Group-based Self-management Intervention Research Articles

Research protocol: investigating the feasibility of a group self-management intervention for stroke (the GUSTO study)

BackgroundLife after stroke can be an ongoing struggle with over half of all survivors reporting unmet emotional and social needs. In the United Kingdom’s (UK) national clinical guidelines for stroke, self-management is suggested as one approach which can support long-term needs. In the UK NHS, self-management interventions are delivered in various ways. Regardless of the delivery mechanism, a tailored approach and ways to integrate peer support are advocated. Group delivery offers a platform for peer support and has the potential to remain individualised. However, before the efficacy of a group self-management intervention can be tested, the feasibility must be explored. This research investigates the feasibility of a GroUp Self-management intervention for sTrOke (GUSTO).MethodsA randomised waitlist control design will be used to investigate the feasibility of a group self-management intervention adapted from an existing one-to-one intervention called Bridges. A mixed methods approach will be used. Qualitative work will capture participant experience, while quantitative work will allow preliminary comparison between the intervention and waitlist groups (between subjects) and pre-post intervention measures (within subjects). Interviews will be conducted with stroke survivors and focus groups with family and friends to assess acceptability of the intervention.DiscussionThere is a growing interest in group-based self-management interventions for stroke as a method of supporting stroke survivors’ ongoing unmet needs. This is an area with limited research to date. This study will inform design of a fully powered trial which would assess the efficacy of a group self-management intervention following stroke.Trial registrationISRCTN19867168

The Restore4Stroke self-management intervention ‘Plan ahead!’: rationale and description of the treatment protocol based on proactive action planning

Objective: To describe the rationale behind and description of a group-based self-management intervention developed for stroke patients and their partners. Rationale: Based on the assumption that proactive coping strategies are beneficial for the re-uptake of daily life by stroke patients and partners, we developed a new stroke-specific, group-based self-management intervention based on proactive action planning. A first concept of the treatment protocol was developed based on the proactive coping theory, the Health Action Process Approach model, existing interventions and expert consultations. Further adjustments were based on two pilot studies, including addition of solution-based therapeutic techniques. Description of the intervention: ‘Plan ahead!’ is a 10-week group-based self-management intervention, consisting of six 2-hour sessions in the first six weeks and a 2-hour booster session in the 10th week. It is offered in an outpatient setting by two rehabilitation professionals with experience in group counselling and working with stroke patients. It is provided to groups of four stroke patients living at home (stroke ≥2 months ago) and their partners. The main features are (1) proactive action planning as the main constituent, (2) stroke-specific elements and (3) considering partners as full participants. Discussion: This stroke-specific intervention is expected to increase the use of proactive action planning and thus improve the participation of stroke patients and their partners. It is innovative in its aim to change behaviour patterns of participants directly, teaching participants a general action planning strategy and considering partners as full participants with their own goals and opportunities.

Self-management groups for people with dementia and their spousal caregivers. A randomized, controlled trial. Baseline findings and feasibility

BackgroundNo previous studies have investigated the effectiveness and feasibility of self-management groups for people with dementia and their caregivers. PurposeWe present the baseline findings of a randomized controlled trial examining the effectiveness of a psychosocial group intervention to enhance self-management skills of persons with dementia and their spouses and have evaluated the feasibility of the intervention. Subjects and methodsAltogether 136 individuals with dementia living with their spousal caregivers in the community were recruited from the memory clinics. They were randomized into two arms: group-based self-management intervention (n=67 couples) and controls (n=69 couples). The patients and spouses met in separate closed groups once a week for 8weeks. Intervention sessions were based on discussions, including topics according to participants’ preferences. Their aim was to enhance participants’ self-efficacy, problem-solving skills and peer support. Anonymous feedback from the intervention group was collected at 3months. ResultsThe mean age of participants with dementia was 76.8years, 51 (38%) were females, and 98 (72%) were at a mild stage of dementia. Cognitive status was poorer in the intervention group than in controls [MMSE; 19.9 (SD 5.7) vs. 21.7 (SD 3.7), P=0.04]. The participation rate in-group sessions was high among patients (93%, range 86–98%) and caregivers (93%, range 86–99%). Participants described the group sessions as beneficial and supportive. ConclusionWe have successfully randomized 136 dyads in a self-management group rehabilitation trial. The feedback from participants was favourable, and the drop-out rate during the first 3months was low.

Spirituality and Optimism: A Holistic Approach to Component-Based, Self-management Treatment for HIV

For people living with HIV (PLWH), spirituality and optimism have a positive influence on their health, can slow HIV disease progression, and can improve quality of life. Our aim was to describe longitudinal changes in spirituality and optimism after participation in the SystemCHANGE™-HIV intervention. Upon completion of the intervention, participants experienced an 11.5 point increase in overall spiritual well-being (p = 0.036), a 6.3 point increase in religious well-being (p = 0.030), a 4.8 point increase in existential well-being (p = 0.125), and a 0.8 point increase in total optimism (p = 0.268) relative to controls. Our data suggest a group-based self-management intervention increases spiritual well-being in PLWH.

A systematic review of outcomes of chronic disease self-management interventions

To carry out a systematic review of program outcomes used in the evaluation of group-based self-management interventions aimed at people with arthritis and other chronic conditions. The systematic search was performed across databases MEDLINE, EMBASE, CINAHL, and PsycINFO. Both between-group and within-group effect sizes (ES) were calculated. Results were interpreted as small (ES~0.2), medium (ES~0.5), or large (ES~0.8) effects. The majority of 18 included trials investigated the effectiveness of arthritis-specific interventions. Across most outcomes, small effects on course participants were shown. While effects on knowledge were large (between-group ES=0.78), effects on clinical outcomes such as pain (ES=0.10) were negligible to small. This paper is consistent with other reviews in this area, suggesting that people with arthritis receive only marginal benefits from participating in chronic disease self-management interventions. When looking at the types of outcomes that trials are based on, however, alternative explanations for these results seem probable. As evaluations heavily rely on patient self-report, current approaches to program evaluation may not be sufficient to assess the intended impact of self-management education. An in-depth investigation of the types of outcomes assessed is provided in a separate paper.

Increasing Self‐Management Skills in Heart Failure Patients: A Pilot Study

Nonadherence to medical treatment among heart failure patients is high and results in frequent exacerbations and premature death. This treatment-only pilot study examined whether a year-long group-based self-management intervention is feasible and improves self-management skills in patients with mild-to-moderate heart failure (ejection fraction < or =40% and New York Heart Association functional class I, II, or III). A total of 31 of 100 recruited patients (31%) agreed to participate. Twenty-six (84%) completed the year-long self-management program. Compared with baseline, the intervention was associated with an increase in overall self-efficacy in practicing self-management skills (p<0.001) and in four of five specific self-management skills. Patients and their group leaders also reported an increase in actual use of self-management skills (p<0.001) and in several psychosocial outcomes. The success of this pilot study suggests the need for a randomized clinical trial to test the efficacy of group-based self-management training on medical outcomes.