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Sartore GM, Pourliakas A, Lagioia V. Peer support interventions for parents and carers of children with complex needs. Cochrane Database Syst Rev 2021; 12:CD010618. [PMID: 34923624 PMCID: PMC8684823 DOI: 10.1002/14651858.cd010618.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents and family carers of children with complex needs experience a high level of pressure to meet children's needs while maintaining family functioning and, as a consequence, often experience reduced well-being and elevated psychological distress. Peer support interventions are intended to improve parent and carer well-being by enhancing the social support available to them. Support may be delivered via peer mentoring or through support groups (peer or facilitator led). Peer support interventions are widely available, but the potential benefits and risks of such interventions are not well established. OBJECTIVES To assess the effects of peer support interventions (compared to usual care or alternate interventions) on psychological and psychosocial outcomes, including adverse outcomes, for parents and other family carers of children with complex needs in any setting. SEARCH METHODS We searched the following resources. • Cochrane Central Register of Controlled Trials (CENTRAL; latest issue: April 2014), in the Cochrane Library. • MEDLINE (OvidSP) (1966 to 19 March 2014). • Embase (OvidSP) (1974 to 18 March 2014). • Journals@OVID (22 April 2014). • PsycINFO (OvidSP) (1887 to 19 March 2014). • BiblioMap (EPPI-Centre, Health Promotion Research database) (22 April 2014). • ProQuest Dissertations and Theses (26 May 2014). • metaRegister of Controlled Trials (13 May 2014). We conducted a search update of the following databases. • MEDLINE (OvidSP) (2013 to 20 February 2018) (search overlapped to 2013). • PsycINFO (ProQuest) (2013 to 20 February 2018). • Embase (Elsevier) (2013 to 21 February 2018). We handsearched the reference lists of included studies and four key journals (European Child and Adolescent Psychiatry: 31 March 2015; Journal of Autism and Developmental Disorders: 30 March 2015; Diabetes Educator: 7 April 2015; Journal of Intellectual Disability Research: 13 April 2015). We contacted key investigators and consulted key advocacy groups for advice on identifying unpublished data. We ran updated searches on 14 August 2019 and on 25 May 2021. Studies identified in these searches as eligible for full-text review are listed as "Studies awaiting classification" and will be assessed in a future update. SELECTION CRITERIA Randomised and cluster randomised controlled trials (RCTs and cluster RCTs) and quasi-RCTs were eligible for inclusion. Controlled before-and-after and interrupted time series studies were eligible for inclusion if they met criteria set by the Cochrane Effective Practice and Organisation of Care Review Group. The comparator could be usual care or an alternative intervention. The population eligible for inclusion consisted of parents and other family carers of children with any complex needs. We applied no restriction on setting. DATA COLLECTION AND ANALYSIS Inclusion decisions were made independently by two authors, with differences resolved by a third author. Extraction to data extraction templates was conducted independently by two authors and cross-checked. Risk of bias assessments were made independently by two authors and were reported according to Cochrane guidelines. All measures of treatment effect were continuous and were analysed in Review Manager version 5.3. GRADE assessments were undertaken independently by two review authors, with differences resolved by discussion. MAIN RESULTS We included 22 studies (21 RCTs, 1 quasi-RCT) of 2404 participants. Sixteen studies compared peer support to usual care; three studies compared peer support to an alternative intervention and to usual care but only data from the usual care arm contributed to results; and three studies compared peer support to an alternative intervention only. We judged risk of bias as moderate to high across all studies, particularly for selection, performance, and detection bias. Included studies contributed data to seven effect estimates compared to usual care: psychological distress (standardised mean difference (SMD) -0.10, 95% confidence interval (CI) -0.32 to 0.11; 8 studies, 864 participants), confidence and self-efficacy (SMD 0.04, 95% CI -0.14 to 0.21; 8 studies, 542 participants), perception of coping (SMD -0.08, 95% CI -0.38 to 0.21; 3 studies, 293 participants), quality of life and life satisfaction (SMD 0.03, 95% CI -0.32 to 0.38; 2 studies, 143 participants), family functioning (SMD 0.15, 95% CI -0.09 to 0.38; 4 studies, 272 participants), perceived social support (SMD 0.31, 95% CI -0.15 to 0.77; 4 studies, 191 participants), and confidence and skill in navigating medical services (SMD 0.05, 95% CI -0.17 to 0.28; 4 studies, 304 participants). In comparisons to alternative interventions, one pooled effect estimate was possible: psychological distress (SMD 0.2, 95% CI -0.38 to 0.79; 2 studies, 95 participants). No studies reported on adverse outcomes. All narratively synthesised data for psychological distress (compared to usual care - 2 studies), family functioning (compared to usual care - 1 study; compared to an alternative intervention - 1 study), perceived social support (compared to usual care - 2 studies), and self-efficacy (compared to alternative interventions - 1 study) were equivocal. Comparisons with usual care showed no difference between intervention and control groups (perceived social support), some effect over time for both groups but more effect for intervention (distress), or mixed effects for intervention (family function). Comparisons with alternative interventions showed no difference between the intervention of interest and the alternative. This may indicate similar effects to the intervention of interest or lack of effect of both, and we are uncertain which option is likely. We found no clear evidence of effects of peer support interventions on any parent outcome, for any comparator; however, the certainty of evidence for each outcome was low to very low, and true effects may differ substantially from those reported here. We found no evidence of adverse events such as mood contagion, negative group interactions, or worsened psychological health. Qualitative data suggest that parents and carers value peer support interventions and appreciate emotional support. AUTHORS' CONCLUSIONS Parents and carers of children with complex needs perceive peer support interventions as valuable, but this review found no evidence of either benefit or harm. Currently, there is uncertainty about the effects of peer support interventions for parents and carers of children with complex needs. However, given the overall low to very low certainty of available evidence, our estimates showing no effects of interventions may very well change with further research of higher quality.
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Affiliation(s)
| | - Anastasia Pourliakas
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Vince Lagioia
- Parenting Research Centre, East Melbourne, Australia
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Rosales CB, Denman CA, Bell ML, Cornejo E, Ingram M, Del Carmen Castro Vásquez M, Gonzalez-Fagoaga JE, Aceves B, Nuño T, Anderson EJ, Guernsey de Zapien J. Meta Salud Diabetes for cardiovascular disease prevention in Mexico: a cluster-randomized behavioural clinical trial. Int J Epidemiol 2021; 50:1272-1282. [PMID: 33842978 DOI: 10.1093/ije/dyab072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Healthy lifestyle interventions offered at points of care, including support groups, may improve chronic disease management, especially in low-resource populations. We assessed the effectiveness of an educational intervention in type 2 diabetes (T2D) support groups to reduce cardiovascular disease (CVD) risk. METHODS We recruited 518 participants to a parallel, two-arm, cluster-randomized, behavioural clinical trial across 22 clinics in Sonora, Mexico, between August 2016 and October 2018. We delivered a 13-week secondary prevention intervention, Meta Salud Diabetes (MSD), within the structure of a support group (GAM: Grupo de Ayuda Mutua) in government-run (community) Health Centres (Centros de Salud). The primary study outcomes were difference in Framingham CVD risk scores and hypertension between intervention (GAM+MSD) and control (GAM usual care) arms at 3 and 12 months. RESULTS CVD risk was 3.17% age-points lower in the MSD arm versus control at 3 months [95% confidence interval (CI): -5.60, -0.75, P = 0.013); at 12 months the difference was 2.13% age-points (95% CI: -4.60, 0.34, P = 0.088). There was no evidence of a difference in hypertension rates between arms. Diabetes distress was also lower at 3 and 12 months in the MSD arm. Post-hoc analyses showed greater CVD risk reduction among men than women and among participants with HbA1c < 8. CONCLUSIONS MSD contributed to a positive trend in reducing CVD risk in a low-resource setting. This study introduced an evidence-based curriculum that provides T2D self-management strategies for those with controlled T2D (i.e. HbA1c < 8.0) and may improve quality of life.
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Affiliation(s)
- Cecilia B Rosales
- Division of Public Health Practice & Translational Research, University of Arizona Mel & Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Catalina A Denman
- Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Hermosillo, SN, México
| | - Melanie L Bell
- Department of Epidemiology & Biostatistics, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Elsa Cornejo
- Centro de Estudios en Salud y Sociedad, El Colegio de Sonora, Hermosillo, SN, México
| | - Maia Ingram
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | - Jesús Eduardo Gonzalez-Fagoaga
- Division of Public Health Practice & Translational Research, University of Arizona Mel & Enid Zuckerman College of Public Health, Phoenix, AZ, USA
| | - Benjamín Aceves
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Tomas Nuño
- Department of Epidemiology & Biostatistics, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Elizabeth J Anderson
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Jill Guernsey de Zapien
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, Tucson, AZ, USA
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Werfalli M, Raubenheimer PJ, Engel M, Musekiwa A, Bobrow K, Peer N, Hoegfeldt C, Kalula S, Kengne AP, Levitt NS. The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: a systematic review. Syst Rev 2020; 9:133. [PMID: 32505214 PMCID: PMC7275531 DOI: 10.1186/s13643-020-01377-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries' (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes. METHODS We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform, Clinicaltrials.gov, Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided. RESULTS Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible. CONCLUSIONS The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.
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Affiliation(s)
- Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Cape Town, Western Cape South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
| | - Peter J. Raubenheimer
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
| | - Mark Engel
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
| | - Alfred Musekiwa
- Chronic Diseases of Lifestyle Research Unit, Durban, Durban, South Africa
| | - Kirsten Bobrow
- Chronic Disease Initiative for Africa, Cape Town, Western Cape South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
| | - Nasheeta Peer
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
- Chronic Diseases of Lifestyle Research Unit, Durban, Durban, South Africa
| | | | - Sebastiana Kalula
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
- Department of Geriatric Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western Cape South Africa
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Naomi S. Levitt
- Chronic Disease Initiative for Africa, Cape Town, Western Cape South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Observatory, Cape Town, Western Cape 7935 South Africa
- Division of Endocrinology and Diabetes, Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, University of Cape Town, J 47 Room 86, Old Groote Schuur Hospital Building, Cape Town, South Africa
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Effect of Peer Education on the Resilience of Mothers of Children with Leukemia: A Clinical Trial. ACTA ACUST UNITED AC 2019. [DOI: 10.5812/msnj.92686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chien WT, Clifton AV, Zhao S, Lui S. Peer support for people with schizophrenia or other serious mental illness. Cochrane Database Syst Rev 2019; 4:CD010880. [PMID: 30946482 PMCID: PMC6448529 DOI: 10.1002/14651858.cd010880.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. OBJECTIVES To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. SELECTION CRITERIA We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve 'peer' individual/group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). DATA COLLECTION AND ANALYSIS The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains.All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term (RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society.One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. AUTHORS' CONCLUSIONS Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.
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Affiliation(s)
- Wai Tong Chien
- The Chinese University of Hong KongNethersole School of Nursing8/F., Esther Lee Building, Chung Chi CampusThe Chinese University of Hong KongShatinNew TerritoriesHong Kong
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Sai Zhao
- The Ingenuity Centre, The University of NottinghamSystematic Review Solutions LtdTriumph RoadNottinghamUKNG7 2TU
| | - Steve Lui
- University of HuddersfieldSchool of Human and Health SciencesHarold Wilson BuildingQueensgateHuddersfieldUKHD1 3DH
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Abstract
PURPOSE OF REVIEW This review presents evidence on support group effectiveness in common diseases, research on support groups in systemic sclerosis (SSc), and work underway by the Scleroderma Patient-centered Intervention Network in collaboration with patient organizations to train SSc support group leaders in order to improve support group access and the experiences of support groups for members and leaders. RECENT FINDINGS Giving and receiving emotional and practical support from others with SSc is an important reason that individuals with SSc attend support groups, but many patients cannot access support groups. SSc support group leaders report confidence in their ability to facilitate groups, but are less confident in tasks such as managing group dynamics and sustaining the group. The Scleroderma Support group Leader EDucation (SPIN-SSLED) Program was developed to provide training to support group leaders and was recently tested through a feasibility trial. A full-scale trial will commence in 2019.
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Islam N, Gepts T, Lief I, Gore R, Levy N, Tanner M, Fang Y, Sherman SE, Schwartz MD. Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes. BMC Public Health 2018; 18:521. [PMID: 29673333 PMCID: PMC5909211 DOI: 10.1186/s12889-018-5419-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) affects 9.4% of US adults and children, while another 33.9% of Americans are at risk of DM. Health care institutions face many barriers to systematically delivering the preventive care needed to decrease DM incidence. Community health workers (CHWs) may, as frontline public health workers bridging clinic and community, help overcome these challenges. This paper presents the protocol for a pragmatic, cluster-randomized trial integrating CHWs into two primary care clinics to support DM prevention for at-risk patients. METHODS The trial will randomize 15 care teams, stratified by practice site (Bellevue Hospital and Manhattan VA), totaling 56 primary care physicians. The study cohort will consist of ~ 2000 patients who are 18-75 years of age, actively enrolled in a primary care team, able to speak English or Spanish, and have at least one glycosylated hemoglobin (HbA1c) result in the prediabetic range (5.7-6.4%) since 2012. Those with a current DM diagnosis or DM medication prescription (other than metformin) are ineligible. The intervention consists of four core activities - setting health goals, health education, activation for doctor's appointments, and referrals to DM prevention programs - adjustable according to the patient's needs and readiness. The primary outcome is DM incidence. Secondary outcomes include weight loss, HbA1C, and self-reported health behaviors. Clinical variables and health behaviors will be obtained through electronic medical records and surveys, respectively. Implementation outcomes, namely implementation fidelity and physicians' perspectives about CHW integration into the clinic, will be assessed using interviews and CHW activity logs and analyzed for the influence of moderating organizational factors. DISCUSSION This is the first rigorous, pragmatic trial to test the effectiveness of integrating CHWs into primary care for DM prevention reaching a population-based sample. Our study's limitations include language-based eligibility and the use of HbA1c as a measure of DM risk. It will measure both clinical and implementation outcomes and potentially broaden the evidence base for CHWs and patient-centered medical home implementation. Further, the intervention's unique features, notably patient-level personalization and referral to existing programs, may offer a scalable model to benefit patients at-risk of DM. TRIAL REGISTRATION Clinicaltrials.gov NCT03006666 (Received 12/27/2016).
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Affiliation(s)
- Nadia Islam
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA.
| | - Thomas Gepts
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA
| | - Isaac Lief
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA
| | - Radhika Gore
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA
| | - Natalie Levy
- NYC Health + Hospitals, Bellevue Hospital, New York, NY, USA.,NYU Langone Health, Department of Medicine, New York, NY, USA
| | - Michael Tanner
- NYC Health + Hospitals, Bellevue Hospital, New York, NY, USA.,NYU Langone Health, Department of Medicine, New York, NY, USA
| | - Yixin Fang
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA.,New Jersey Institute of Technology, Department of Mathematical Sciences, Newark, NJ, USA
| | - Scott E Sherman
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA.,VA New York Harbor Health Care System, New York, NY, USA
| | - Mark D Schwartz
- NYU School of Medicine, Department of Population Health, New York, NY, 10016, USA.,VA New York Harbor Health Care System, New York, NY, USA
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Simpson A, Oster C, Muir-Cochrane E. Liminality in the occupational identity of mental health peer support workers: A qualitative study. Int J Ment Health Nurs 2018; 27:662-671. [PMID: 28548455 PMCID: PMC5900877 DOI: 10.1111/inm.12351] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 11/27/2022]
Abstract
Peer support is increasingly provided as a component of mental health care, where people in recovery from mental health problems use their lived experiences to provide support to those experiencing similar difficulties. In the present study, we explored the evolution of peer support workers' (PSW) occupational identities. A qualitative study was undertaken alongside a pilot randomized, controlled trial of peer support for service users discharged from a mental hospital in London, UK. Two focus groups were conducted with eight PSW. Semistructured interviews were conducted with 13 service users receiving peer support and on two occasions with a peer support coordinator. The data were analysed using theoretical thematic analysis, focussing on occupational identity formation. We discuss how the occupational identity of PSW evolved through the interplay between their lived experience, their training, and their engagement in the practice environment in such a way as to construct a liminal identity, with positive and negative outcomes. While the difficulties associated with the liminality of PSW could be eased through the formalization and professionalization of the PSW role, there are concerns that this could lead to an undermining of the value of PSW in providing a service by peers for peers that is separate from formal mental health care and relationships. Skilled support is essential in helping PSW negotiate the potential stressors and difficulties of a liminal PSW identity.
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Affiliation(s)
- Alan Simpson
- Centre for Mental Health Research, School of Health Sciences, City University of London and East London National Health Service Foundation Trust, London, UK
| | - Candice Oster
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - Eimear Muir-Cochrane
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
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Lindsay S, Stinson J, Stergiou-Kita M, Leck J. Improving Transition to Employment for Youth With Physical Disabilities: Protocol for a Peer Electronic Mentoring Intervention. JMIR Res Protoc 2017; 6:e215. [PMID: 29146566 PMCID: PMC5709654 DOI: 10.2196/resprot.8034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background Although youth with disabilities have much to gain from employment readiness programs, they are often excluded from or have limited access to vocational programs. One encouraging approach to address gaps in vocational programming is through peer electronic mentoring (e-mentoring), which may facilitate a smoother transition to adulthood by offering support to enhance coping skills. Despite the increase in online communities, little is known about their impact on vocational mentoring for youth with physical disabilities and their parents. Objective The aim of this paper is to develop, implement, and assess the feasibility of an online peer mentor employment readiness intervention for youth with physical disabilities and their parents to improve their self-determination, career maturity, and social support compared to controls. Methods A mixed-methods feasibility randomized controlled trial (RCT) design will be conducted to develop and assess the feasibility, acceptability, and initial efficacy of the “Empowering Youth Towards Employment” intervention. Youth (aged 15 to 25) with physical disabilities and their parents will be randomly assigned to a control or experimental group (4-week, interactive intervention, moderated by peer mentors). Results Data collection is in progress. Planned analyses include pre-post measures to determine the impact of the intervention on self-determination, career maturity, and social support. A qualitative thematic analysis of the discussion forums will complement the surveys to better understand why certain outcomes may have occurred. Conclusions Our intervention includes evidence-informed content and was co-created by a multi-disciplinary group of researchers and knowledge users. It has the potential for widespread implications as a cost-effective resource to supplement educational and vocational programming for youth with disabilities. Trial Registration Clinicaltrials.gov NCT02522507; https://clinicaltrials.gov/ct2/show/NCT02522507 (Archived by WebCite at http://www.webcitation.org/6uD58Pvjc)
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Lawrence Bloomberg Faculty of Nursing and Hospital for Sick Children, Toronto, ON, Canada
| | - Mary Stergiou-Kita
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Joanne Leck
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
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Burton E, Farrier K, Hill KD, Codde J, Airey P, Hill AM. Effectiveness of peers in delivering programs or motivating older people to increase their participation in physical activity: Systematic review and meta-analysis. J Sports Sci 2017; 36:666-678. [PMID: 28535358 DOI: 10.1080/02640414.2017.1329549] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The objective of this systematic review and meta-analysis was to evaluate the effectiveness of peers to deliver programs or encourage older people to be physically active and improve physical outcomes. Peer reviewed articles published in English between January 1976 and June 2016, retrieved from six databases according to the predefined inclusion criteria were included. Where possible results were pooled and meta-analyses conducted. Eighteen articles were included in the review, a total of 3,492 intervention participants, average age 66.5 years and 67.1% were female. Overall, study quality was medium to high. Interventions mainly included resistance, flexibility and cardiovascular training, however there was one aquatic exercise group. Eight studies were delivered by peers and five utilised peer support, which included advice and being positive but was not directly linked to an exercise intervention. While 16 of the 18 studies reported improvement in levels of physical activity and/or noted physical benefits by peer involvement, the meta-analyses findings supported the control groups for the six-minute-walk-test and the timed-up-and-go test. Findings from this review suggest exercise programs involving peers can promote and maintain adherence to exercise programs. However, results were inconclusive as to whether peers have a positive effect on improving older people's physical function.
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Affiliation(s)
- Elissa Burton
- a Institute for Health Research , The University of Notre Dame Australia , Fremantle , Western Australia , Australia
| | - Kaela Farrier
- b School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia , Australia
| | - Keith D Hill
- b School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia , Australia
| | - Jim Codde
- a Institute for Health Research , The University of Notre Dame Australia , Fremantle , Western Australia , Australia
| | - Phil Airey
- c Council on the Ageing (WA) , Perth , Western Australia , Australia
| | - Anne-Marie Hill
- b School of Physiotherapy and Exercise Science , Curtin University , Perth , Western Australia , Australia
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Kramer JM, Ryan CT, Moore R, Schwartz A. Feasibility of electronic peer mentoring for transition-age youth and young adults with intellectual and developmental disabilities: Project Teens making Environment and Activity Modifications. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:e118-e129. [PMID: 28247558 DOI: 10.1111/jar.12346] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND There is a need for mentoring interventions in which transition-age youth and young adults with intellectual and/or developmental disabilities (I/DD) participate as both mentors and mentees. Project TEAM (Teens making Environment and Activity Modifications) is a problem-solving intervention that includes an electronic peer-mentoring component. METHODS Forty-two mentees and nine mentors with I/DD participated. The present authors analysed recorded peer-mentoring calls and field notes for mentee engagement, mentor achievement of objectives and supports needed to implement peer mentoring. RESULTS Overall, mentees attended 87% of scheduled calls and actively engaged during 94% of call objectives. Across all mentoring dyads, mentors achieved 87% of objectives and there was a significant relationship between the use of supports (mentoring script, direct supervision) and fidelity. CONCLUSIONS Transition-age mentees with I/DD can engage in electronic peer mentoring to further practice problem-solving skills. Mentors with I/DD can implement electronic peer mentoring when trained personnel provide supports and individualized job accommodations.
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Affiliation(s)
- Jessica M Kramer
- Department of Occupational Therapy, Boston University, Boston, MA, USA
| | | | - Rachel Moore
- Mercy Hospital and Medical Center, Chicago, IL, USA
| | - Ariel Schwartz
- Department of Occupational Therapy, Boston University, Boston, MA, USA
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Mother-to-mother therapy in India and Pakistan: adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme. BMC Psychiatry 2017; 17:79. [PMID: 28231791 PMCID: PMC5324237 DOI: 10.1186/s12888-017-1244-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan. METHODS The study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach. RESULTS Most mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging. CONCLUSIONS The study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions. TRIAL REGISTRATION Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).
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Burnell K, Charlesworth G, Feast AR, Hoe J, Poland FM, Orrell M. Peer support interventions for family carers of adults with chronic mental or physical illness who are living at home. Hippokratia 2016. [DOI: 10.1002/14651858.cd010231.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Karen Burnell
- University of Portsmouth; School of Health Sciences and Social Work (SHSSW); James Watson Building (West) 2 King Richard 1st Road Portsmouth UK PO1 2FR
| | - Georgina Charlesworth
- University College London; Research Department of Clinical, Educational, and Health Psychology; 67-73 Riding House Street 1st Floor, Charles Bell House London UK W1W 7EJ
| | - Alexandra R Feast
- North East London NHS Foundation Trust; Research and Development Department; 1st Floor, Maggie Lilley Suite Goodmayes Hospital, Barley Lane Ilford Essex UK IG3 8XJ
| | - Juanita Hoe
- University College London; Mental Health Sciences Unit; Charles Bell House 67-73 Riding House Street London UK W1W 7EJ
| | - Fiona M Poland
- University of East Anglia; School of Allied Health Professions (AHP) and Health and Social Science Research Institute; Norwich Norfolk UK NR7 4TJ
| | - Martin Orrell
- University of Nottingham; Institute of Mental Health; Triumph Road Nottingham Nottinghamshire UK
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Bourke C, Sanders B, Allchin B, Lentin P, Lang S. Occupational therapy influence on a carer peer support model in a clinical mental health service. Aust Occup Ther J 2015; 62:299-305. [PMID: 26395612 DOI: 10.1111/1440-1630.12235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Current policy frameworks call for the participation of consumers and carers in all levels of mental health service delivery in Australia. Such inclusion leads to better outcomes for all, however, it is recognised that carers have needs and occupations beyond their carer role. The aim of this article is to describe an innovative carer peer support program developed by a group of occupational therapists. The article describes the rationale, phases of development and the role that occupational therapists played in developing and sustaining the model. This is followed by an exploration of the occupational therapy attitudes, knowledge and skills that contributed to the conceptualisation and implementation of the model. METHOD Five occupational therapists engaged in a review process involving documentation, literature review, evaluation, reflection and discussion. Four of the occupational therapists had either coordinated or managed the service described. The fifth author facilitated the process. RESULTS Review of the model indicates it equips carers to perform their caring occupation and helps carers recognise the need for occupations beyond caring, for their health and wellbeing. Employing carers as paid workers values their 'real life' experience in their caring occupation. Findings also illustrate that the attitudes, knowledge, skills and competency standards of occupational therapists are well suited in enabling this emerging area of service delivery. CONCLUSION Although this model has been developed in a clinical mental health setting, the key principles could be applied with carers or consumers across a variety of settings in which occupational therapists are employed.
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Affiliation(s)
- Cate Bourke
- Eastern Health Mental Health Program, Box Hill, Victoria, Australia
| | | | - Becca Allchin
- Eastern Health FaPMI, East Ringwood, Victoria, Australia
| | - Primrose Lentin
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Shannon Lang
- Eastern Health Mental Health Program, Box Hill, Victoria, Australia
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Hamdani SU, Atif N, Tariq M, Minhas FA, Iqbal Z, Rahman A. Family networks to improve outcomes in children with intellectual and developmental disorders: a qualitative study. Int J Ment Health Syst 2014; 8:7. [PMID: 24485093 PMCID: PMC3915557 DOI: 10.1186/1752-4458-8-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/27/2014] [Indexed: 11/21/2022] Open
Abstract
Background There are at least 50 million children with an intellectual or developmental disorder in South Asia. The vast majority of these children have no access to any service and there are no resources to develop such services. We aimed to explore a model of care-delivery for such children, whereby volunteer family members of affected individuals could be organized and trained to form an active, empowered group within the community that, a) using a task-sharing approach, are trained by specialists to provide evidence-based interventions to their children; b) support each other, with the more experienced FaNs i.e. family networks, providing peer-supervision and training to new family members who join the group; and c) works to reduce the stigma associated with the condition. Methods We used qualitative methods to explore carers’ perspectives about such a care-delivery model. Results The key findings of this research are that there is a huge gap between the needs of the carers and available services. Carers would welcome a volunteer-led service, and some community members would have time to volunteer. Raising community awareness in a culturally sensitive manner prior to launching such a service and linking it to the community health workers programme would increase the likelihood of success. Gender-matching would be important. It would be possible to form family networks around the more motivated volunteers, with support from local non-governmental organizations. The carers were receptive to the use of technology to assist the work of the volunteers as well as for networking. Conclusions We conclude that family volunteers delivering evidence-based packages of care after appropriate training is a feasible system that can help reduce the treatment gap for childhood intellectual and developmental disorders in under-served populations.
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Affiliation(s)
| | | | | | | | | | - Atif Rahman
- Human Development Research Foundation, Islamabad, Pakistan.
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Chien WT, Lui S, Clifton AV. Peer support for schizophrenia. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Wai Tong Chien
- The Hong Kong Polytechnic University; School of Nursing; PQ402, School of Nursing Kowloon Hung Hom Kowloon Hong Kong HKSAR
| | - Steve Lui
- University of Huddersfield; School of Human and Health Sciences; Harold Wilson Building Queensgate Huddersfield UK HD1 3DH
| | - Andrew V Clifton
- University of Huddersfield; School of Human and Health Sciences; Harold Wilson Building Queensgate Huddersfield UK HD1 3DH
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Prictor M, Hill S. Cochrane Consumers and Communication Review Group: leading the field on health communication evidence. J Evid Based Med 2013; 6:216-20. [PMID: 24325413 DOI: 10.1111/jebm.12066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/27/2013] [Indexed: 01/11/2023]
Abstract
This paper presents an overview of the history and achievements of the Cochrane Consumers and Communication Review Group, part of the international Cochrane Collaboration. It surveys the Group's establishment and structure, the scope of its Cochrane Reviews and the growth in its publication output over its 16-year history. The paper examines the Group's developmental work in interventions and outcomes related to patient communication and involvement, as well as methodological resources for review authors. It also outlines the Review Group's research partnerships with state, national and international agencies, particularly in the areas of chronic disease management, medicines use, public involvement, and vaccines communication. The Group's strong contribution to an evidence-base for health communication and participation are acknowledged.
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Affiliation(s)
- Megan Prictor
- Cochrane Consumers and Communication Review Group, School of Public Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Australia
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Sartore G, Lagioia V, Mildon R. Peer support interventions for parents and carers of children with complex needs. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gina Sartore
- Parenting Research Centre; Knowledge Exchange and Implementation division; Level 5, 232 Victoria Parade East Melbourne VIC Australia 3002
| | - Vince Lagioia
- Parenting Research Centre; Knowledge Exchange and Implementation division; Level 5, 232 Victoria Parade East Melbourne VIC Australia 3002
| | - Robyn Mildon
- Parenting Research Centre; Knowledge Exchange and Implementation division; Level 5, 232 Victoria Parade East Melbourne VIC Australia 3002
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Ashton M, Mulconray S, Weston M, Rigby A, Galletly C. Peer workers' role in smoking-cessation groups for people with mental illness. Australas Psychiatry 2013; 21:246-8. [PMID: 23152359 DOI: 10.1177/1039856212466924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this article is to evaluate the impact of peer workers' involvement as co-leaders in smoking-cessation programmes provided within mental health services. METHOD Group smoking-cessation programmes were provided for people living with mental illness. Peer workers were involved in the development and delivery of these programmes. Group participants and mental health workers were asked to respond to a questionnaire about their experience of the peer workers. The questionnaire included both Likert scales and qualitative responses. RESULTS Thirty-three mental health workers and 108 group participants completed the questionnaire. The majority of participants believed that the peer workers increased their confidence, helped them to learn about smoking cessation and promoted well-being. Mental health workers were also positive about the role of peer workers in the groups. CONCLUSIONS This study supports the role of peer workers providing support and guidance within smoking-cessation programmes for people with mental illness. The results suggest that peer workers make a substantial contribution and that greater peer worker involvement in such programmes is likely to improve their acceptability and efficacy.
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Affiliation(s)
- Maxie Ashton
- Tobacco and Mental Illness Project, Adelaide Health Service, Adelaide, SA, Australia.
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Burnell K, Charlesworth G, Feast AR, Hoe J, Poland FM, Orrell M. Peer support interventions for family carers of adults with chronic mental or physical illness who are living at home. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd010231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Santin O, Coleman H, Mills M, Cardwell CR, Donnelly M. Psychosocial interventions for informal caregivers of people living with cancer. Hippokratia 2012. [DOI: 10.1002/14651858.cd009912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Olinda Santin
- Queen's University Belfast; School of Nursing and Midwifery; Institute of Clinical Sciences B Royal Victoria Hospital Site, Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Helen Coleman
- Queen's University Belfast; Centre for Public Health; Mulhouse Building Royal Victoria Hospital, Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Moyra Mills
- Northern Health and Social Care Trust; Fern House, Antrim Area Hospital Bush Road Antrim Northern Ireland UK BT41 2RL
| | - Chris R Cardwell
- Queen's University Belfast; Centre for Public Health; Mulhouse Building Royal Victoria Hospital, Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
| | - Michael Donnelly
- Queen's University Belfast; Centre for Public Health; Mulhouse Building Royal Victoria Hospital, Grosvenor Road Belfast Northern Ireland UK BT12 6BJ
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Stant AD, Castelein S, Bruggeman R, van Busschbach JT, van der Gaag M, Knegtering H, Wiersma D. Economic aspects of peer support groups for psychosis. Community Ment Health J 2011; 47:99-105. [PMID: 19308728 DOI: 10.1007/s10597-009-9193-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 03/10/2009] [Indexed: 10/21/2022]
Abstract
Peer support groups are rarely available for patients with psychosis, despite potential clinical and economic advantages of such groups. In this study, 106 patients with psychosis were randomly allocated to minimally guided peer support in addition to care as usual (CAU), or CAU only. No relevant differences between mean total costs of both groups were found, nor were there significant differences in WHOQoL-Bref outcomes. Intervention adherence had a substantial impact on the results. It was concluded that minimally guided peer support groups for psychosis do not seem to affect overall healthcare expenses. Positive results of additional outcomes, including a significant increase in social contacts and esteem support, favour the wider implementation of such groups.
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Affiliation(s)
- A D Stant
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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McDowell JRS, McPhail K, Halyburton G, Brown M, Lindsay G. Perceptions of a service redesign by adults living with type 2 diabetes. J Adv Nurs 2009; 65:1432-41. [PMID: 19457006 DOI: 10.1111/j.1365-2648.2009.05003.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This article is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign. BACKGROUND Diabetes is reaching epidemic proportions and the management of this chronic illness is changing in response to this challenge. In the United Kingdom, there is ongoing restructuring of healthcare services for people with chronic illnesses to ensure that their general health and clinical needs are met predominantly in primary care. METHOD An explorative qualitative approach was used. Eight focus groups were conducted with 35 people with type 2 diabetes in one urban location between 2003 and 2004. Five focus groups were conducted with people who had recently experienced the restructured service and three groups with people who had up to 2 years' experience of the new service. Concurrent data collection and thematic analysis were conducted by three researchers and credibility and verification sought by feedback to participants. FINDINGS Five main themes were identified: impact of living with diabetes; understanding diabetes; drivers for organizational change; care in context and individual concerns. Participants identified issues for ongoing development of the service. CONCLUSION People with type 2 diabetes appreciate their care management within the primary care setting where there has been investment in staff to deliver this care. Healthcare resources are required to support the development of staff and the necessary infrastructure to undertake management in primary care. Policy makers need to address the balance of resources between primary and secondary care.
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Abstract
BACKGROUND Peer support telephone calls have been used for a wide range of health-related concerns. However, little is known about their effects. OBJECTIVES To assess the effects of peer support telephone calls in terms of physical (e.g. blood pressure), psychological (e.g. depressive symptoms), and behavioural health outcomes (e.g. uptake of mammography) and other outcomes. SEARCH STRATEGY We searched: The Cochrane Library databases (CENTRAL, DARE, CDSR) (issue 4 2007); MEDLINE (OVID) (January 1966 to December 2007); EMBASE (OVID) (January 1985 to December 2007); CINAHL (Athens) (January 1966 to December 2007), trials registers and reference lists of articles, with no language restrictions. SELECTION CRITERIA Randomised controlled trials of peer support interventions delivered by telephone call. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. We present results narratively and in tabular format. Meta-analysis was not possible due to heterogeneity between studies. MAIN RESULTS We included seven studies involving 2492 participants.Peer support telephone calls were associated with an increase in mammography screening, with 49% of women in the intervention group and 34% of women in the control group receiving a mammogram since the start of the intervention (P </ = 0.001). In another study, peer telephone support calls were found to maintain mammography screening uptake for baseline adherent women (P = 0.029).Peer support telephone calls for post myocardial infarction patients were associated at six months with a change in diet in the intervention and usual care groups of 54% and 44% respectively (P = 0.03). In another study for post myocardial infarction patients there were no significant differences between groups for self-efficacy, health status and mental health outcomes.Peer support telephone calls were associated with greater continuation of breastfeeding in mothers at 3 months post partum (P = 0.01).Peer support telephone calls were associated with reduced depressive symptoms in mothers with postnatal depression (Edinburgh Postnatal Depression Scale (EPDS) > 12). The peer support intervention significantly decreased depressive symptomatology at the 4-week assessment (odds ratio (OR) 6.23 (95% confidence interval (CI) 1.15 to 33.77; P = 0.02)) and 8-week assessment (OR 6.23 (95% CI 1.40 to 27.84; P = 0.01). One study investigated the use of peer support for patients with poorly controlled diabetes. There were no significant differences between groups for self-efficacy, HbA1C, cholesterol level and body mass index. AUTHORS' CONCLUSIONS Whilst this review provides some evidence that peer support telephone calls can be effective for certain health-related concerns, few of the studies were of high quality and so results should be interpreted cautiously. There were many methodological limitations thus limiting the generalisability of findings. Overall, there is a need for further well designed randomised controlled studies to clarify the cost and clinical effectiveness of peer support telephone calls for improvement in health and health-related behaviour.
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Affiliation(s)
- Jeremy Dale
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Gibbet Hill campus, Coventry, Warwickshire, UK, CV4 7AL.
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Dale J, Caramlau I, Lindenmeyer A, Williams SM. Peer support telephone call interventions for improving health. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006903] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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