Care Interventions For People Research Articles

Exploratory multi-methods evaluation of an online intervention for carers of people with high-grade glioma.

Inadequate knowledge and skills and a lack of confidence to provide care have been identified as major unmet needs for carers of people with brain cancer. An online intervention was developed to address the unmet needs of carers of people with high-grade glioma. Ten carers evaluated the intervention through multiple methods. Acceptability and usability were measured through online data analytics (unique page views, time on page), surveys, and interviews. Questionnaires measured potential impacts on distress (Distress Thermometer), depression, anxiety (Hospital Anxiety and Depression Scale), carer competence (Carer Competence Scale), carer preparedness (Caregiving Preparedness Scale), unmet needs (Supportive Care Needs Scale - Brain Tumor Specific for carers), usability and acceptability (USE). Results suggested the intervention had high levels of usability (usability scales' means range = 5.1 to 6.7 out of 7) and acceptability (M = 76.3/100). Correlations indicated the potential to impact depression. Qualitative findings highlighted benefits of the intervention as a comprehensive reliable resource that could validate and normalize carer experiences. Interview findings guided further improvements (eg, additional carer videos, content organization). The study indicated high acceptability and usability of an online intervention for carers of people with high-grade glioma. This exploratory study also provided preliminary indications of a potential to decrease depression. However, a more robust, potentially longitudinal, investigation is needed with a larger and broader sample. Informed by this study, the intervention has been amended and a randomized controlled trial will further evaluate the enhanced intervention.

Psychosocial interventions for carers of people with severe mental and substance use disorders: a systematic review and meta-analysis.

Severe mental disorders - such as schizophrenia, bipolar disorder, and substance use disorders - exert a negative impact not only on affected people but also on their carers. To support carers of people with severe mental disorders, several psychosocial interventions have been developed. This systematic review and meta-analysis aimed to assess whether psychosocial interventions for carers of persons with schizophrenia, bipolar disorder, or substance use disorders produce benefit/harm with respect to a series of outcomes - including subjective and objective burden, depressive symptoms, well-being/quality of life, sleep, skills/knowledge, self-efficacy, physical health - as compared to standard support/support as usual or other control conditions. In carers of persons with schizophrenia, psychoeducational interventions were associated with significant improvement in personal burden, well-being, and knowledge about the illness; and a supportive-educational intervention with an improvement in personal burden. In carers of persons with bipolar disorder, psychoeducational interventions were associated with significant improvement in personal burden and depressive symptoms; family-led supportive interventions with an improvement in family burden; family-focused intervention and online "mi.spot" intervention with a significant reduction in depressive symptoms. Psychosocial interventions used for carers of persons with substance use disorders were found to be overall effective on the level of well-being, but the low number of trials did not allow detection of differences between the various psychosocial interventions. The quality of the evidence ranged from very low to moderate, suggesting the need for further better-quality research.

Online counselling for family carers of people with young onset dementia: The RHAPSODY-Plus pilot study.

Compared to late life dementia, Young Onset Dementia (YOD) has its own distinct challenges, including a lack of specialised and age-appropriate support services. Carers of people with YOD experience higher levels of psychological and physical symptoms, and lower quality of life. This study (RHAPSODY-Plus) assessed the acceptability and feasibility of combining RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young; a web-based information and skill-building programme for carers of people with YOD) with individually tailored support sessions with health professionals (a social worker and a clinical psychologist) provided via online videoconferencing. Participants (n = 20) were informal carers aged over 18 years, who were caring for a person with YOD (either Alzheimer's disease or frontotemporal dementia type). Participants used the RHAPSODY programme for 4 weeks, then attended 2 support sessions. Participants and the health professionals then attended individual feedback sessions. Feedback was collected via open-ended and Likert-style questions. The majority of carers rated the RHAPSODY-Plus programme as good to very good, demonstrating a high level of acceptability. Positive feedback about the programme included being able to receive personal advice additionally to the information provided in RHAPSODY. The healthcare professionals also thought the programme was acceptable and beneficial for access to support. Some limitations in the feasibility of videoconferencing included network and technical issues and the loss of non-verbal communication. This online pilot study had a high level of acceptability, demonstrating the potential of an individualised multi-modal intervention for carers of people with YOD which offers opportunities to overcome geographical and service access barriers.

Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum.

The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. Three themes were generated. "Suicide as the ultimate threat" highlights fears emerging from carers' difficulties with understanding and managing suicidal behaviour. "Bouncing from one crisis to another" reflects carers' experiences of recurring crises and the challenges of relying on emergency healthcare support. "It definitely needs to be easier to get help" emphasises carers' desires to be acknowledged by healthcare professionals and included in support offered to service users. Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers' needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.

Co-designing an online support program for and with informal carers of people with heart failure

Funding AcknowledgementsType of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish research council for health, working life and welfareBackgroundInformal care is increasing due to societal challenges such as ageing populations, more non-communicable diseases in combination with lack of health care personnel. Informal carers, namely family members, friends and neighbours, are important actors in the care and support of people with heart failure. To support them in their caring, information and communication technology has shown to be promising. The mentioned challenges have also put pressure on digitalising health care. The COVID 19 pandemic has further highlighted the need to provide and receive support through digital services. There is currently a lack of support interventions for carers of people with heart failure that are directly integrated within the health care system. To develop relevant support carers should be involved in the process.PurposeThe aim of the study was to describe the co-design process in the development of an online support program for carers of people with heart failure.MethodsInformal carers, researchers and practitioners were involved in the co-design process. In the first phase an assessment of carers’ needs and preferences was performed based on a literature search, focus group interviews (n=23 carers), individual interviews and user group sessions (n= 7 carers). Phase two continued with the actual development of the support program prototype, based on the results of phase one. This phase included 13 carers and 18 researchers and practitioners. In the final phase, the program was reviewed and refined by carers, practitioners, and researchers. The project group coordinated the co-design process and took part in the development of the support program.ResultsThe co-design process resulted in an online support program consisting of 15 modules with the aim to increase carers’ preparedness to care for a person with heart failure. Each module focused on different topics such as "About heart failure" and "To be a carer". The support program was designed and integrated within the Swedish national e-health platform "1177" in a section called "support and treatment". During the co-design process, various challenges arose, which included the choice of platform itself which then influenced the further co-design process. This process involved balancing implementation and sustainability requirements, against carers’ needs and preferences regarding the program itself.ConclusionsTo conduct a co-design process involving carers and other actors means to navigate diverse interests, goals and pay due attention to regulations. It is an explorative process in which researchers need to be flexible. The effects of the program will now be tested via a randomized controlled trial, and the results will also illuminate the co-design process further.

Information needs and mHealth applications for carers of people with dementia in managing behavioural and psychological symptoms of care recipients: an integrative review protocol

IntroductionThis integrative review aims to synthesise, appraise and analyse the evidence on informal carers’ information needs, features and functions of available mHealth applications, and informal carers’ usability and engagement with...

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.

Group-Based Interventions for Carers of People With Dementia: A Systematic Review.

Background and ObjectivesIt is well documented that caring for someone with dementia is associated with many negative mental health outcomes, such as depression, anxiety, and a reduction in quality of life. Group-based interventions are one strategy for improving well-being for carers, but previous systematic reviews have reported inconsistent findings about the efficacy of group-based interventions for carers of people with dementia.Research Design and MethodsThis systematic review investigates the qualitative and quantitative evidence for the effectiveness of group-based interventions and identifies targets for future research. Narrative synthesis was used to analyze the data.ResultsA comprehensive search of 4 databases revealed 117 potentially relevant studies, 19 of which met the full inclusion criteria. Five studies investigated group cognitive behavioral therapy, 8 investigated psycho-educational interventions, and 6 investigated support groups. The effectiveness of the interventions varied widely, even within subcategories. No type of intervention was consistently shown to improve well-being, though qualitative data and data about participant satisfaction was generally very positive.Discussion and ImplicationsBased on the quality and quantity of the evidence currently available, there is not enough evidence to reach firm conclusions about the impact of group-based interventions on well-being. In order to establish the effectiveness of group-based interventions there needs to be more high-quality studies with larger sample sizes about this topic. Future research may benefit from the use of mixed methods data collection to explore the disparity between qualitative and quantitative findings in the literature.

START-online: acceptability and feasibility of an online intervention for carers of people living with dementia

BackgroundWith increasing numbers of people living with dementia relying on family to care for them at home, there is an urgent need for practical and evidence-based programs to support carers in maintaining their mental health and well-being. The objective of this study was to evaluate the acceptability and feasibility of a modified STrAtegies for RelaTives (START) program delivered online (START-online).MethodA mixed-methods non-blinded evaluation of START-online (using Zoom as videoconferencing platform) for acceptability and feasibility (completion rates and qualitative feedback through surveys and focus groups) and quantitative evaluation. This occurred at the National Ageing Research Institute, in metropolitan Victoria, Australia.ResultsTwenty-nine eligible carers were referred, 20 (70%) consented to the study. Of these, 16 (80%) completed all 8 sessions, 2 completed only 3 sessions, and 2 withdrew. Carers’ qualitative feedback indicated that the therapist interaction was valued, content and online delivery of the program was acceptable. Feedback was mixed on the appropriate stage of caring.ConclusionSTART-online was feasible and acceptable for carers, including those living outside of metropolitan areas who might otherwise be unable to access face-to-face programs. With the recent COVID-19 pandemic necessitating social distancing to avoid infection, interventions such as this one have increasing relevance in the provision of flexible services.

Assessment of peer-conceptualised, written and led single-session group interventions for carers supporting a person with borderline personality disorder

ABSTRACT Objective No research to date has investigated the utility of a single session peer-informed and peer-led intervention for carers of people with borderline personality disorder (BPD). Two single session format group interventions – a 2.5-hour information session and an all-day (7-hour) workshop – were conceptualised, written, and facilitated by a carer peer with the assistance of a clinician experienced in supporting people with BPD. This study aimed to evaluate the effectiveness of these interventions. Method Participants completed the Burden Assessment Scale (BAS), Kessler-10 (K10) and the BPD attitude and knowledge survey (e-KALM) before and after the intervention as well as a set of questions seeking participants’ thoughts about the usefulness of the content of the intervention and their overall satisfaction. Results 225 carers who attended the 7-hour workshop and 100 carers who completed the 2.5-hour information session completed the pre-intervention survey. The carer participants’ e-KALM scores improved significantly following interventions. Following the 7-hour workshop, K10 (p < 0.05) and BAS (p < 0.001) scores had a statistically significant improvement. Participants from both interventions reported that they appreciated the opportunity to be heard and supported and were very satisfied overall with the format and content. Discussion Both single session carer intervention formats resulted in meaningful improvements in participants’ knowledge about and attitudes towards BPD. The full-day workshop also reduced the perceived burden associated with care-giving; highlighting the community need for longer-term carer support.

Adaptation of an evidence‐based intervention for family carers of people living with dementia for delivery to UK‐based South Asian carers: Widening access to START (Strategies for Relatives)

AbstractBackgroundFamily members caring for a relative with dementia often become anxious or depressed. We developed START (STrAtegies for RelaTives) for family carers of relatives with dementia to promote helpful coping strategies. START is the first clinically‐ and cost‐effective intervention of its kind, and is currently delivered within UK National Health Service. However, barriers to delivery of START to South Asian carers include delayed presentation to health services, stigma, and language. In this study, we therefore aimed to widen access to START by adapting it for delivery to UK‐based South Asian family carers.MethodsIn Phase 1, we used the Cultural Treatment Adaptation Framework (CTAF) to guide data collection, through a semi‐structured interview guide. We interviewed 15 UK‐based South Asian carers about START and factors affecting its implementation to inform modifications. We transcribed interviews and researchers double‐coded them independently, using the CTAF to organise the findings.In Phase 2, we trained and supervised facilitators to deliver the adapted START intervention to South Asian family carers. In Phase 3, after START delivery, we used the i‐PARIHS framework to evaluate the implementation, through qualitative and quantitative interviews with all carers and qualitative interviews with facilitators.ResultsWe interviewed 15 South Asian carers in London and Bradford, UK. There were no changes to START’s core components. We incorporated cultural values and beliefs into the START intervention manual by modifying and adding in new examples and testimonials, and adding prompts. We also translated the manual into Urdu, a common South Asian language in the UK, and produced an audio version of the manual in Urdu. The project group met to agree on the modifications. The intervention was delivered to 13 family carers between January 2019 and January 2020 including 4 in Urdu and conducted interviews afterwards assessing satisfaction with the intervention and its effect on depression and quality of life.ConclusionsWe used multiple methodologies to identify barriers and facilitators to effective delivery of a psychosocial intervention for South Asian family carers based in the UK. We found that adaptations to the content and delivery of an intervention may improve its acceptability and efficacy.

The Namaste Care Intervention for People with Advanced Dementia Living in Care Homes: Results from a Feasibility Cluster Randomised Controlled Trial (RP527)

The Namaste Care Intervention for People with Advanced Dementia Living in Care Homes: Results from a Feasibility Cluster Randomised Controlled Trial (RP527)

Service evaluation of a sole-session psychoeducational intervention to improve caregivers’ key illness beliefs after first episode psychosis (FEP)

Abstract Carers of people experiencing a first episode of psychosis are at an increased risk of developing their own physical and mental health problems. Psychoeducation has been found to improve carer wellbeing and reduce distress. However, few psychoeducation interventions have considered the resource constraints on mental health services and the impact that these can have on the implementation of any such interventions. The present service evaluation aimed to evaluate an abbreviated version (sole session) of a previously tested psychoeducation intervention (three sessions) that targets less adaptive illness beliefs (n = 17). Pre–post effect sizes reveal that all of the carers’ illness beliefs changed in the desired direction, with four out of the 10 illness beliefs associated with large to moderate improvements. When compared with the outcomes obtained in our evaluation of the more intensive, three-session version of the intervention, the between-group effects largely favoured the three-session version but were mostly small. Moderate to large effects in favour of the three-session version were found for two of the 10 illness beliefs. These findings support the further investigation of the sole session psychoeducation intervention as part of a randomised controlled trial. Key learning aims (1) To evaluate the impact of a sole-session psychoeducation intervention on illness beliefs. (2) To compare the outcomes of the sole-session psychoeducation intervention to the previous, more intensive (three-session) version of the same intervention. (3) To consider the value of research approaches to evaluating psychoeducation interventions for carers of people with psychosis.

Pragmatic randomised controlled trial of a personalised intervention for carers of people requiring home oxygen therapy.

We used a pragmatic randomised controlled trial to evaluate a behavioural change strategy targeting carers of chronically hypoxaemic patients using long-term home oxygen therapy. Intervention group carers participated in personalised educational sessions focusing on motivating carers to take actions to assist patients. All patients received usual care. Effectiveness was measured through a composite event of patient survival to hospitalisation, residential care admission or death to 12 months. Secondary outcomes at baseline, 3, 6 and 12 months included carer and patient emotional and physical well-being. No difference between intervention (n = 100) and control (n = 97) patients was found for the composite outcome (hazard ratio (HR) 1.22, 95% confidence interval (CI) = 0.89, 1.68; p = 0.22). Improved fatigue, mastery, vitality and general health occurred in intervention group patients (all p values < 0.05). No benefits were seen in carer outcomes. Mortality was significantly higher in intervention patients (HR = 2.01, 95% CI = 1.00, 4.14; p = 0.05; adjusted for Australia-modified Karnofsky Performance Status), with a significant diagnosis–intervention interaction (p = 0.028) showing higher mortality in patients with COPD (HR 4.26; 95% CI = 1.60, 11.35) but not those with interstitial lung disease (HR 0.83; 95% CI = 0.28, 2.46). No difference was detected in the primary outcome, but patient mortality was higher when carers had received the intervention, especially in the most disabled patients. Trials examining behavioural change interventions in severe disease should stratify for functionality, and both risks and benefits should be independently monitored. Trial registration: Australian New Zealand Clinical Trials Registry (ACTRN12607000177459).

Support, interventions and outcomes for families/carers of people with borderline personality disorder: A systematic review.

It is clear from existent literature that families and carers of relatives and friends with borderline personality disorder (BPD) experience high levels of burden. Whilst family interventions are considered vital to improving the outcomes of those with a range of mental health difficulties, there has been limited development of direct interventions for carers of people with BPD, despite a high level of need. This systematic review aimed to appraise and synthesize the existing research evidence for interventions for carers of people with BPD. Ten studies were included that were directly related to six interventions for families and carers of people with personality disorder. The findings of these studies, whilst limited, do provide some initial evidence that interventions for carers may lead to significant outcomes for the participants, particularly in improving carer well-being and reducing carer burden. © 2019 John Wiley & Sons, Ltd.

The necessity for sustainable intervention effects: lessons-learned from an experience sampling intervention for spousal carers of people with dementia

Objectives Caring for a person with dementia can be challenging over the years. To support family carers throughout their entire caregiving career, interventions with a sustained effectivity are needed. A novel 6-week mobile health (mHealth) intervention using the experience sampling method (ESM) showed positive effects on carers’ well-being over a period of 2 months after the intervention. In this study, the effects after 6 months of the selfsame intervention were examined to evaluate the sustainability of positive intervention effects. Method The 6-week mHealth intervention consisted of an experimental group (ESM self-monitoring and personalized feedback), a pseudo-experimental group (ESM self-monitoring without feedback), and a control group (providing regular care without ESM self-monitoring or feedback). Carers’ sense of competence, mastery, and psychological complaints (depression, anxiety and perceived stress) were evaluated pre- and post-intervention as well as at two follow-up time points. The present study focuses on the 6-month follow-up data (n = 50). Results Positive intervention effects on sense of competence, perceived stress, and depressive symptoms were not sustained over 6-month follow-up. Conclusion The benefits of this mHealth intervention for carers of people living with dementia were not sustained over a long time. Similarly, other psychosocial interventions for carers of people with dementia rarely reported long-lasting effects. In order to sustainably contribute to carers’ well-being, researchers and clinicians should continuously ensure flexible adjustment of the intervention and consider additional features such as ad-hoc counseling options and booster sessions. In this regard, mHealth interventions can offer ideally suited and unique opportunities.

Internet-Based Interventions for Carers of Individuals With Psychiatric Disorders, Neurological Disorders, or Brain Injuries: Systematic Review.

BackgroundNonprofessional carers who provide support to an individual with a psychiatric or neurological disorder will often themselves experience symptoms of stress, anxiety, or low mood, and they perceive that they receive little support. Internet-based interventions have previously been found to be effective in the prevention and treatment of a range of mental health difficulties in carers.ObjectiveThis review seeks to establish the status of internet-based interventions for informal (nonprofessional) carers of people with psychiatric or neurological disorders by investigating (1) the number and quality of studies evaluating the efficacy or effectiveness of internet-based carer interventions and (2) the impact that such interventions have on carer mental health, as well as (3) how internet-based interventions compare with other intervention types (eg, face-to-face treatment).MethodsA systematic literature search was conducted in January 2019 using the EMBASE (1974-present), Ovid MEDLINE (1946-present), PsychARTICLES, PsychINFO (1806-present), and Global Health (1973-present) databases, via the Ovid Technologies database. Search terms included carer, caregiver, online, technology, internet-based, internet, interactive, intervention, and evaluation. Studies selected for inclusion in this review met the following predetermined criteria: (1) delivering an intervention aimed primarily at informal carers, (2) carers supporting individuals with psychiatric disorders, stroke, dementia, or brain injury, (3) the intervention delivered to the carers was primarily internet based, (4) the study reported a pre- and postquantitative measure of carer depression, anxiety, stress, burden, or quality of life, (5) appeared in a peer-reviewed journal, and (6) was accessible in English.ResultsA total of 46 studies were identified for inclusion through the detailed search strategy. The search was conducted, and data were extracted independently by 2 researchers. The majority of studies reported that 1 or more measures relating to carer mental health improved following receipt of a relevant intervention, with interventions for carers of people with traumatic brain injury showing a consistent link with improved outcomes.ConclusionsStudies investigating internet-based interventions for carers of individuals with diverse psychiatric or neurological difficulties show some evidence in support of the effectiveness of these interventions. In addition, such interventions are acceptable to carers. Available evidence is of varying quality, and more high-quality trials are needed. Further research should also establish how specific intervention components, such as structure or interactivity, contribute to their overall efficacy with regard to carer mental health.

Linking two new E-health caregiver interventions to meeting centres for people with dementia and their carers; a process evaluation

Objectives: Research shows that carers of people with dementia experience worse physical and psychological functioning than non-caregivers or than caregivers of people with a different chronic illness. This study investigated the implementation of two new e-health interventions for carers of people with dementia, Dementelcoach (telephone coaching) and STAR e-learning (online platform to learn about dementia). The interventions were linked to existing Meeting Centres for people with dementia and their carers.Method: We conducted a qualitative multiple case study. Semi-structured interviews regarding experienced influencing factors were conducted with 15 key figures/stakeholders (14 interviews) in eight Meeting Centres during the preparation, starting and continuation phases of the implementation of Dementelcoach and STAR e-learning.Results: Several influencing factors were found on micro level (e.g. PR, training, qualified personnel), meso level (e.g. finances, division of tasks) and macro level (e.g. laws and regulations, national and regional policy) during the different phases of the implementation process. Factors mentioned by most stakeholders were human and financial resources. Another important factor found was the fit between the interventions and region.Conclusion: Insight into facilitators and barriers in the implementation of Dementelcoach and STAR e-learning provided by this study will inform and enable other Meeting Centres to adopt a fitting strategy to implement these interventions in their own centre. This is expected to help disseminate the intervention further, and will result in better-informed and supported carers. This will contribute to the prevention of overburdening in carers and will potentially enable carers to provide better care for their relatives with dementia.

Can a carer (peer) led psychoeducation programme improve mental health carers well-being, reduce burden and enrich empowerment: a service evaluation study

PurposeCarers of people with mental health problems present with high levels of burden, poor mental well-being and feelings of disempowerment by mental health services. The purpose of this paper is to establish whether providing a psychoeducation skill programme for carers would lead to an improvement of mental well-being, reduce the levels of burden that carers sometimes feel while caring for someone with mental illness and also to increase empowerment. This paper provides a service evaluation study of an innovative carer-led psychoeducational intervention that was undertaken.Design/methodology/approachThis programme was initiated and led by a carer who had experienced a lack of service provision to support carers and families in understanding and caring for a relative with severe and enduring mental health diagnoses. A model of co-production was adopted with the carer who led this initiative working closely with an occupational therapist and consultant psychologist in its development and delivery. Data were collected to measure the impact of the training at five different time points. The measures employed to measure outcomes were the Warwick-Edinburgh Mental Well-being Scale, the Burden Assessment Scale and Family Empowerment Scale.FindingsResults indicated improved well-being, reduced burden and increased family empowerment in carers who completed this peer-led carer initiative psychoeducational programme.Research limitations/implicationsThis service evaluation study was conducted in a single site and in the site in which it was developed. The carer consultant who led this evaluation and development of the intervention was also the peer worker who delivered the interventions. Hence, the authors are unable to ascertain if the results reported are unique to the individual peer worker. The transferability of this programme and generalisability of the result should therefore be treated with caution and further replication of this model and research is required. This would be beneficial to be conducted in an alternative site from where it was developed, delivered by different facilitators and include a control group.Practical implicationsThe evidence from this study indicates that carers are able and willing to attend a group psychoeducational programme. A high number of referrals to the programme in a relatively short timeframe indicates that there is significant demand for such a service. The implementation of the programme is relatively straightforward. The key challenges for practical implementation are to have the right carer to lead and deliver the programme and the right support system in place for them (financial and supervision). Co-production also is not without challenges, the peer worker and occupational staff need to ensure that mutually valued and respected working relationship should develop.Originality/valueThis is the first evaluation of the impact of a carer-led psychoeducation intervention for carers of people with mental health difficulties in secondary mental health services.

Systematic review of community pharmacy-based and pharmacist-led foot care interventions for adults with type 2 diabetes.

To prevent diabetic foot disease, proper foot care is essential for early detection and treatment. Pharmacists are well suited to provide accessible foot care to adults with type 2 diabetes. Limited research has examined this role. We conducted a systematic review of community pharmacy-based and pharmacist-led foot care interventions for adults with type 2 diabetes compared to usual care. Data sources included MEDLINE, EMBASE, the Cochrane Library, CINAHL, Academic Search Complete and Health Source: Nursing/Academic Edition and Google Scholar, plus Google and hand-searching. Original research studies reported in English, focused on community pharmacy-based or pharmacist-led foot care interventions were eligible for review. Participants were adults with type 2 diabetes. Studies were summarized narratively; pooled data were not possible. Seven studies were included in this review, 3 focusing on improving foot self-care behaviours and 4 on promoting foot examinations by the health care provider. Only 2 studies were randomized and were assessed as high quality. Six out of 7 studies reported significantly positive findings related to foot care practices. An opportunity to influence foot care exists at each clinical encounter. Pharmacists are accessible health care practitioners and appropriate to provide a range of diabetes foot care interventions. Seven studies examined community pharmacy-based and pharmacist-led foot care interventions for people with type 2 diabetes. Community pharmacies and pharmacists are capable of providing a variety of foot care interventions to patients with diabetes, helping detect problems early and leading to prompt intervention.