Group Intervention For People Research Articles

The diabetes insulin self-management education (DIME) intervention for people with type 2 diabetes starting insulin: a pilot feasibility randomised controlled trial

ObjectiveTo determine the feasibility and acceptability of a diabetes insulin self-management education (DIME) group intervention for people with type 2 diabetes starting insulin.DesignSingle-centre parallel randomised pilot trial.SettingPrimary care, South London, UK.SubjectsAdults with type 2 diabetes, requiring insulin treatment, on maximum tolerated dose of 2 or more oral antidiabetic drugs with HbA1c > / = 7.5% (58 mmol/mol) on 2 occasions. We excluded people who were non-fluent in English; morbid obesity (BMI > / = 35 kg/m2); in employment that contraindicates insulin treatment; and those with severe depression, anxiety disorders, psychotic disorders, personality disorders, or cognitive impairment.MethodsParticipants were randomised using blocks of 2 or 4 to 3, 2-h group, face-to-face, DIME sessions or standard insulin group education sessions (control). We assessed feasibility according to consent to randomisation and attendance at intervention (DIME) and standard group insulin education sessions. Acceptability of the interventions was determined using exit interviews. We additionally measured change in self-reported insulin beliefs, diabetes distress and depressive symptoms between baseline and 6-month post-randomisation.ResultsThere were 28 potentially eligible participants, of which 17 consented to randomisation, 9 were allocated to the DIME group intervention and 8 were allocated to the standard group insulin education. Three people withdrew from the study (1 from DIME and 2 from standard insulin education) before the start of the first session and did not complete baseline questionnaires. Of the remaining participants (n = 14), all DIME participants (n = 8) completed all 3 sessions, and all standard insulin education participants (n = 6) completed at least 1 standard insulin education session. The median group size was 2, the mean age of participants was 57.57 (SD 6.45) years, and 64% were female (n = 9). Exit interviews demonstrated that all participants (n = 7) found the group sessions acceptable, and thematic analysis of interview transcripts indicated social support, the content of group sessions and post-group experiences were positive, especially amongst DIME participants. There was improvement on self-report questionnaires.ConclusionsThe DIME intervention was acceptable and feasible to deliver to participants with type 2 diabetes starting insulin in South London, UK.Trial registrationInternational Study Registration Clinical Trial Network (ISRCTN registration number 13339678).

Supplemental Material for A Multicomponent Positive Psychology Group Intervention for People With Severe Psychiatric Conditions; a Randomized Clinical Trial

Supplemental Material for A Multicomponent Positive Psychology Group Intervention for People With Severe Psychiatric Conditions; a Randomized Clinical Trial

Proof of concept of participant informed, psycho-educational, community-based intervention for people with severe mental illness in rural Vietnam.

There is a lack of an intervention model that empowers people with severe mental illness (SMI) and their families and addresses the mental health gap in low- and middle-income countries. There is a significant gap in care for people with SMI in rural Vietnam due to the low quality of care in the formal mental health system and the lack of access to an evidence-informed informal approach to care. To assess acceptability, feasibility, preliminary evidence of impact and potential cost savings of a mental health support group intervention for people with SMI in the community. The proof of concept used a pre-post design with qualitative assessment, impact evaluation and cost analysis. A mental health support group intervention facilitated by Women's Union staff using a positive deviance approach was conducted among 68 people with SMI. Qualitative evaluation showed that the approach was highly acceptable and feasible. There was a significant improvement in personal functioning and a reduction in stigma and discrimination experienced by intervention participants. The intervention was found to reduce significantly the financial burden on the families having members with SMI. The proof of concept of the mental health support group intervention delivered by informal community care providers for people with SMI provides promising evidence to address the mental health gap with high acceptability, feasibility and low-cost for low- and middle-income countries.

A Prospective Outcomes Pilot Evaluation of Inspire Now: A Program for People with Lung Cancer.

Background:Lung cancer is the leading cause of cancer mortality in Canada, yet patients are often under-supported. A six-week program called Inspire Now, created to address unmet supportive care needs, was evaluated in this study. Feasibility and preliminary outcomes were assessed in order to inform future changes to the program.Objectives:(1) Assess the feasibility of the program and its evaluation; (2) pilot the collection of patient-reported outcomes; (3) identify outcomes that may be positively influenced; and (4) inform program modifications.Methods:Participants were recruited from the first session of Inspire Now for an observational pilot study. The primary outcome was feasibility. Secondary outcomes included within-person changes in Functional Assessment of Cancer Therapy – Lung (FACT-L) and Measure Yourself Concerns and Wellbeing (MYCaW), and program satisfaction and qualitative experiences of participants and facilitators through internally-developed questionnaires and semi-structured interviews. Analysis was primarily descriptive, within person changes in FACT-L and MYCaW were analyzed using the Wilcoxon signed-rank test and qualitative data was assessed for common themes.Results:The program and its evaluation were feasible; 8 of 9 (89%) participants consented to the study, median attendance was 6 of 6 sessions (IQR 4.5-6), and questionnaire completion was 100% at baseline and 75% at follow-up. There were clinically meaningful improvements in MYCaW concern 1 (−1.2, 95% CI −2.0 to −0.4) and overall wellbeing (−0.9, 95% CI −2.1 to 0.4). Seven of eight FACT-L sub-sections trended toward improvement, with absolute changes ranging from −1.7 to 10.8%. Participant feedback was overwhelmingly positive; group support and social interactions were highly valued.Conclusions:The group intervention for people with lung cancer was feasible to both run and evaluate. Participants responded positively to the program. Findings will inform changes to future sessions and an analysis of multiple sessions is planned.

A group-based, individualized physiotherapy intervention for people with multiple sclerosis-A qualitative study.

Group-based interventions for people with multiple sclerosis (MS) have gained increased attention in the field of physiotherapy research. However, no studies have investigated whether or how the prevailing principle of individualization is embedded in such interventions. The purpose of this study was to investigate how professional actions and interactions affect individualized exercise adaptations in a group intervention for people with MS. This study had a qualitative design and investigated and analysed the actions and interactions of six different physiotherapists (PTs) with expertise in neurology and 40 patients (27 female and 13 male, mean age 52.2years, mean Expanded Disability Status Scale 2.45) in a group-based exercise intervention (GroupCoreDIST) for people with MS. We performed nonparticipatory video observations of 13 group exercise sessions, each consisting of three patients, followed by 13 semistructured in-depth interviews with the PTs. Systematic text condensation analysis was conducted within an enactive theoretical framework. The results of our study indicated that the extent of embodied interaction and patient participation affect the possibilities and challenges regarding individualization within a group intervention. Handling, facilitation, emphasis on movement quality, and PTs who invited their patients to play an active role in the encounter enriched the reasoning and decision-making processes and yielded opportunities to adapt exercises to the specific patient's impairments. However, the combination of individuality and collectivity within a group context brings forth challenges in which the PTs are obligated to both preserve the benefits of being in a group and simultaneously attend to individual patients. Our study indicates that despite challenges, the PTs' integration of embodied interaction and mutual participation enables the patients to concurrently benefit from individualization and being in a group. These findings contribute to the question regarding the significance of individual adaptations in group interventions and point toward a need for future effect studies that compare standardized and individualized exercise protocols.

Experiential group work for cancer patients shaped by experiences of participants during group intervention.

Cancer tends to have an impact on a person's psychological and social well-being. Group work is one approach that can help manage the psychosocial impact of cancer. Group interventions for people living with cancer have existed for a number of decades with a majority of them adopting the cognitive-behavioral approach. While this approach has been found to be efficacious, it may be limited for people who prefer acts of service and metaphors. This article describes an experiential approach to group intervention, an alternative to cognitive-behavioral groups. The group intervention featured is designed for participants of Enreach Retreat, a retreat for people living with cancer and their caregivers, by the Department of Psychosocial Oncology, National Cancer Centre Singapore.

Comparing individual and group intervention for psychological adjustment in people with multiple sclerosis: a feasibility randomised controlled trial

Objective: To modify a published group intervention for adjustment to multiple sclerosis (MS) to suit an individual format, and to assess the feasibility of a randomised controlled trial (RCT) to compare individual and group intervention for people with multiple sclerosis and low mood. Design: Feasibility randomised controlled trial. Setting: Participants were recruited through healthcare professionals at a hospital-based multiple sclerosis service and the MS Society. Subjects: People with multiple sclerosis. Interventions: Adjustment to multiple sclerosis in individual or group delivery format. Main measures: Participants completed mood and quality of life assessments at baseline and at four-month follow-up. Measures of feasibility included: recruitment rate, acceptability of randomisation and the intervention (content and format), and whether the intervention could be adapted for individual delivery. Participants were screened for inclusion using the General Health Questionnaire-12 and Hospital Anxiety and Depression Scale, and were randomly allocated to receive either individual or group intervention, with the same content. Results: Twenty-one participants were recruited (mean age 48.5 years, SD 10.5) and were randomly allocated to individual (n=11) or group (n=10) intervention. Of those offered individual treatment, nine (82%) completed all six sessions. Of those allocated to group intervention, two (20%) attended all six sessions and three (30%) attended five sessions. There were no statistically significant differences between the groups on the outcome measures of mood and quality of life. Conclusions: The intervention could be provided on an individual basis and the trial design was feasible. There were lower attendance rates at group sessions compared to individual sessions.

The feasibility and acceptability of a brief Acceptance and Commitment Therapy (ACT) group intervention for people with psychosis: The ‘ACT for life’ study

Background and objectivesAcceptance and Commitment Therapy (ACT) is a contextual cognitive-behavioural approach with a developing evidence base for clinical and cost-effectiveness as an individually-delivered intervention to promote recovery from psychosis. ACT also lends itself to brief group delivery, potentially increasing access to therapy without inflating costs. This study examined, for the first time, the feasibility and acceptability of ACT groups for people with psychosis (G-ACTp). MethodsParticipants were recruited from community psychosis teams. Ratings of user satisfaction, and pre-post change in self-rated functioning (primary outcome), mood (secondary outcome) and ACT processes were all completed with an independent assessor. Of 89 people recruited, 83 completed pre measures, 69 started the four-week G-ACTp intervention, and 65 completed post measures. ResultsIndependently assessed acceptability and satisfaction were high. Functioning (Coeff. = -2.4, z = −2.9, p = 0.004; 95% CI: -4.0 to −0.8; within subject effect size (ES) d = 0.4) and mood (Coeff. = -2.3, z = −3.5, p = 0.001; 95% CI: -3.5 to −1.0; d = 0.4) improved from baseline to follow-up. Commensurate changes in targeted ACT processes were consistent with the underlying model. LimitationsThe uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Participants may have improved as a result of other factors, and findings require replication in a randomized controlled trial (RCT). ConclusionsThis preliminary study showed that brief group ACT interventions for people with psychosis are feasible and acceptable. Uncontrolled, pre-post assessments suggest small clinical improvements, and changes in psychological processes consistent with an ACT model. Replication in an RCT is required, before implementation can be recommended.

The tree of life methodology used as a group intervention for people with learning disabilities

In this article we describe the use of the ‘tree of life’ methodology with a group of people with learning disabilities over two days. We contextualise the tree of life in terms of narrative therapy. We, therefore, begin with a main overview of the key elements of this approach (White & Epston, 1990). We then discuss the rationale for using the tree of life, who we invited, group preparation, and the constituent elements. We end by focusing on outcomes and reflections.

Staff's Experiences of a Person-Centered Health Education Group Intervention for People with a Persistent Mental Illness

Patient education in mental health care is a conventional intervention to increase patients’ knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large.

Evaluation of an outpatient, peer group intervention for people with acquired brain injury based on the ICF ‘Environment’ dimension

Purpose. This study aimed to evaluate the effectiveness of an intervention based on the ICF ‘Environment’ dimension for enhancing the well-being and psychosocial outcomes of patients with acquired brain injury in an outpatient (day hospital) setting.Method. A mixed methodology cohort study comparing an intervention group with an historical non-intervention group using pre- and post-intervention and follow-up measures. The 6-week group intervention involved participants and their significant others. Pre- and post-intervention data from the intervention group and the non-intervention group were compared using 2 × 2 analyses of variance for five standardised outcome measures. Semi-structured interviews with intervention participants and significant others were used to provide qualitative feedback.Results. A significant group by time interaction was found for level of community integration on the Sydney Psychosocial Reintegration Scale and depression scores on the Hospital Anxiety and Depression Scale, with greater improvements for the intervention group compared with the non-intervention group. No other significant differences between groups were found. Gains in community integration were maintained by the intervention group at 1-month follow-up. Qualitative feedback from participants indicated the value of: sharing experiences, the group content, goal setting, comparing with others and the group processes.Conclusions. The Environment-focused intervention was useful in improving patient outcomes in terms of better self-reported community integration.

Memory Club: a group intervention for people with early-stage dementia and their care partners.

Diagnosis of dementia in its early stages presents a window of opportunity for examining the immediate and long-term consequences of the illness at a point when the individual with memory loss can still participate in decision making. Memory Club is a 10-session group program designed to provide information about memory loss and resources for coping with it in an emotionally supportive atmosphere for people with dementia and their care partners. Memory Club sessions are structured so that dyads meet together, as well as separately with other care partners and people with dementia, respectively. This approach allows for time for the dyad to talk together about issues in a supportive setting, and for the people in the same role (person with dementia or the care partner) to share experiences with one another. A preliminary evaluation indicated that people with dementia and their care partners rated Memory Club very positively. Facing an inevitable decline, persons with early-stage dementia and their care partners found it helpful to talk with one another and with peers in the same circumstances about the disease and its effects.

Sharing, caring and learning to take control: Self-management training for people with arthritis

Community-based health interventions have been shown to be effective in promoting self-management amongst people with arthritis in the USA, but have rarely been evaluated in a UK context. The aim of this study was to determine the effectiveness of self-management training among people with arthritis against the backdrop of the UK system of health care. The study was a multiple baseline, pre-test post-test design of 117 people attending Arthritis Self-Management Programmes (ASMP) delivered in community settings on a nationwide basis. Data were collected by self-administered questionnaires at two points in time: prior to the ASMP and after the ASMP, four months from baseline. The sample comprised 81% women, with a mean age of 59 and mean disease duration of 14.5 years. Most participants had either rheumatoid arthritis (RA) or osteoarthritis (OA). Results showed that after four months, participants demonstrated significant increases in arthritis self-efficacy (p < 0.0005), cognitive symptom management (p < 0.0005), communication with doctors (p = 0.001), use of flexibility exercises (p = 0.0001), strengthening exercises (p = 0.0008) and relaxation (p < 0.00005). In addition, significant decreases were found in terms of pain (p = 0.002), fatigue (p = 0.002) and anxiety (p = 0.002). A trend towards improvement on depression and disease acceptance was noted. The results suggest that group interventions for people with arthritis can enhance perceived control of arthritis, can encourage the use of cognitive-behavioural techniques, help to reduce symptoms of pain and fatigue, and can improve psychological wellbeing.