Participation In Self-help Groups Research Articles

Outpatient pulmonary rehabilitation - rehabilitation models and shortcomings in outpatient aftercare.

Background The chronic obstructive pulmonary disease (COPD) and the bronchial asthma are widespread diseases. They need long-lasting and sustainable rehabilitation.Objectives The goal of this HTA is to describe the present supply and the economic relevance of out-patient pulmonary rehabilitation in conjunction with its social aspects. A further target is to derivate options for actions in the health-care system and possible research necessities.Methods Relevant publications are identified by means of a structured search in 37 database accessed through the German Institute of Medical Documentation and Information (DIMDI). In addition a manual search of identified reference lists has been done. The present report includes German and English literature published from 2004 to 2009. The methodological quality was assessed by two independent researchers according to pre-defined quality criteria of evidence based medicine.Results Among 860 publications 31 medical studies, four economic studies and 13 ethical studies meet the inclusion criteria. The studies cover rehabilitation programmes in 19 countries. The majority of them has a high level of evidence (1A to 2C). The pulmonary rehabilitation programmes differ by the setting (in-patient, out-patient, in-home, community-based), by the length of intervention (from two weeks to 36 months), by the way and the frequency of intervention and by the duration of the follow-up treatment. Overall out-patient rehabilitation programmes achieve the same positive effects for COPD patients as in-patient programmes do. This is especially true for physical performance and health related quality of life. There are only a few studies dealing with asthma. Therefore, valid statements cannot be given. The results for cost-effectiveness are not distinct enough.Discussion Goals of pulmonary rehabilitation like prevention and adequate treatment of acute exacerbations, the minimisation of hospitalisation and the reduction of mortality are attained in out-patient as well as in in-patient pulmonary rehabilitation. Regarding the best frequency of training units per week or the duration and the content of a unit further research is needed. Final results for the ideal length of an in-patient rehabilitation are still missing. None of the studies deals with the analysis of the different treatment forms of a COPD which are frequently defined by an alteration of in-patient and out-patient treatments and participation in sports clubs or self-help groups. There are some other limitations of the studies. The results concerning self-management programmes are not distinct. (Self-) Selection leads to high drop-out rates. Many studies have only small sample sizes. Confounder and long-time effects are seldom researched, relevant economic evaluations do not exist The improvement of health related quality of life is primarily obtained by an improved disease management than by an improvement of a medical parameter.Conclusion Out-patient pulmonary rehabilitation is as effective as in-patient pulmonary rehabilitation. But there is a critical shortage of out-patient pulmonary rehabilitation supply in Germany. Domains for further research are the evaluation of models for integrated care, the length, frequency and content of training programmes, psychiatric assessments and the cost-effectiveness of out-patient pulmonary rehabilitation.

Does microfinance empower women? Evidence from self‐help groups in India

Microfinance programmes like the Self Help Bank Linkage Program in India have been increasingly promoted for their positive economic impact and the belief that they empower women. However, only a few studies rigorously examine the link between microfinance and women’s empowerment. This article contributes to this discussion by arguing that women’s empowerment takes place when women challenge the existing social norms and culture, to effectively improve their well‐being. It empirically validates this hypothesis by using quasi‐experimental household sample data collected for five states in India for 2000 and 2003. A general model is estimated by employing appropriate techniques to treat the ordinal variables in order to estimate the impact of the Self Help Group (SHG) on women’s empowerment for 2000 and 2003. The results strongly demonstrate that on average, there is a significant increase in the empowerment of women in the SHG members group. No such significant change is observed however, for the members of the control group. The elegance of the result lies in the fact that the group of SHG participants show clear evidence of a significant and higher empowerment, while allowing for the possibility that some members might have been more empowered than others.

Does Self Help Group Participation Lead to Asset Creation?

Summary We evaluate the effect of Self Help Group participation on a long-term impact parameter, namely, asset creation. Indian Self Help Groups (SHGs) are unique in that they are mainly NGO-formed microfinance groups but later funded by commercial banks. The results reveal that longer membership in SHGs positively impacts asset creation, robust to various asset specifications. With longer participation in SHGs, members move away from pure agriculture as an income source toward other sources such as livestock income. Training by NGOs positively impacts asset creation but the type of SHG linkage per se has no effect.

Does a History of Violence Influence Treatment, Self-Help, and 1-Year Outcomes in Substance Use Disorder Patients?

ABSTRACT Rates of violence perpetration are high among patients with substance use disorder, but the impact of violence on substance use disorder treatment outcomes has received little attention. Patients with (n = 155) or without (n = 190) a history of difficulty controlling violent behavior were interviewed at entry to substance use disorder treatment and 1 year later. Substance use disorder severity, amount of treatment, and extent of participation in 12-step self-help groups were assessed to examine potential differences in treatment outcomes between violent and non-violent patients. After adjusting for baseline differences, no differences in substance use disorder severity were found at 1 year. However, over the year, violent patients received more treatment and participated more in 12-step groups compared to non-violent patients. In addition, violent patients benefited more from 12-step group participation than non-violent patients did. Referral to 12-step self-help groups may enhance the likelihood of recovery from a substance use disorder for patients with a history of violence.

Addiction and substance abuse in anesthesiology.

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact anesthesiologists at rates similar to those in other professions, as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid. There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions. Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the anesthesiologist wishes to attempt reentry into clinical practice.

Patients’ abstinence status affects the benefits of 12-step self-help group participation on substance use disorder outcomes

BackgroundStudies measuring the effectiveness of 12-step self-help group attendance have yielded mixed results but none of the prior studies have accounted for the potential impact of interim abstinence status. MethodsParticipants were 1683 patients with substance use disorders (SUD) from 88 community residential facilities. Self-report data were collected at baseline and 1- and 4-year follow-ups, and included measures of SUD severity, social resources, coping, and 12-step self-help group attendance. We tested the hypothesis that 12-step self-help group attendance is more effective for non-abstinent patients than for abstinent patients. We also controlled for self-selection effects by using propensity score analyses and we cross-validated our results in a second sample of patients (N=2173). ResultsSample 1. Patients abstinent at 1-year post-treatment who attended 12-step self-help group meetings were no more likely to be abstinent at 4 years than abstinent patients who did not attend. However, for patients not abstinent at 1 year, a significant improvement in abstinence rates at 4 years emerged for those who attended 12-step self-help groups compared to those who did not (42% vs. 28.9%). A similar pattern emerged for SUD problems. There were no benefits from 12-step self-help group attendance for patients abstinent at 1 year, but non-abstinent patients who attended 12-step self-help groups had significantly fewer problems at 4 years. Sample 2. The cross-validation yielded consistent results as 12-step self-help group attendance led to higher abstinence rates and fewer SUD problems only among patients non-abstinent at interim assessment. ConclusionsIndividual's abstinence status should be considered when evaluating the potential influence of 12-step self-help group attendance on SUD outcomes. In addition, increased clinical resources should focus on assessing patients after discharge and on improving linkage of non-abstinent patients to self-help groups.

Association of psychiatric and substance use disorder comorbidity with cocaine dependence severity and treatment utilization in cocaine-dependent individuals

The relations among psychiatric and substance dependence disorders and treatment utilization are of interest both for their clinical management and for health services. We examined these relations using six self-reported indices of cocaine dependence severity and three self-reported measures of treatment utilization and self-help group participation for cocaine dependence. The sample consisted of dyads: namely, a cocaine-dependent adult proband (N=449) and a cocaine-dependent sibling (N=449). Psychiatric and substance use disorders were assessed with the Semi-structured Assessment for Drug Dependence and Alcoholism. We controlled for the nesting within families of proband-sibling dyads and for demographic features using generalized estimating equation linear and logistic regression analyses. We found that psychiatric disorders were associated with an increased likelihood of cocaine dependence treatment or self-help group participation, but with only one of six indices of cocaine dependence severity. Bipolar disorder and antisocial personality disorder were associated with greater past heavy cocaine use, and with utilizing self-help but not treatment. Major depressive disorder and posttraumatic stress disorder were associated with treatment utilization and overall services utilization, respectively. The presence of other substance use disorders (SUDs) was the strongest correlate of cocaine dependence severity. Results suggest that co-occurring substance dependence and psychiatric disorders warrant attention in cocaine dependence assessment, treatment, and self-help.

`Blokes Don't Like That Sort of Thing'

Research has demonstrated that gender is a barrier to men's participation in self-help groups. In this article I analyse how four men and seven women negotiate their identities as members of cancer self-help groups. Their accounts were transcribed and analysed using a synthetic approach to discursive psychology. Women's accounts were organized around the notion of receiving help whereas men appeared to resist this type of identity. I explore how men attended to the presentation of a masculine identity and focus on how men negotiated 'legitimately masculine' reasons to be engaged in self-help groups.

Social Support and Interpersonal Stress in Professional-Led Breast Cancer Self-Help Groups

This participatory action research study included three professionally-led self-help groups for women recovering from breast cancer. The groups ran sequentially and met once a week for approximately four months. Empowerment was an explicit and strongly emphasized theme in the self-help groups' activities, aimed at stimulating the participants' strengths and abilities. The study revealed that self-help group participation was considered valuable by the women involved. The participants experienced a strong sense of fellowship, mutual empathy and care, healing laughter and improved relationships with families, friends, colleagues and health professionals. Negative experiences also occurred, caused by variations in ability to express emotions and in severity of disease, the expected death of a group member, pre-termination of group membership and stress induced by listening to others' stories. The negative experiences originated only rarely from interpersonal stress. The study shows that the social support pr...

Can microcredit help improve the health of poor women? Some findings from a cross-sectional study in Kerala, India.

BackgroundThis study examines associations between female participation in a microcredit program in India, known as self help groups (SHGs), and women's health in the south Indian state of Kerala. Because SHGs do not have a formal health program, this provides a unique opportunity to assess whether SHG participation influences women's health via the social determinants of health.MethodsThis cross-sectional study used special survey data collected in 2003 from one Panchayat (territorial decentralized unit). Information was collected on women's characteristics, health determinants (exclusion to health care, exposure to health risks, decision-making agency), and health achievements (self assessed health, markers of mental health). The study sample included 928 non elderly poor women.ResultsThe primary finding is that compared to non-participants living in a household without a SHG member, the odds of facing exclusion is significantly lower among early joiners, women who were members for more than 2 years (OR = 0.58, CI = 0.41–0.80), late joiners, members for 2 years and less (OR = 0.60, CI = 0.39–0.94), and non-participants who live in a household with a SHG member (OR = 0.53, CI = 0.32–0.90). We also found that after controlling for key women's characteristics, early joiners of a SHG are less likely to report emotional stress and poor life satisfaction compared to non-members (OR = 0.52, CI = 0.30–0.93; OR = 0.32, CI = 0.14–0.71). No associations were found between SHG participation and self assessed health or exposure to health risks. The relationship between SHG participation and decision-making agency is unclear.ConclusionMicrocredit is not a panacea, but could help to improve the health of poor women by addressing certain issues relevant to the context. In Kerala, SHG participation can help protect poor women against exclusion to health care and possibly aid in promoting their mental health.

History of Physical or Sexual Abuse and Participation in 12-Step Self-Help Groups

Objectives: Although 12-step groups are an important resource for managing substance use problems, their efficacy for patients with a physical or sexual abuse history is unknown. Methods: In the present study, patients with a history of physical or sexual (n = 122) or no (n = 143) abuse were interviewed at entry to outpatient substance use treatment at the Veterans Administration. Results: After adjusting for baseline substance use, physical or sexual abuse was associated with more attendance at and involvement in 12-step groups. Participation in 12-step groups predicted abstinence at one year, regardless of abuse history. Conclusions: Limitations and implications are discussed.

The challenge of fitting in: non‐participation and withdrawal from an online self‐help group for breast cancer patients

Online self-help groups multiply peoples' possibilities to exchange information and social support. Such possibilities are expected to be of crucial value for the 'new' healthcare user. However, similar to experiences from face-to-face based groups, studies of online self-help groups report high drop-out rates. Knowledge about why this happens is scarce. By means of qualitative interviews and participant observation, this article examines non-participation and withdrawal from an online self-help group for Norwegian breast cancer patients. Five conditions are identified as barriers to use; a need to avoid painful details about cancer, not being 'ill enough' to participate, the challenge of establishing a legitimate position in the group, the organisation of everyday life and illness phases that did not motivate for self-help group participation. I suggest that an adoption of the biomedical explanation model represents an important background for this pattern, an argument which contrasts prominent assumptions about the new healthcare user who does not accept the biomedical 'restitution story' in her efforts to make sense of an illness. A further suggestion is that experiences of self-help groups as arenas for successful coping need to be further considered as a barrier to use.

Inanspruchnahme von Selbsthilfegruppen und Psychotherapie im Anschluss an eine stationäre psychosomatisch-psychotherapeutische Behandlung

Until now little is known about the role of participation in self-help groups alone or combined with psychotherapy in post-in-patient care. In the present study 2933 patients were questioned about their experience of self-help groups and psychotherapy after discharge from a clinic for psychosomatic medicine and psychotherapy. Nearly 8 % of them utilized self-help groups (mostly combined with out-patient psychotherapy), and altogether 68 % out-patient psychotherapy following in-patient treatment. Patients without out-patient treatment were psychologically less burdened and had better resources than participants of self-help groups or psychotherapy. Self-help group members differed from patients in out-patient psychotherapy by expressing a more positive opinion of groupwork and higher openness to new experiences. Additionly, they had discussed the topic of self-help groups more frequently with their therapists. This may be a starting-point for promoting more self-help activities of patients in the future.

Participation in specific treatment components predicts alcohol-specific and general coping skills

This study identified which aspects of substance abuse treatment in community residential facilities (CRFs) were correlated with patients' post-treatment coping. A total of 2376 patients supplied demographic information and completed measures at baseline (coping and abstinence self-efficacy) and one year after treatment (coping, level of drug and alcohol use, and substance-related problems). Staff provided information about treatment orientation and patients' participation in treatment (e.g., life skills training, vocational counseling). The data were used to predict coping 1 year after treatment. As expected, higher levels of general approach coping and alcohol-specific coping and lower levels of general avoidance coping were associated with less 1-year alcohol and drug use and fewer drinking problems. Patients' greater level of participation in life skills counseling predicted more approach coping at 1 year. In addition, positive social relationships and participation in 12-step self-help groups predicted less general avoidance coping and more alcohol-specific coping at 1 year post-treatment. Life skills training, 12-step self-help groups, and enhancement of supportive relationships during CRF treatment for substance abuse are related to healthy coping. Future research should examine the effect of these components in less intensive programs and with women.

High effectiveness of self-help programs after drug addiction therapy

BackgroundThe self-help groups Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are very well established. AA and NA employ a 12-step program and are found in most large cities around the world. Although many have argued that these organizations are valuable, substantial scepticism remains as to whether they are actually effective. Few treatment facilities give clear recommendations to facilitate participation, and the use of these groups has been disputed. The purpose of this study was to examine whether the use of self-help groups after addiction treatment is associated with higher rates of abstinence.MethodsOne hundred and fourteen patients, 59 with alcohol dependency and 55 with multiple drug dependency, who started in self-help groups after addiction treatment, were examined two years later using a questionnaire. Return rate was 66%. Six (5%) of the patients were dead.ResultsIntention-to-treat-analysis showed that 38% still participated in self-help programs two years after treatment. Among the regular participants, 81% had been abstinent over the previous 6 months, compared with only 26% of the non-participants. Logistic regression analysis showed OR = 12.6, 95% CI (4.1–38.3), p < 0.001, for participation and abstinence.ConclusionThe study has several methodological problems; in particular, correlation does not necessarily indicate causality. These problems are discussed and we conclude that the probability of a positive effect is sufficient to recommend participation in self-help groups as a supplement to drug addiction treatment.Previous publicationThis article is based on a study originally published in Norwegian:Kristensen O, Vederhus JK: Self-help programs in drug addiction therapy. Tidsskr Nor Laegeforen 2005, 125:2798–2801.

Alcohol treatment utilization: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background Epidemiological studies consistently show low rates of alcohol treatment utilization among individuals with an alcohol use disorder (AUD). However, there is not as great consistency in the characteristics that predict alcohol treatment utilization. Methods Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we examined attributes associated with treatment utilization among individuals with an AUD. We used stepwise backward selection logistic regression analysis to examine demographic and clinical predictors of treatment utilization, in order to identify opportunities to improve the delivery of services to this population. Results Only 14.6% of individuals who met lifetime criteria for an AUD reported ever having received alcohol treatment (including self-help group participation). A greater proportion of respondents with both alcohol abuse and dependence (27.9%) reported having received treatment, compared with 7.5% of those with alcohol abuse only and 4.8% of those with alcohol dependence only. Older individuals, men, and those who were divorced, had less education or more lifetime comorbid mood, personality, and drug use disorders were also more likely to have received treatment. Conclusions The majority of individuals with an AUD never receive formal alcohol treatment, nor do they participate in self-help groups. Although natural recovery from an AUD is well documented, participation in alcohol treatment is associated with improved outcomes. The data presented here should be taken into account when efforts are made to enhance alcohol treatment utilization.

Empowerment Effect of Self-Help Group Participation in a Chinese Context

Although self-help group participation and its empowerment effect have been widely discussed, very few studies have been conducted in a Chinese context. This paper addresses this important issue in Hong Kong. Delineated into intrapersonal empowerment, interpersonal empowerment and extra-personal empowerment, personal empowerment is viewed as a form of social capital that can be derived from participation in the social relations within the group, and one that can facilitate the obtaining of maximum benefits from the group for the goal of effectively coping with the problems concerned. A path model is constructed to compare the direct effects and indirect effects of participation on personal empowerment, and of participation and personal empowerment on reported extent of benefits obtained. Findings support a somewhat weak relationship between participation and personal empowerment, but a strong relationship between personal empowerment and reported extent of benefits obtained. The implications of the findings for future research on self-group empowerment in Hong Kong and overseas are discussed.

Soziale Einflussfaktoren der Teilnahme an Selbsthilfezusammenschlüssen

Using selected data collected by the Health Monitor (Bertelsmann-Stiftung) from 1,539 adults aged between 18 and 79 years this article describes which social factors have an impact on participation in self-help groups or organisations. Furthermore, questions about the length of participation, fields of self-help activity, and their usefulness were analysed. All participants were approached in written form. The questionnaire included 103 health-related items (6 about self-help), and 15 demographic characteristics. The sample was weighted statistically by federal state, sex and age. 4.1% stated to be a member of self-help organisations for chronically ill or disabled people. On the whole, 9.1% have participated in self-help activities during their lifetime (currently active: 2.8%). Membership in self-help organisations increases with age, social class and according to personal involvement, whereas participation in self-help groups is quite different. The rate of participation of women is nearly twice as high as that of men (11.1 versus 6.9%). Generally, participation in self-help groups was also rated positively, but assessments vary with social class and the length of using them. Particularly with regard to the distribution of self-help participants depending on social class there are some discrepancies to other studies. These differences can supposedly be ascribed to methodical factors (e. g., social class index, sample size).

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Perceived Effectiveness of Medications Among Mental Health Service Users With and Without Alcohol Dependence

Quality of Life of Spouses of Mentally Ill People

Spouses of people with mental disorder experience various forms of objective and subjective burden. This should negatively affect their quality of life. However, until now no single study has addressed this question. To investigate the quality of life of spouses of people with schizophrenia, depression or anxiety disorders. Spouses of patients suffering from schizophrenia (n = 45), depression (n = 49) and anxiety disorders (n = 39) were consecutively recruited from outpatient services in the city of Leipzig. Quality of life was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organisation. Compared with the general population, the quality of life of the spouses of mentally ill people was lower in the domains 'psychological well-being' and 'social relationships'. There was a significant association between the patient's functional level and the spouse's quality of life. Better treatment, professional support and participation in self-help and advocacy groups may help to improve the quality of life of spouses of mentally ill people.