Psychosocial Group Intervention Research Articles

Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil.

Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation.

Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges.

“CLIMBING IS MY WEAPON” – A PSYCHOSOCIAL BOULDERING INTERVENTION FOR ADOLESCENTS AND ITS IMPACT ON THE PSYCHOLOGICAL WELL-BEING OF ADOLESCENTS IN LEBANON

INTRODUCTION AND AIMS Previous research highlights the positive effects of physical activity, also climbing therapy, on mental health, including benefits on depression and self-esteem. Recognising the mental health challenges faced by young people in Lebanon, particularly in the context of multiple crises and forced displacement, this interventional study explores the benefits of a psychosocial climbing programme in eastern Lebanon. METHODS In collaboration with the non-profit organisation ClimbAID, this waitlist-controlled, partially randomised, mixed-methods study examines the effects of an eight-week psychosocial bouldering group intervention on overall mental well-being, levels of psychological distress, self-efficacy and social cohesion among a group of host and refugee youth in the Bekaa Valley. Qualitative interviews with 40 participants provide insights into their experiences, lessons learned and subjective outcomes. The intervention, delivered by 2 trained facilitators and up to 2 volunteers, took place weekly for 2 hours with groups of up to 12 young people. RESULTS With 233 participants, the trial had a dropout rate of approximately 33%. The intervention group showed significant improvements in overall mental well-being and psychological distress compared with the waitlist groups. Group allocation was the only significant predictor of improved mental well-being, in addition to baseline scores. While no significant differences in self-efficacy and social cohesion were observed, qualitative analysis revealed that participants highly valued the non-judgmental approach, highlighting significant benefits in interpersonal relationships and mental well-being. CONCLUSION In the challenging humanitarian context of forced displacement, the psychosocial bouldering intervention effectively enhanced well-being and reduced psychological distress among host and refugee youth in Bekaa, Lebanon. As a group intervention, bouldering emerges as a valuable option for supporting host and refugee populations in low-income countries.

Eficiența programului de intervenție psihosocială în adaptarea studenților internaționali

The study examines the effects of a special psychosocial intervention program on the adaptation of international students to a new university and sociocultural environment. The program was designed considering the resources and challenges of adaptation, focusing on the specific needs of these students. Using surveys and comparative analyses, the research assessed the program’s impact on social contact distances and the quality of psychosocial adaptation. The results indicate a significant reduction in social contact distances and an improvement in adaptation at the macro-, meso-, and micro-social levels. Compared to other university adaptation programs, the specialized intervention proved effective in facilitating the integration of international students, providing a supportive environment for personal development. The conclusions underscore the importance of group psychosocial intervention programs in promoting the adaptation and integration of international students into new academic and social environments.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status.

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

Comparative Efficacy of Online vs. Face-to-Face Group Interventions: A Systematic Review

Purpose: Online group-based interventions are widely adopted, but their efficacy, when compared with similar face-to-face (F2F) psychosocial group interventions, has not been sufficiently examined. Methods: This systematic review included randomly controlled trials (RCTs) that compared an intervention/model delivered in both F2F and online formats. The review adhered to PRISMA guidelines and was registered with PROSPERO. Results: The search yielded 15 RCTs. Effect sizes ranged from small to exceptionally large. Between-condition effect sizes yielded nonsignificant differences in effectiveness except for three studies that reported superior effectiveness in outcomes for F2F interventions. High heterogeneity was found where only two studies integrated rigorous designs, thus limiting opportunity for a meta-analysis evaluation. Conclusions: Most studies showed comparable outcomes in both F2F and online modalities. However, given the heterogeneity of samples and outcomes, it is premature to conclude that online treatment is as effective as F2F for all challenges and populations.

Barriers and Facilitators to Implementing a Community-Based Psychosocial Support Intervention Conducted In-Person and Remotely: A Qualitative Study in Quibdó, Colombia.

Community-based psychosocial support group (CB-PSS) interventions using task-shifting approaches are well suited to provide culturally appropriate services in low- and middle-income countries. However, contextual barriers and facilitators must be considered to tailor interventions effectively, particularly considering the challenges introduced by the COVID-19 pandemic. We explore the barriers, facilitators, and psychosocial changes associated with implementing a CB-PSS group intervention delivered by local lay providers to conflict-affected adults in Quibdó, Colombia, using both in-person and remote modalities. Data were analyzed from 25 individual interviews with participants and a focus group discussion involving staff members, including 7 community psychosocial agent facilitators and 2 mental health professional supervisors. The analysis used a thematic approach grounded in a descriptive phenomenology to explore the lived experiences of participants and staff members during implementation. Participant attendance in the in-person modality was compromised by factors such as competing work and family responsibilities and disruption caused by the COVID-19 pandemic. Participants in the remote modality faced challenges concerning unstable Internet connectivity, recurrent power outages caused by heavy rain, distractions, interruptions, and threats to confidentiality by family and coworkers. Despite these challenges, data revealed key contextual facilitators, including the community-based knowledge of facilitators and integration of traditional practices, such as the comadreo (informal talks and gatherings). Respondents shared that the CB-PSS groups promoted stronger community relationships and created opportunities for participants to exchange peer support, practice leadership skills, develop problem-solving skills based on peers' experiences, and enhance emotional regulation skills. Differences and similarities across in-person and remote modalities are discussed, as are key considerations for practitioners and policymakers.

Digital adaptation of the Standing up for Myself intervention in young people and adults with intellectual disabilities: the STORM feasibility study.

Stigma contributes to the negative social conditions persons with intellectual disabilities are exposed to, and it needs tackling at multiple levels. Standing Up for Myself is a psychosocial group intervention designed to enable individuals with intellectual disabilities to discuss stigmatising encounters in a safe and supportive setting and to increase their self-efficacy in managing and resisting stigma. To adapt Standing Up for Myself to make it suitable as a digital intervention; to evaluate the feasibility and acceptability of Digital Standing Up for Myself and online administration of outcome measures in a pilot; to describe usual practice in the context of the coronavirus disease 2019 pandemic to inform future evaluation. Adaptation work followed by a single-arm pilot of intervention delivery. Four third and education sector organisations. Individuals with mild-to-moderate intellectual disabilities, aged 16+, members of existing groups, with access to digital platforms. Digital Standing Up for Myself intervention. Adapted from face-to-face Standing Up for Myself intervention, delivered over four weekly sessions, plus a 1-month follow-up session. Acceptability and feasibility of delivering Digital Standing Up for Myself and of collecting outcome and health economic measures at baseline and 3 months post baseline. Outcomes are mental well-being, self-esteem, self-efficacy in rejecting prejudice, reactions to discrimination and sense of social power. Adaptation to the intervention required changes to session duration, group size and number of videos; otherwise, the content remained largely the same. Guidance was aligned with digital delivery methods and a new group member booklet was produced. Twenty-two participants provided baseline data. The intervention was started by 21 participants (four groups), all of whom were retained at 3 months. Group facilitators reported delivering the intervention as feasible and suggested some refinements. Fidelity of the intervention was good, with over 90% of key components observed as implemented by facilitators. Both facilitators and group members reported the intervention to be acceptable. Group members reported subjective benefits, including increased confidence, pride and knowing how to deal with difficult situations. Digital collection of all outcome measures was feasible and acceptable, with data completeness ≥ 95% for all measures at both time points. Finally, a picture of usual practice has been developed as an intervention comparator for a future trial. The pilot sample was small. It remains unclear whether participants would be willing to be randomised to a treatment as usual arm or whether they could be retained for 12 months follow-up. The target number of groups and participants were recruited, and retention was good. It is feasible and acceptable for group facilitators with some training and supervision to deliver Digital Standing Up for Myself. Further optimisation of the intervention is warranted. To maximise the acceptability and reach of the intervention, a future trial could offer the adapted Digital Standing Up for Myself, potentially alongside the original face-to-face version of the intervention. This study was registered as ISRCTN16056848. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/149/03) and is published in full in Public Health Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

COMPARING THE FEASIBILITY OF A LONELINESS AND SOCIAL ISOLATION GROUP IN A PRIMARY CARE VS COMMUNITY SETTING

Abstract Social isolation and loneliness is now considered a public health epidemic in the United States for the older adult population. While providers try to address certain health and lifstyle issues in this population through medications and other medical referrals, there are few non-pharmacological group interventions to curb feelings of isolation and loneliness. This study will determine if a psychosocial group intervention in primary care results in decreases of loneliness and health risks compared to a community-based group. The intervention is called “Circle of Friends,” which is an evidence-based group to alleviate loneliness and increase socialization through a rehabiliation model of care. Participants must be 60 years and older, report subjective feelings of loneliness, have reported being homebound and/or isolated over the last six months, and have very few social connections. The current study has collected initial pre-group data from eight older adults from the community group, and the research team is recruiting participants in the primary care group setting. It is anticipated that the Primary Care Circle of Friends Group will report higher improvements in loneliness and health indicators compared to the community-based group. The primary group will take place in an underserved Federally Qualified Health Center, and the community-based group will take place in the conference room of a university setting. Early qualitative themes that facilitators have reported around recruitment include: 1.) Challenges with planning transportation, 2.) Building trust in joining a new group, and 3.) requests of extra resources in addition to this group.

Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial.

Introduction: Poor adherence to pharmacological treatment is frequent in people with severe mental disorders and it often causes lack of effectiveness of many psychotropic drugs. Thus, efforts should be made to improve adherence to pharmacological treatments in patients with these disorders. Methods: In this paper, based on the LIFESTYLE randomized, controlled multicentric trial, we aim to: 1) assess the level of adherence in a real-world sample of patients with severe mental disorders; 2) evaluate differences in treatment adherence according to patients' socio-demographic and clinical characteristics; 3) evaluate the impact of an innovative psychosocial intervention, on patients' adherence to treatments. The Lifestyle Psychosocial Group Intervention consists of group sessions, focused on different lifestyle behaviours, including healthy diet; physical activity; smoking habits; medication adherence; risky behaviours; and regular circadian rhythms. At end of each session a 20-min moderate physical activity is performed by the whole group. Results: The sample consists of 402 patients, mainly female (57.1%, N = 229), with a mean age of 45.6years (±11.8). Less than 40% of patients reported a good adherence to pharmacological treatments. Adherence to treatments was not influenced by gender, age, diagnosis and duration of illness. At the end of the intervention, patients receiving the experimental intervention reported a significant improvement in the levels of adherence to treatments (T0: 35.8% vs. T3: 47.6%, p < 0.005). Patients practicing moderate physical activity reported a two-point improvement in the levels of adherence [odds ratio (OR): 1,542; 95% confidence intervals (CI): 1,157-2,055; p < 0.001], even after controlling for several confounding factors. Discussion: The experimental lifestyle intervention, which can be easily implemented in the routine clinical practice of mental health centres, was effective in improving adherence to pharmacological treatments.

Implementation Evaluation of Community-Based Mental Health and Psychosocial Support Intervention for Refugee Newcomers in the United States

Refugee newcomers resettled in the United States face numerous challenges impacting their mental health and overall well-being. Despite extensive research on clinical interventions, multimodal interventions with peer-based group models in resettlement contexts remain scarce. Adopting a realist evaluation approach, this study aims to conduct a comprehensive implementation evaluation of a complex community-based mental health and psychosocial support (CB-MHPSS) group intervention, examining its mechanisms and processes while considering the interplay among context, implementing agents, and community settings. Qualitative and quantitative data on the implementation process were collected from 11 refugee agencies, involving trained resettlement staffers (n = 32) and refugee community facilitators (n = 31) who implemented the 31 CB-MHPSS psychosocial groups in 2021. The analysis included fidelity reports, process reflections, and follow-up survey responses, utilizing a structured template based on the CB-MHPSS Theory of Change (ToC) and Medical Research Council (MRC) guidance. Results of an in-depth exploration of complex relations between context and implementation processes reveal the vital role that adaptability to socio-ecological circumstances during the global coronavirus pandemic played in achieving successful implementation of psychosocial group interventions. Striking a balance between fidelity and refinement of intervention of the intervention curriculum emerged as crucial factors for aligning facilitation goals with newcomer needs. This approach maintained the integrity and appropriateness of the intervention, requiring implementers to utilize local knowledge of community resources and their understanding of lived experience of forced migrants and their within the community. Furthermore, exploring intervention barriers and facilitators revealed merits aligned with program change theories and areas for adjustment, while cataloged guidelines addressed community needs, showcasing competence beyond standard checkboxes. Strategic dissemination guidance provided by the central office in a supportive and nonintrusive manner facilitated uptake in a participatory and context-specific manner. This study emphasizes the importance of leveraging community partnerships and local knowledge to result in sustained improvements in the mental health and well-being of refugees.

Piloting a community-based psychosocial group intervention designed to reduce distress among conflict-affected adults in Colombia: a mixed-method study of remote, hybrid, and in-person modalities during the COVID-19 pandemic

BackgroundCommunity members in Quibdó (Choco, Colombia) are highly vulnerable to psychosocial problems associated with the internal armed conflict, poverty, and insufficient public services, and exacerbated by the COVID-19 pandemic. A pilot study was conducted with conflict-affected adults in Quibdó to assess feasibility and outcomes of a community-based psychosocial support group intervention using three different intervention modalities: in-person, remote (conducted online), and hybrid (half of sessions in-person, half-remote). This group model integrated problem-solving and culturally based expressive activities and was facilitated by local community members with supervision by mental health professionals.MethodsThis study utilized a mixed-explanatory sequential design (a quantitative phase deriving in a qualitative phase) with 39 participants and 8 staff members. Participants completed quantitative interviews before and after an eight-week group intervention. A subset of 17 participants also completed in-depth qualitative interviews and a focus group discussion was conducted with staff at post-intervention.ResultsFrom pre- to post-intervention, participants in all modalities demonstrated improved wellbeing and reduced symptoms of generalized distress, anxiety, depression, and posttraumatic stress. Use of coping skills varied across modalities, with remote groups associated with a decrease in some forms of coping, including use of social support. In qualitative interviews and the focus group discussion, participants and staff described logistical challenges and successes, as well as facilitators of change such as problem resolution, emotional regulation and social support with variations across modalities, such that remote groups provided fewer opportunities for social support and cohesion.ConclusionsResults offer preliminary evidence that this model can address psychosocial difficulties across the three modalities, while also identifying potential risks and challenges, therefore providing useful guidance for service delivery in conflict-affected settings during the COVID-19 pandemic and other challenging contexts. Implications of this study for subsequent implementation of a Randomized Control Trial (RCT) are discussed.

Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens.

This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.

Building coping skills to relieve distress and physical symptoms: Findings from a quality improvement project of a five-week group psychoeducational program for cancer patients

Purpose/objective: To examine the effectiveness of Mind Over Matter (MOM), a group psychosocial intervention based on CBT, ACT, and mind-body interventions, from data collected during a quality improvement project. MOM was offered in person prior to COVID-19 and via telehealth after COVID-19 began. Design/research approach: Distress, as measured by anxiety, depression, the severity of physical symptoms and the impact of physical symptoms on daily functioning, was measured pre- and post-MOM. Sample: The sample included 46 participants with an experience of cancer ranging in age from 31 to 75. Findings: Overall, there were significant differences in anxiety, depression, and physical symptom severity and interference pre and post MOM. The in-person intervention showed significant differences in anxiety, depression, and physical symptom interference. There were significant differences in anxiety and physical symptom severity reported in the telehealth groups. Implications: MOM may be an effective psychosocial intervention for addressing cancer-related physical and emotional challenges making it a valuable resource for institutions trying to meet needs identified by distress screenings.

Standing up for Myself (STORM): Adapting and piloting a web-delivered psychosocial group intervention for people with intellectual disabilities

BackgroundOur STORM intervention was developed for people (16 +) with intellectual disabilities to enhance their capacity to manage and resist stigma. The current study describes the adaptation of STORM for (synchronous) on-line delivery in the context of the Covid-19 pandemic. AimsTo adapt the manualised face-to-face STORM group intervention for delivery via web-based meeting platforms and to conduct an initial pilot study to consider its acceptability and feasibility. Methods and proceduresThe 5-session STORM intervention was carefully adapted for online delivery. In a pilot study with four community groups (N = 22), outcome, health economics and attendance data were collected, and fidelity of delivery assessed. Focus groups with participants, and interviews with facilitators provided data on acceptability and feasibility. Outcomes and resultsThe intervention was adapted with minimal changes to the content required. In the pilot study, 95% of participants were retained at follow-up, 91% attended at least three of the five sessions. Outcome measure completion and fidelity were excellent, and facilitators reported implementation to be feasible. The intervention was reported to be acceptable by participants. Conclusions and implicationsWhen provided with the necessary resources and support, people with intellectual disabilities participate actively in web-delivered group interventions.

Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial

Background The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. Methods A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox’s proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. Results The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41–1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53–1.11). Conclusions We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.

Psychosocial Group Intervention at a Low-Resource Setting Environment for Women Who Are Diagnosed and Treated for Breast Cancer: A Systematic Review

Psychosocial Group Intervention at a Low-Resource Setting Environment for Women Who Are Diagnosed and Treated for Breast Cancer: A Systematic Review

Mixed-methods evaluation of a group psychosocial intervention for refugee, migrant and host community women in Ecuador and Panamá: Results from the Entre Nosotras cluster randomized feasibility trial.

Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.

Non-pharmacological, psychosocial MAKS-s intervention for people with severe dementia in nursing homes: results of a cluster-randomised trial

BackgroundSevere dementia is one of the most challenging conditions when caring for people in nursing homes. A manualised non-pharmacological, psychosocial group intervention especially adapted to the needs of people with severe dementia (PWSDs) is currently still lacking. To close this gap, we adapted the evidence-based multicomponent non-pharmacological MAKS intervention (Motor stimulation, ADL stimulation, Cognitive [german: Kognitive] stimulation, and Social functioning in a group setting) to the special needs of PWSDs called the MAKS-s intervention, where the s stands for severe dementia.MethodsIn a prospective, multicentre, cluster-randomised trial with a waitlist control group design, 26 nursing homes comprising 152 PWSDs were randomly assigned to either the MAKS-s intervention group (IG) or control group (CG) – 121 PWSDs were still alive after the 6-month intervention period (t6) and included in the intention-to-treat (ITT) sample. The two primary outcomes, behavioural and psychological symptoms (BPSDs, measured with NPI-NH) and quality of life (QoL, measured with QUALIDEM), and the secondary outcome, activities of daily living (ADLs, measured with ADCS-ADL-sev), were assessed at baseline (t0) and at t6. Mixed ANOVAs were computed to investigate possible effects of the MAKS-s intervention on the outcomes.ResultsIn the ITT sample, BPSDs and QoL did not change significantly over time, and group assignment did not affect them, although the IG participants had significantly better overall QoL than the CG participants. ADLs decreased significantly over time, but group assignment did not affect them. Analyses in the per protocol (PP) sample showed comparable results, with the exception that the IG participants showed a significantly greater increase in BPSDs than the CG participants did.DiscussionUnder the situational conditions of the Covid-19 pandemic, no beneficial effects of the MAKS-s intervention on BPSDs, QoL, or ADLs were observed. This finding also means that under ‘normal circumstances’ (i.e., if there had been no pandemic), we could not make any statements about the effect or non-effect of MAKS-s. In order to be able to address the hypotheses formulated here, the study will have to be repeated incorporating helpful experiences of the present study.Trial registrationhttps://doi.org/10.1186/ISRCTN15722923 (Registered prospectively, 07. August 2019).

Worlds of Pain: A process evaluation of the Caregiver Support Intervention with Syrian refugees in Lebanon

This paper reports on a process evaluation conducted as part of a randomized controlled trial of the Caregiver Support Intervention (CSI), a nine-session preventive group psychosocial intervention, with Syrian refugees in Lebanon (n ​= ​480, 240 families). Fifteen focus group discussions (FGDs) were conducted with 122 CSI participants (51% of participants in the intervention arm of the trial), including 63 female and 59 male caregivers. We analyzed the focus group data to explore the mechanism of impact of the CSI on caregiver wellbeing and parenting. We also examine the impact of multiple adversities on the results of the trial, which was conducted in a context of widespread social unrest, a severe economic crisis, and the COVID-19 pandemic. Despite these adversities, participants described improvements in their psychological wellbeing and parenting as a result of the CSI. Changes in parenting include a reduction in harsh parenting and an increase in warm and responsive parenting. Findings suggest a pathway from the mindfulness practices and anger management techniques taught in the CSI, to improved caregiver wellbeing, to positive changes in parenting. Participants described becoming less angry and more patient, as well as better able to lower their arousal before responding to conflictual situations with their children. Increased knowledge of positive parenting also contributed to changes in parenting. About half of focus group participants reported a marked attenuation of effects following the intervention, which they attributed primarily to the high stress generated by the combination of the economic crisis and the pandemic. We examine specific ways in which the focus group findings diverge from the trial results, and consider the limitations of standalone psychosocial interventions in contexts of extreme adversity.