Group learning for adults with disabilities or chronic disease

Effective interventions in preventing gestational diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Lifestyle choices, metformin, and dietary supplements may prevent GDM, but the effect of intervention characteristics has not been identified. This review evaluated intervention characteristics to inform the implementation of GDM prevention interventions.

METHODS

Ovid, MEDLINE/PubMed, and EMBASE databases were searched. The Template for Intervention Description and Replication (TIDieR) framework was used to examine intervention characteristics (who, what, when, where, and how). Subgroup analysis was performed by intervention characteristics.

RESULTS

116 studies involving 40,940 participants are included. Group-based physical activity interventions (RR 0.66; 95% CI 0.46, 0.95) reduce the incidence of GDM compared with individual or mixed (individual and group) delivery format (subgroup p-value = 0.04). Physical activity interventions delivered at healthcare facilities reduce the risk of GDM (RR 0.59; 95% CI 0.49, 0.72) compared with home-based interventions (subgroup p-value = 0.03). No other intervention characteristics impact the effectiveness of all other interventions.

CONCLUSIONS

Dietary, physical activity, diet plus physical activity, metformin, and myoinositol interventions reduce the incidence of GDM compared with control interventions. Group and healthcare facility-based physical activity interventions show better effectiveness in preventing GDM than individual and community-based interventions. Other intervention characteristics (e.g. utilization of e-health) don't impact the effectiveness of lifestyle interventions, and thus, interventions may require consideration of the local context.

Can a brief peer-led group training intervention improve health literacy in persons living with HIV? Results from a randomized controlled trial

OBJECTIVE

The goal of this study was to determine if a 6-week, peer-led intervention improves health literacy and numeracy among people living with HIV (PLWH).

METHODS

We used a randomized controlled trial with repeated measurements, which included six, 90-minute, group-based training sessions. We recruited PLWH participants (n = 359) from safety-net practices in the New York City Metropolitan area and Rochester, NY. Participants were randomly assigned (1:1) to an intervention group (n = 180) or a control group (n = 179). Outcome measures were collected at baseline, eight weeks post-baseline, and at six months using the Brief Estimate of Health Knowledge and Action-HIV (BEHKA-HIV), the Electronic Health Literacy Scale (eHEALS), the Rapid Estimate of Adult Literacy (REALM), and the Newest Vital Sign (NVS).

RESULTS

The intervention group had statistically significant improvements in eHealth literacy and BEHKA-HIV compared to the control group. There were no statistically significant changes in general health literacy or numeracy in either group. The intervention had the greatest impact on participants with the lowest levels of eHealth literacy at baseline.

CONCLUSION

The intervention had a positive impact on participants' HIV health literacy and eHealth literacy.

PRACTICE IMPLICATIONS

Our findings have implications for broadening the function of peer-workers in the health care continuum.

The effects of a mindfulness-based lifestyle program for adults with Parkinson's disease: a mixed methods, wait list controlled randomised control study

BACKGROUND

Parkinson's disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.

METHODS

An exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012-2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18-75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.

RESULTS

Group 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = -0.59) and at 6-month post intervention (t-score = -1.42) as reported by the PDQ-39 SI. However this finding was not significant (p = 0.56 and 0.16 respectively). A small yet significant effect size (β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score -1.8, p = 0.04). Four secondary measures are reported.

CONCLUSIONS

Our findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson's disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820 , 17(th) April 2012.

Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes

OBJECTIVE

To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period.

DESIGN

The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence.

RESULTS

Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months.

CONCLUSIONS

Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.

Peer support within a health care context: a concept analysis

Peer support, and the integration of peer relationships in the provision of health care, is a concept of substantial significance to health scientists and practitioners today, as the focus shifts from the treatment of disease to health promotion. If the nursing profession is to effectively incorporate peer relationships into support-enhancing interventions as a means to improve quality care and health outcomes, it is essential that this growing concept be clearly explicated. This paper explores the concept of peer support through the application of Walker and Avant's (Strategies for Theory Construction in Nursing, 3rd Edition, Prentice-Hall, Toronto, 1995) concept analysis methodology. This analysis will provide the nursing profession with the conceptual basis to effectively develop, implement, evaluate, and compare peer support interventions while also serving as a guide for further conceptual and empirical research.

Predialysis education helps patients choose dialysis modality and increases disease-specific knowledge

The aims of this study were first, to evaluate the effects of a patient-education programme for a group of 28 uraemic patients (the Experimental (EG) group) with regard to their knowledge and perceived amount of information and to relate these effects to their sense of coherence and secondly, to study the patients' perception of their dialysis treatment. The results were compared with a comparison group (the Companion (CG) group, n = 28) which had received routine information only. The education programme seemed to have covered what the EG wanted to know. Significantly more patients in the EG group stated that they had acquired sufficient knowledge to enable them to participate in choosing dialysis modality compared with the CG group. The EG patients were significantly more informed in the post-educational evaluation compared with the pre-educational evaluation. In the EG, there was a significant relationship between the scores for knowledge and perceived amount of information. Men and younger patients perceived that they had received a greater amount of information than women and older patients. After having started dialysis treatment, there were no differences in the scores for knowledge and information between the EG and the CG. This indicates that other sources of knowledge and information were available to the CG patients. There was no significant correlation between the score of the Sense of Coherence (SOC) scale and the knowledge and information scores. Kidney transplantation, progression of renal failure, other patients' experiences of dialysis, dependence - independence, present and future wellbeing, how to cope with physical and psycho-social demands and continuity in their contacts with doctors and other health professionals were predominant concerns for the two groups of patients.

CONCLUSION

the predialysis group education programme enabled patients to choose dialysis modality to achieve an understanding of their illness and its treatment. It also provided the possibility of informal support by fellow patients and health professionals. The study emphasizes the special needs of elderly patients and we recommend that education programmes are tailored to their requirements.

A rural diabetes support group

Rural residents with diabetes often feel isolated from health professionals. Support groups provide a bridge between formal health care and the self-help that is practiced by clients with diabetes. Increased knowledge and social support can lead to increased glucose control in adults with diabetes. The purpose of this project was to address the social support and educational needs of rural residents with diabetes by implementing an adult diabetes support group. Future research on implementing support groups would guide advanced practice nurses and nurse educators in developing more appropriate support groups for clients.