Support Interventions Research Articles

A rapid review of the evidence for online interventions for bereavement support.

Grieving is a natural process, and many people adjust with support from family and friends. Around 40% of people would benefit from additional input. Online bereavement support interventions may increase access to support. Evidence regarding their acceptability and effectiveness is emerging but needs to be synthesised. To synthesise evidence on the feasibility, acceptability, effectiveness, impacts and implementation of online interventions to improve wellbeing, coping and quality of life after bereavement. A rapid review of evidence regarding online bereavement support. We appraised study quality using AMSTAR 2 and the Mixed Methods Appraisal Tool. English language articles published 1 January 2010 to 4 January 2024, using Ovid MEDLINE, Ovid Embase and APA PsycINFO. Eligible articles examined formal and informal online interventions to improve bereavement outcomes. We screened 2050 articles by title and abstract. Four systematic reviews and 35 individual studies were included. Online bereavement support was feasible, acceptable and effective in reducing grief intensity, stress-related outcomes and depression. Where reported, participant retention was typically >70%. Positive impacts included: access to a supportive community at any time, reduced isolation; opportunities to process feelings; normalisation of loss responses; access to coping advice and opportunities for meaning-making and remembrance. Negative impacts included upset due to insensitive comments from others via unmoderated online forums. Online interventions can widen access to acceptable, effective bereavement support and improve outcomes for bereaved people. National policies and clinical guidelines relating to bereavement support need to be updated to take account of online formats.

Evaluation of Mental Health Status of Obstetrics and Gynecology Assistants during the COVID-19 Pandemic in Iran - A Cross-sectional Study

Background: Some evidence shows that the COVID-19 pandemic has had negative effects on the mental health status of different sections of society, including the medical staff. Aims: The current study was conducted with the aim of investigating the mental health status of obstetrics and gynecology (OB-GYN) assistants during the COVID-19 pandemic in Iran. Methods: The present cross-sectional study was conducted in 23 hospitals across Iran in 2021 (January- March). Four hundred OB-GYN assistants were randomly and voluntarily enrolled in the study. The instrument used in this study was the 28-item General Health Questionnaire (GHQ-28), which had four subscales, including somatic symptoms, anxiety/ insomnia, social dysfunction and severe depression. To collect data and to reach respondents in distant areas, the questionnaires were provided to the OB-GYN assistants by the online platform. Results: The mean age of the OB-GYN assistants was 32.3±2.6 years, and all were female. Of 400 OB-GYN assistants, 132 (33%) had no distress and 268 (67%) had psychiatric distress. According to subscales scoring, 72 (18%), 68 (17%), 92 (23%) and 64 (16%) had severe distress in somatic symptoms, anxiety/ insomnia, social dysfunction and severe depression, respectively. Conclusion: Considering that more than half of the Iranian OB-GYN assistants had poor mental health, it seems that the COVID-19 pandemic has had a negative and destructive effect on the mental health of OB-GYN assistants. In this situation, they need psychological support and appropriate intervention.

Menopause dynamics: From symptoms to quality of life, unraveling the complexities of the hormonal shift

The article delves deeply into the nature and process of menopause through which women undergo, which comprises profound transitions that occur during all menopausal stages. These findings emphasize the critical importance of comprehending and effectively addressing the diverse array of menopausal symptoms. The profound decline in progesterone and estrogen levels has been identified as the catalyst for triggering a spectrum of symptoms, which include but are not limited to hot flashes, mood swings, sleep disturbances, and genitourinary issues. These symptoms are noted to have a tangible impact on the daily functioning and overall well-being of women. This article underscores the pivotal role played by hormonal shifts in the manifestation of these symptoms and highlights the pressing need for the development of robust management strategies. Furthermore, hormone replacement therapy (HRT) is a well-researched treatment option, albeit with the caveat that its potential risks necessitate a personalized and nuanced approach. It also emphasizes the importance of lifestyle modifications, such as engaging in regular physical activity, adopting a balanced diet, and considering cognitive behavioral therapy, as pivotal elements in mitigating certain menopausal symptoms while concurrently enhancing overall health. The article also underscores the importance of addressing sexual health through therapeutic interventions, acknowledging their potential to significantly ameliorate vaginal symptoms and enhance sexual function, thereby fostering greater intimacy and relational satisfaction. Additionally, it highlights the profound psychosocial adjustments that women undergo during menopause, which are intrinsically intertwined with sociocultural factors. A holistic approach to menopause management is advised, which encompasses psychological support, medical treatments, and social interventions, underscoring their collective importance in effectively supporting women through this important life transition.

Anorexia nervosa: A narrative review of diagnostic criteria, pathophysiology, and innovative management approaches

This narrative review delves into the complexities of anorexia nervosa (AN), focusing on its unique manifestations within diverse contexts, particularly in cancer patients. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic approach was employed via electronic databases such as PubMed, Scopus, and Google Scholar. AN has been explored in the context of cancer-related anorexia‒cachexia syndrome, aging, and autoimmune disorders. The diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are outlined, emphasizing severe disturbances in eating behavior and self-imposed starvation. A thorough examination of the physiological, psychological, and social aspects of AN provides a comprehensive understanding of its multifactorial nature. This review outlines diverse management strategies for AN, encompassing nutritional rehabilitation, psychotherapeutic interventions, and potential pharmacological treatments. Various studies have summarized emerging signaling pathways in cancer-related AN, the bidirectional associations between AN and autoimmune disorders, and potential therapeutic modalities such as acupuncture. Emphasis is placed on the importance of family support, psychoeducation, and early intervention in cancer patients with AN, highlighting the integral role of a comprehensive approach in improving outcomes. In conclusion, this narrative review offers valuable insights into the intricate nature of AN, providing a basis for future research and clinical efforts to refine targeted interventions, particularly within the context of cancer patients. The article provides a broad overview of AN, serving as a resource for those interested in understanding its diverse manifestations.

Individual placement and support (IPS) – a time-out from modernity: an investigation on the relationship between IPS specialists and clients

ABSTRACT This study examines how evidence-based individual placement and support (IPS) interventions can be perceived to go beyond their constituent principles and fidelity scale to foster a relationship between IPS specialists and clients guided by three principles that promote deceleration and resonance, concepts put forward by Hartmut Rosa. This article is based on a case-study involving two municipalities in Denmark where the IPS method was implemented, resulting in high fidelity and good job outcomes. This study shows that when IPS specialists adhere to the IPS model, their relationship with their clients was seemingly guided by three values, namely, patience in securing sustainable employment, persistence in experimenting with employment and accepting and dealing with barriers to employment. These values originate from the evidence-based IPS approach and principles, but they can be interpreted to supplement the IPS model and form a professional practice. This practice promotes deceleration of social life as well as the immersion of clients in a resonant relationship with job opportunities, with their own mental health and with IPS specialists. The IPS intervention is in sharp contrast to the regular employment service wherein clients are pressured into taking jobs they do not want before they are ready to work. In this sense, the relationship IPS clients establish with IPS specialists is a time-out from modernity.

Contextual Factors Predictive of Social-Emotional Functioning Among Children of Mothers With and Without Low Intellectual Functioning

This study used Future of Families Child and Wellbeing Study data to examine community, family, and maternal predictors of social-emotional outcomes for kindergarten-aged children of mothers with and without low intellectual functioning. Multivariate analysis of variance and multivariate regression explored relationships between maternal intellectual functioning, covariates, and outcomes. As poverty was an important covariate, predictive of outcomes, marginal analysis was used to understand the interaction between poverty and intellectual functioning on each of the outcomes. Children whose mothers had low intellectual functioning had poorer outcomes than their peers regarding positive, anxious/depressed, and withdrawn behaviors regardless of poverty level. This research supports prioritizing these children for early social-emotional education as they enter elementary school, as well as prioritizing their families for supportive interventions in community-based settings.

DiaBetter Together: Clinical trial protocol for a strengths-based Peer Mentor intervention for young adults with type 1 diabetes transitioning to adult care

BackgroundType 1 diabetes (T1D) management is challenging for young adults, who are expected to transfer from the pediatric to adult T1D healthcare system while also managing typical developmental demands (e.g., social, financial, work/school, residential). Many young adults have extended gaps in care before following up in adult care, increasing risk for poor health outcomes. There are few evidence-based programs to support young adults with T1D to promote a timelier transition during this period. This paper reports on the design of DiaBetter Together, a randomized controlled trial to evaluate a 12-month Peer Mentor-delivered intervention compared to usual care among young adults with T1D during the transfer from pediatric to adult care. MethodsOne-hundred young adults (age 17–25) with T1D and 29 Peer Mentors enrolled in this randomized clinical trial. Peer Mentors are experienced, older young adults with T1D, trained by the study team to share transition experiences and strategies to successfully navigate the adult healthcare system, help young adults prepare for the first adult care visit, and use strengths-based support strategies to teach and model skills for managing T1D-related challenges. ResultsThe primary outcome of the trial is HbA1c, and secondary outcomes include time to adult care, engagement in diabetes self-management behaviors, and psychosocial well-being. ConclusionThe goal of this research is to evaluate a developmentally appropriate, supportive intervention that can improve T1D self-management and successful transfer of care during the difficult young adult years and promote optimal T1D health outcomes.

Perceived employability of international doctoral students in the UK: applying Bronfenbrenner’s ecological systems theory

ABSTRACT The quality of the UK’s doctorate training system plays a fundamental role in fostering vibrant research outputs and attracting global talent. However, while maintaining a consistently high standard of quality remains static and challenging, little is known about how the employability of international doctorate students is shaped and at what juncture it is opportune to support their employability during their research studies. This paper aims to understand the employability of international doctoral students within business schools at British universities, drawing on Urie Bronfenbrenner’s ecological systems theory as a framework. The qualitative study involves 15 international doctoral students from 9 business schools. The findings uncover various environmental systems impacting their employability. In addition, this study theoretically extends employability research by applying Bronfenbrenner’s ecological systems theory to provide a multi-layered understanding of international doctorate employability, offering a novel framework for targeted career support interventions. Further, the implications highlight the urgent need for tailored support to build industrial connections, promote departmental collaboration to scaffold a dynamic research environment, proffer multiple resource channels, and create employment opportunities both inside and outside of the university.

Documentation of anthropometrics in people with cancer: a cross-site collaboration audit in four hospital settings in the UK

BackgroundMalnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England.MethodologyData were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors.ResultsFindings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres.ConclusionsFindings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed.

Experiences of parents with very premature-born children at risk of neurodevelopmental disorders: A qualitative study.

Premature birth is a traumatic and stressful situation for parents who are immediately separated from their infant because of the newborn's need for specialized care. The staff of these units are in charge of following the principles of family-centred care and practices for neonates at risk of neurodevelopmental disorders, including providing training to the family during their hospital stay and after being discharged. The aim of this study is to explore the perceptions of parents of premature children at risk of neurodevelopmental disorders in regard to care, interventions and assistance provided during the first months of their child's life. A qualitative descriptive study was carried out through individual interviews. The data analysis was conducted through a thematic analysis. The methodology and results were reported following the standards for preparing qualitative research reports and recommendations. Twenty-one parents of premature children were interviewed. From these interviews, three main themes emerged: (i) parents' perspectives on preterm birth risk communication, (ii) navigating parental support and early interventions in preterm birth and (iii) perceptions of preterm birth protective and challenging factors. The parents of premature children need to receive better communication about the care and interventions for their child, and it is necessary that health personnel are better trained in terms of management and administration of public resources. Strategies must be implemented that continuously guide parents on the follow-up and care of their premature child not only during their first moments of life but also after being discharged from the hospital. This study highlights the need to improve care for parents with premature infants at risk, emphasizing the necessity for health care system reforms and support structures, allowing health care professionals to enhance attention and care.

Enrollment to exams: Perceived stress dynamics among first-year physics students

The current dropout rate in physics studies in Germany is about 60%, with the majority of dropouts occurring in the first year. Consequently, the physics study entry phase poses a significant challenge for many students. Students’ stress perceptions can provide more profound insights into the processes and challenges during that period. In a panel study featuring 67 measuring points involving up to 128 participants at each point, we investigated students’ stress perceptions with the perceived stress questionnaire (PSQ), identified underlying sources of stress, and assessed self-estimated workloads across two different cohorts. This examination occurred almost every week during the first semester, and for one cohort also in the second semester, yielding a total of 3241 PSQ data points and 5823 stressors. The PSQ data indicate a consistent stress trajectory across all three groups studied that is characterized by significant dynamics between measuring points, spanning from M=20.1,SD=15.9 to M=63.6,SD=13.4 on a scale from 0 to 100. Stress levels rise in the first weeks of the lecture, followed by stable, elevated stress levels until the exams and a relaxation phase afterward during the lecture-free time and Christmas vacation. In the first half of the lecture period, students primarily indicated the weekly exercise sheets, the physics lab course, and math courses as stressors; later on, preparation for exams and the exams themselves emerged as the most important stressors. Together with the students’ self-estimated workloads that correlate with the PSQ scores, we can create a coherent picture of stress perceptions among first-year physics students, which builds the basis for supportive measures and interventions. Published by the American Physical Society 2024

Building employability in PASS leaders through peer-assisted study sessions (PASS) programs

PurposeThe peer-assisted study sessions program (PASS) – variously known as supplemental instruction, peer mentoring and peer-assisted learning – is regarded as a global phenomenon in academic support interventions and has well established presence in higher education. The purpose of this study was to add to the body of knowledge of how PASS may add value to the employability of the student leaders, in relation to the CareerEDGE model.Design/methodology/approachThis qualitative research was based on interviews from a sample of 18 former PASS leaders who have since obtained employment.FindingsFindings demonstrate that being a PASS leader enhanced many of their competencies as defined by CareerEDGE model, for example subject related knowledge, interpersonal skills and some generic skills. However, many of the reported competency enhancements led to unexpected future career advancement.Research limitations/implicationsThis study contributes to the body of knowledge relating to how PASS may add value to the employability of student leaders in relation to the CareerEDGE model using a sample of leaders who have already graduated and have obtained employment. Limitations of this study include: lack of generalisability of small geographically isolated sample; coding and analsysis not comparing findings from different demographic groups; only explores individual perceptions and relies on self-reported data.Practical implicationsThe results of this study have implications for the development of future PASS programs and other similar academic support interventions. Given the global prevalence of such programs in higher education institutions, this research may have wide-scale transferability. Insights from this paper will allow future PASS leaders to proactively reflect and evaluate their experience and increase their confidence in pursuing their employment opportunities.Originality/valueWhile there is much understanding on the role that PASS has in improving students grades and in improving retention rates, less is known about the value of this experience on improving student employability, and little attempt has been made in examining this within relevant employability models post-employment.

Digital Health Readiness: Making Digital Health Care More Inclusive.

This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person's stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person's goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care.

Process evaluation of a breastfeeding support intervention to promote exclusive breastfeeding and reduce social inequity: a mixed-methods study in a cluster-randomised trial

BackgroundBreastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The ‘Breastfeeding – a good start together’ intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention.MethodsThe study was guided by the Medical Research Council’s guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8).ResultsOverall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families’ chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers’ context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high.ConclusionsHealth visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts.Trial registrationClinical Trials: NCT05311631. First posted April 5, 2022.

Predictive model for the risk of paediatric intensive care utilization in children with medical complexity: A longitudinal retrospective cohort study.

Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services. To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU). A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization. A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors. Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions. This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care.

“Surviving against the odds. The impact of peer support workers on a chronically suicidal adolescent in secure residential youth care: a single case report from the Netherlands”

ABSTRACT Background The use of peer support workers to support suicidal adolescents is underdeveloped. This study focuses on the effects of a one-year intervention with peer support workers on a chronically suicidal adolescent residing in a secure residential youth care facility in the Netherlands. Moreover, we explore the mechanisms that underpin the role of peer support workers in detail. Method This study employed a single case study design. We conducted seven semi-structured interviews with staff, peer support workers, and a chronically suicidal adolescent. The interviews were analysed using a thematic analysis. Results The results indicate that the suicidal tendencies of the adolescent decreased significantly one year after the peer support intervention compared to the initial baseline. Working mechanisms that underpinned the peer support intervention emphasized building meaningful and trust-based relationships, providing recognition and hope, and practical support from a recovery-oriented perspective. Conclusion The results suggest that peer support has a beneficial impact on the adolescent and treatment teams. Peer support workers contribute to a sense of belonging and connection, coping with suicidality, rediscovering life goals, and improving adolescent self-management. Barriers and facilitators to implementing peer support workers are also discussed.

Mapping disability in war-to-peace transitions: global patterns and the Lebanese experience

The inclusion of people with disabilities can facilitate sustainable peace after civil war. To shed a novel light on the relationship between war-to-peace transitions and disability, we map approaches to impairments in 286 worldwide intra-state political agreements, before considering the experience of Lebanon. Through a rigorous mixed methods research design, we show that war-to-peace transitions entrench the marginalisation of people with disabilities. Political agreements reproduce oversimplified understandings of disability; emphasise war-related physical impairments over non-physical and congenital ones; and prioritise support for former combatants. In Lebanon, disability-related legislation suffers from similar blind spots and remains unimplemented because of lack of financial resources, of weak capacity and cooperation among responsible local and international agencies, and of the features of the local political settlement. We discuss some significant implications for the lives of people with disabilities and their families, before providing recommendations to promote inclusive war-to-peace transitions. POINTS OF INTEREST Peace processes provide a crucial window of opportunity to build more inclusive societies. At a global level, civil war peace agreements overlook people with disabilities. Even when they mention impairments, peace accords adopt over­simplified understandings of disability, prioritise war-related physical impairments over non-physical and congenital ones, and emphasise interventions in support of former combatants. In Lebanon, lack of financial resources, weak capacity and cooperation among responsible local and international agencies, and local political dynamics further constrain the implementation of disability-focused policies. Globally, discourses on transition between civil war and a peaceful and just future, remain ableist and disempowering.

Strategies for unlocking EMR Interoperability: A Narrative Review

Electronic Medical Records (EMR) is intended to solve many issues in patient care pathway besides the administrative roles which equally makes the hospital paperless, but they still face major interoperability issues. When there is no systematic connection between different healthcare providers, medical information pertaining to patients becomes fragmented, incomplete, and outdated. This study was undertaken to investigate the strategies used to overcome interoperability challenges by EMR implementors. A narrative review was conducted, and various keywords were used to search in EBSCO, Google Scholar, and pertinent healthcare informatics articles for papers published between 2012 and 2024. Drawing from a range of studies, the findings indicate that Machine learning and artificial intelligence, Standardization of Data Exchange Protocols, Blockchain technology, EHR-Agnostic Platforms, Training and Organizational Support, Government and Policy Interventions, social factors are the strategies that successful EMR implementers have employed to achieve EMR interoperability.

Integrating the Memory Support Intervention into the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C): can improving memory for treatment in midlife and older adults improve patient outcomes? Study protocol for a randomized controlled trial

BackgroundPoor memory for treatment is associated with poorer treatment adherence and poorer patient outcomes. The memory support intervention (MSI) was developed to improve patient memory for treatment with the goal of improving patient outcomes. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether a new, streamlined, and potent version of the MSI improves outcomes for midlife and older adults. This streamlined MSI is comprised of constructive memory supports that will be applied to a broader range of treatment content. The platform for this study is the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C). We will focus on midlife and older adults who are low income and experiencing mobility impairments.MethodsParticipants (N = 178) will be randomly allocated to TranS-C + MSI or TranS-C alone. Both intervention arms include eight 50-min weekly sessions. Assessments will be conducted at pre-treatment, post-treatment, 6-, and 12-month follow-up (6FU and 12FU). Aim 1 will compare the effects of TranS-C + MSI versus TranS-C alone on sleep and circadian functioning, daytime functioning, well-being, and patient memory. Aim 2 will test whether patient memory for treatment mediates the relationship between treatment condition and patient outcomes. Aim 3 will evaluate if previously reported poor treatment response subgroups will moderate the relationship between treatment condition and (a) patient memory for treatment and (b) treatment outcome. Exploratory analyses will compare treatment condition on (a) patient adherence, patient-rated treatment credibility, and patient utilization of treatment contents, and (b) provider-rated acceptability, appropriateness, and feasibility.DiscussionThis study has the potential to provide evidence for (a) the efficacy of a new simplified version of the MSI for maintaining health, well-being, and functioning, (b) the wider application of the MSI for midlife and older adults and to the treatment of sleep and circadian problems, and (c) the efficacy of the MSI for sub-groups who are likely to benefit from the intervention.Trial registrationClinicalTrials.gov NCT05986604. Registered on 2 August 2023.

Father support breastfeeding self-efficacy positively affects exclusive breastfeeding at 6 weeks postpartum and its influencing factors in Southeast China: a multi-centre, cross-sectional study

BackgroundThe exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy.MethodsThis research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data.ResultsResults indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017–4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time.ConclusionsHigh-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding.