constructs in each scale in patients and informal caregivers. ResultsA convenience sample of 493 patients and informal caregivers, with a mean age of 76.47 and 52.76 years, respectively, was studied. In the self-care maintenance scales, 2 correlated factors (r = 0.34, P < .001) were identified, indicating the presence of a dyadic second-order construct. In addition, 2 factors that were not correlated (r = 0.11, P = .064) were identified in the self-care monitoring scales, indicating the absence of a dyadic construct. Finally, we found a 3-factor model in the self-care management scales composed of both patient and caregiver items, indicating a dyadic first-order construct. ConclusionsKnowing which care behaviors are dyadic in chronic conditions is important for tailoring interventions to improve self-care. Self-care maintenance and management would benefit from dyadic interventions, while self-care monitoring would not. The results of this study may illuminate future theoretical and scientific developments in dyadic care of chronic illness.

Dyadic Profiles of Couples Coping With Body Image Concerns After Breast Cancer: Preliminary Results of a Cluster Analysis.

Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at (1) exploring rates of body image concerns among breast cancer patients, and (2) identifying dyadic profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners (n = 32) were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics (BFQ-2), psychological distress (HADS), coping flexibility (PACT), dyadic coping (DCQ), and closeness (IOS). Body image (BIS) and adjustment to cancer (Mini-MAC) measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” (cluster-1) reported low rates of body image concerns (p < 0.001), anxious preoccupation, negative dyadic coping, and self-oriented stress communication (p < 0.05), compared to “worried patients” (cluster-2). “Comfortable partners” (cluster-1) reported lower anxiety and depression (p < 0.001), self-oriented negative dyadic coping and closeness (p < 0.05) than “uncomfortable partners” (cluster-2). Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations (p < 0.05) by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions.

Peer-Based Intervention for Socioemotional Concerns Among Children with ADHD.

This study examined the potential benefits of peer-based dyadic interventions for improving the socioemotional functioning of children with ADHD. Participants included children ages 8-12 diagnosed with ADHD-combined type (n = 34) pooled from a larger randomized study comparing peer-based dyadic interventions. Self-concept and depressive symptoms were evaluated at pre- and post-treatment using single group design. Results showed significantly positive child responses to intervention for self-concept. Further, improvements in self-concept were not moderated by the type of dyadic intervention received or by treatment related changes in externalizing behaviors. The severity of reported depressive symptoms, however, did not significantly change. This suggests therapeutic interaction with peers, as demonstrated in peer-based dyadic intervention models, can improve self-concept in children with ADHD even when socioemotional concerns are not a primary target of treatment and independent of behavioral outcomes achieved. These preliminary findings support promoting prosocial peer behavior as a critical domain for ADHD intervention for children.

Systematic Review of the Evidence for Stroke Family Caregiver and Dyad Interventions.

Stroke family caregiver and dyad literature has expanded over the past few years. The purpose of this review was to build upon 2 prior systematic reviews to critique, analyze, and synthesize the evidence pertaining to the impact of family caregiver and dyad interventions on stroke survivor and family caregiver outcomes. CINAHL, PsychINFO, PubMed, and reference lists were searched from December 1, 2016 through March 31, 2021. Using PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), articles were identified that tested outcomes from stroke family caregiver or dyad interventions that targeted the health or well-being of family caregivers. Data from the articles were abstracted into tables for analysis, then compared with recommendations from the 2 prior systematic reviews. A total of 18 articles met inclusion criteria (10 caregiver interventions; 8 dyad interventions) representing sample sizes ranging from 7 to 349 caregivers or dyads. Most were randomized controlled trials (n=13); 2 were cluster randomized trials; and 3 were single-group quasi-experimental designs. Of the 18 studies, 8 had <50 caregivers or dyads and 5 were small feasibility studies that reported data trends rather than testing for significance. Only 6 studies reported significant survivor outcomes. Eleven studies reported significant caregiver outcomes, the most common being burden. A number of survivor and caregiver outcomes were not significant, or only significant for certain subgroups. The limited number of studies, small sample sizes, and conflicting results, made it difficult to draw firm conclusions regarding the impact of these interventions on outcomes. Based on the available evidence from these 18 studies, recommendations from the 2 prior reviews were generally supported. Well-designed and well-powered randomized controlled clinical trials are still needed to confirm efficacy of stroke family caregiver and dyad interventions.

Beyond the outcomes: generic change indicators in a video-feedback intervention with a depressed mother and her baby: a single case study.

Child and dyadic psychotherapy have been scarcely investigated from the psychotherapy process research perspective. Thus, content and mechanisms related to therapeutic change have been overlooked by research. This study aimed at testing the applicability of the generic change indicators (GCI) model to identify moments of change in the parent during dyadic interventions, as well as to explore, describe and illustrate the therapeutic process through a brief mentalization-informed intervention with a depressive mother and her baby, using video-feedback as its main strategy, which has ample evidence about its effectiveness. We conducted a single case qualitative study using the GCI model. The mother’s ongoing change was determined by identifying episodes of change (EC) and moments of change (MC). Each MC was then labelled with one of the 19 GCIs. GCIs were observed from the intervention’s start. GCI’s hierarchical levels were increasing over the intervention, in association with the video-feedback situation. Our findings suggest that the GCI model is feasible to observe and understand dyadic interventions, contributing to the growing body of evidence supporting psychotherapists’ training and supervision.

Mealtime Behavior and Depressive Symptoms in Late-Life Marriage.

This study examined whether one spouse's mealtime behaviors were associated with their own and their partner's depressive symptoms among older, married couples. We examined gender differences in these associations and tested marital satisfaction as a mediator of these associations. 101 couples self-reported mealtime behavior (number of meals, snacks, fast-food meals, and meals eaten alone), depressive symptoms, and marital satisfaction. Results of the Actor Partner Interdependence Model revealed a statistically significant actor effect of number of fast-food meals on depressive symptoms and a significant partner effect of number of fast-food meals and number of meals eaten alone on depressive symptoms. There were gender differences. Husbands' marital satisfaction mediated the effect of meals eaten alone on depressive symptoms. Wife's marital satisfaction mediated the effect of the husband's meals eaten alone, and wife's number of fast-food meals on the wife's depressive symptoms. Findings have implications for dyadic interventions to improve depressive symptoms.

Testing Functional Analytic Psychotherapy's mediational model of change in social connectedness for people with fear of intimacy

In efforts to decrease psychological distress, psychotherapy frequently focuses on a client's intimate relationships and connectedness with others. One contextual-behavioral approach, Functional Analytic Psychotherapy (FAP), aims to do so by employing the therapeutic relationship to shape improvements in the clients' in-session interpersonal behaviors. In a recent randomized trial of a FAP intervention for dyads who wanted to improve their relationships (Kanter et al., 2018), clients who presented with fear of intimacy were specifically taught in-session interpersonal skills to improve intimate behaviors and connectedness within dyads and reduce related fears. The current study employed a secondary analysis of those data and tested a mediational model in which decreases in fear of intimacy from pre-treatment to post-treatment for these participants would be associated with increases in social connectedness, and this association would be mediated by increases in self-reported intimacy-related behaviors. Results indicated that as fear of intimacy decreased, social connectedness increased, and this association was partially mediated by self-reported improvements in the intimacy-related behaviors targeted by the intervention. Thus, findings support a model in which fear of intimacy is associated with avoidance of intimacy-related behaviors which in turn decreases social connectedness; when these behaviors are targeted and improved, fear of intimacy may decrease and social connectedness may increase.

"A kaleidoscope of relationships" - cervical cancer survivors' perspectives on their intimate relationships: A qualitative study.

Cervical cancer is known to affect survivors' intimate relationships, as well as their communication and coping. Yet little is known about the perspectives of these survivors on their intimate relationships in the context of their needs during and after medical treatment. Additionally, only a few studies have focused on survivors' perceived needs or on existing psychosexual support. Understanding these perceptions can help provide a tailored response and improve dyadic interventions. The aim of this study was to examine cervical cancer survivors' perspectives on their intimate relationships during and after their treatment. The present study adopted a qualitative-phenomenological approach. In-depth, semi-structured interviews were conducted with 15 survivors of cervical cancer between the ages of 38 and 44 who were diagnosed at stages I-II and were treated with radiotherapy or chemo-radiotherapy and surgery. Data collection continued until saturation of concepts was reached. The results underwent thematic analysis. Analysis of the findings revealed two key themes: (1) Together and apart in the shadow of cervical cancer. This theme focuses on the recovery period as a potential opportunity for changing and improving the couple relationship, such that men no longer withdraw but rather provide their partners with needed support and encouragement. (2) Changes in sexual life and couple intimacy. This theme focuses on changes in sexual relations, which have become a burden, painful, and something to avoid. The study provides a comprehensive picture of intimate relationships during and after cervical cancer treatment and highlights the women's needs and desires for support from their intimate partners. The discussion notes that oncology providers can better facilitate supportiveness on the part of cervical cancer partners by offering better couple-oriented education and interventions to promote couple communication.

Association between sleep and quality of life in heart failurepatient-caregiver dyads and mediation of fatigue: An actor-partner interdependence mediation model.

Quality of life is essential to heart failure patients and their family caregivers. This study aimed to examine the mediating role of fatigue in the association between sleep and quality of life in heart failure patient-caregiver dyads. A cross-sectional descriptive study was conducted from November 2017 to August 2018. A total of 269 heart failure patient-caregiver dyads at two hospitals in China were included. The Chinese version of the Pittsburgh Sleep Quality Index, the Chalder Fatigue Scale and the 12-item Short-Form Health Survey were used to collect data on heart failure patients and their family caregivers. The structural equation model was employed in the dyadic analysis based on the actor-partner interdependence mediation model. Regarding the actor effects, poor sleep was negatively associated with physical and mental quality of life in heart failure patients and their family caregivers, respectively, and the relationship was mediated by their fatigue. Regarding the partner effects, caregivers' fatigue was positively associated with patients' physical quality of life and mediated the association between caregivers' sleep and patients' physical quality of life. Heart failure patients and their family caregivers experience reduced quality of life when they have poor sleep and fatigue, and caregivers' fatigue is related to patients' improved physical quality of life. Hence, dyadic interventions targeting to improving sleep and fatigue may be beneficial to their quality of life. This study highlights the importance of routinely measuring and managing sleep and fatigue for heart failure patients and their family caregivers. Effective dyadic-based interventions that maintain equal attention to family caregivers should be considered by healthcare providers to maximize the improvement of patients' quality of life.

Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression.

Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor–partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study.

Reprint of: Collecting experimental network data from interventions on critical links in workplace networks

This article describes and discusses challenges associated with interventionist network data gathering in organizational settings, with a special focus on dyadic interventions. While pointing out major risks of these approaches, we argue that collecting data in combination with dyadic network alteration methods can enable social network researchers to explore network mechanisms from a new angle and potentially benefit the members of the targeted social networks and the entire collectives, if certain research design and implementation principles are followed. We introduce a facilitated self-disclosure method for strengthening critical dyads in social networks in combination with longitudinal and retrospective network measurement. We assess the participants’ perceptions of the different stages of this process by qualitative interviews. The study illustrates that experimental network data collection includes some extra challenges in addition to the many challenges of observational network data collection but participants also reported practical benefits that would not be gained through observational network surveys alone. The results highlight the importance of early and continuous communication during the data collection process with all research participants, not just the management, and the benefits of sharing more of the preliminary results. The lessons learnt through this study can inform the design of experimental network data collection to prioritize the preferences of the participants and their benefits.

Arts-Based Program for Home-Based Care Dyads in Singapore

Creative Arts Educ Ther (2021) 7(2):200–215 DOI: 10.15212/CAET/2021/7/21 Arts-Based Program for Home-Based Care Dyads in Singapore Abstract This article describes an arts-based intervention program for seven care dyads of elderly persons and their caregivers who are foreign domestic workers (FDWs) in Singapore. The intervention aimed to introduce interdisciplinary tools of artmaking and mindfulness that could be used to improve the communication and relationship between the care dyad and to support the stress reduction and self-care of caregivers. Following a client-based approach, eight sessions were conducted, once weekly, over a 2-month period in hybrid structure, at the home of the care dyad and through the use of Google Meet. Qualitative data were collected in personal interviews, questionnaires, and visual data, and they were connected with art therapists’ fieldnotes and reflection journals. At the end of the program, an online feedback session was offered to the elderly participants’ family members, and their feedback was collected using a questionnaire. The data analysis confirms the impact of the artmaking intervention on the communication and relationship of the dyad. Participants reported that artmaking combined with mindfulness tools contributed to their understanding of their care-recipient (CR)/caregiver, improved their daily care activities, and helped caregivers explore new ways of self-care and stress relief. The hybrid model of implementation was effective and encouraged caregivers to explore and practice the tools learned independently between sessions. The results of this pilot program inform the development of intervention programs for care dyads as well as training programs for both caregivers, art therapists, and other care professionals. The intervention for care dyads highlights the importance of dyadic care as part of a holistic approach to caregiving. The inclusion of FDWs in the program suggests that both CRs and caregivers are one unit in which their well-being is interdependent. Further research may explore specific artmaking activities for other dyads of caregivers and CRs with differing care needs and backgrounds. Potential training activities and models could support the use of this intervention by therapists and other professionals. Keywords: art-based, mindfulness, care dyad, self-care, homecare, elderly, domestic workers, hybrid intervention, Singapore 摘要 本文介绍了一项以艺术为基础的干预计划, 该计划已应用于新加坡的七对年长者以及担 任其照顾者的外籍家庭佣工。该干预计划旨在引入艺术制作和正念的跨学科工具, 改善 护理二分体 (即年长者与其照顾者形成的一个单位) 之间的沟通和关系, 并支持照顾 者减压和自我照顾。该计划遵循以个案为中心的方法, 历时两个月时间, 以每周一次, 一共八次, 混合式结构的方式, 在护理二分体的家中通过使用 Google Meet 视频会 议进行干预。本研究通过个人访谈、问卷调查和视觉数据收集定性数据, 并将这些数 据与艺术治疗师的实地记录和反思日志结合起来。在干预计划结束时, 计划实施者为 年长参与者的家人提供了一次在线双向反馈会议, 并通过问卷收集了家人的反馈。数据 分析证实了艺术制作干预对护理二分体的沟通和关系的正面影响。参与者报告说, 艺术 制作与正念的工具相结合, 有助于他们了解对方 (照顾者/被照顾者), 改善他们的 日常护理活动, 并帮助照顾者探索自我照顾和缓解压力的新方法。实施的混合式模型 是有效的, 并鼓励照顾者在视频会议干预以外的时间独立探索和练习所学到的工具。 该试点计划的结果为护理二分体干预计划的制定以及照顾者、艺术治疗师和其他护理专 业人员的培训计划提供了信息。针对护理二分体的干预计划强调了二分体式的护理 作为全面护理方法的一个重要组成部分。将外籍家庭佣工纳入该计划表明, 被照顾 者和照顾者是一个单位, 他们的福祉相互依存。进一步的研究可以探索针对其他具有 不同护理需求和背景的照顾者和被照顾者的特定艺术制作活动。潜在的培训活动和 模型也可以支持治疗师和其他专业人员使用这种干预。 关键词： 以艺术为基础, 正念, 护理二分体, 自我照顾, 居家护理, 年长者, 家庭佣工, 混合式干预, 新加坡

Understanding the interplay between lifestyle factors and emotional distress for hemorrhagic stroke survivors and their informal caregivers: Protocol for a mixed methods dyadic natural history study.

Emotional distress (depression, anxiety, and PTS) and unhealthy lifestyle factors (e.g., smoking, alcohol consumption, poor diet, limited physical activity, medication adherence) are common in hemorrhagic stroke (HS) survivors and may increase risk for recurrence, morbidity, and mortality. Emotional distress and unhealthy lifestyle factors tend to be interdependent between survivors and their informal caregivers (e.g., family and friends who provide unpaid care; together called dyads), such that one partner's lifestyle and coping behaviors influence the other's behaviors, yet no research has closely examined this relationship in HS dyads over time. We will conduct a mixed methods study to quantitatively and qualitatively understand the longitudinal relationship between emotional distress and lifestyle factors across time in this population (HS dyads) to identify treatment targets to prevent emotional distress chronicity and stroke recurrence. In aim 1, we will assess emotional distress (i.e., depression, anxiety, and PTS) and lifestyle factors (smoking, alcohol consumption, poor diet, limited physical activity medication adherence/blood pressure control) in dyads of survivors of HS and their caregivers (N = 80), at three separate time points (hospitalization in the Neuro-ICU, 1, and 3 months later). We hypothesize that 1) lifestyle factors and emotional distress will be interrelated within and across time for both survivors and caregivers, and 2) lifestyle factors and emotional distress will be interdependent between survivors and caregivers. We also aim to explore the nuanced interplay between lifestyle factors and emotional distress and gain in depth information on barriers and facilitators for a dyadic intervention to optimize lifestyle behaviors and emotional functioning in HS dyads. Eligible patients will be adults who have a caregiver also willing to participate. Patients will be referred for study participation by the nursing team who will ensure that they are cognitively able to meaningfully participate. Multilevel dyadic modeling (i.e., actor-partner interdependence model; APIM) with distinguishable dyads will be used to determine influences of these factors onto each other over time. In Aim 2, we will conduct live video qualitative dyadic interviews (N = 20 or until theme saturation) at all time points from the same participants with and without emotional distress and at least one lifestyle risk factor, to understand the nuanced relationships between emotional distress and lifestyle behaviors, and barriers and facilitators to engagement in a skills-based psychosocial intervention. Interviews will be analyzed using inductive and deductive approaches. The present study is currently ongoing. So far, we enrolled 2 participants. Recruitment will end October 2022 with plans to analyze data by December 2022. The findings from this study will be used to further develop psychosocial interventions and inform novel treatments for survivors of HS and their informal caregivers.

Correlates of Substance Misuse, Transactional Sex, and Depressive Symptomatology Among Partnered Gay, Bisexual and Other Men Who Have Sex with Men in South Africa and Namibia

Despite having some of the world's highest rates of HIV, there is a lack of knowledge on correlates of transmission risk among gay, bisexual and other men who have sex with men in Southern Africa. There is even less known about the factors that shape HIV risk in male-male couples. Using data from Together Tomorrow, a study of partnered GBMSM in South Africa and Namibia, this study assessed the individual and dyadic correlates of three major HIV risk factors in this population: substance misuse, transactional sex, and depressive symptomatology. Data were collected during November 2016-March 2017 via a quantitative survey conducted with 140 partnered MSM (70 couples) in Windohoek, Keetmanshoop, Walvis Bay, and Swakopmund, Namibia and 300 partnered MSM (150 couples) in Pietermaritzburg and Durban, KwaZulu-Natal, South Africa for a total sample size of 440 partnered MSM (220 couples). Results of multilevel modeling analyses show several significant factors present in partnered GBMSM that differ from studies of single GBMSM, with intimate partner violence being a significant correlate across all three risk factors. Future interventions should consider dyadic approaches and integrate IPV prevention and mitigation efforts to reduce HIV in this population as part of a multisectoral approach. To reduce rates of HIV in partnered GBMSM in Namibia and South Africa multilevel, multisectoral work is needed in policy, social norms change, and relationship-focused dyadic interventions to reduce the social and structural stigma facing male couples.