Mindfulness-based practices with family carers of adults with learning disability and behaviour that challenges in the UK: Participatory health research

Transitions-Related Support for Ageing Family Carers of Older People With Intellectual Disabilities Who Convey Behaviours That Challenge Others: A Systematic Rapid Scoping Review

BACKGROUND

There are increasing numbers of ageing family carers of older (40+) adults with intellectual disabilities who convey behaviours that challenge others in the UK. It is important to understand the needs and experiences of these carers as they support their older family member to transition to different care contexts.

METHOD

A rapid scoping review of published and unpublished literature, using systematic methods of data searching, extraction and analysis.

RESULTS

Exhaustion, reluctance to burden others, distrust of alternative living arrangements and deep interpersonal ties with their family member with intellectual disabilities mean ageing carers can avoid planning ahead. There is a lack of appropriate information, support and professional advice available. Developing trust in services is critical, as is a 'whole family' approach to planning.

CONCLUSIONS

More research is vital to understand the support ageing carers receive to make choices, and how it meets their needs.

Effectiveness of Online Programmes for Family Carers of People with Intellectual Disabilities: Systematic Review of the International Evidence Base

This systematic literature review examines the evidence base on the effectiveness of online programmes on the mental health and well-being of family carers of people with intellectual disabilities. Databases (ERIC, Medline, PsycINFO and CINAHL) were searched for intervention studies that considered online interventions for family carers of people with intellectual disabilities. Data were extracted using standardised data extraction tools. Bias was assessed using the Cochrane risk of bias tool for randomised trials (RoB 2). Screening, extraction and assessment of bias were completed independently by two members of the research team. Given the low number of included studies and different outcomes assessed within them, it was not possible to conduct a meta-analysis; therefore, data are presented narratively. Two studies met the criteria to be included in the review. Both studies utilised a feasibility randomised controlled trial methodology. One study found a significant decrease in parental stress, while the other found a significant increase in psychological well-being. Caution must be taken in drawing firm conclusions, given the small sample sizes and low retention rates in both studies. Online programmes seem to offer potential benefits to family carers of people with intellectual disabilities. However, further investigation is needed to examine these programmes, adopting a collaborative approach with family carers.

Qualitative Protocol of Chinese Parents and Siblings Experiences of Managing Challenging Behaviours of Adult Persons with Intellectual Disability in Hong Kong and Northern China

BACKGROUND

While the literature has highlighted the immense challenges in caring for family members, it is still unclear what the needs of family carers of persons with intellectual disability and challenging behaviours are and what has worked for them. This study aims to examine 60 parents' and siblings' experiences in managing the challenging behaviours of their adult family member with intellectual disability whilst living at home.

METHODS

A qualitative grounded theory approach using semi-structured interviews will be adopted. Purposive sampling will be used to recruit family carers who live with adult persons with intellectual disability and use one community service in Hong Kong. Three special schools for persons with intellectual disability from northern China will be approached.

RESULTS

This study will aim to provide an in-depth understanding of the experiences of family carers and compare the different circumstances they face when managing the challenging behaviours of their adult relatives with intellectual disability in their family home.

CONCLUSIONS

Although this study targets adults with intellectual disability, the findings will provide a point of reference for adolescents and younger persons who exhibit demanding and challenging behaviours and live with their families. Recommendations can guide the development of appropriate strategies to strengthen services for family carers.

Randomised controlled feasibility study protocol of the Carers-ID online intervention to support the mental health of family carers of people with intellectual disabilities

BACKGROUND

Family carers play a crucial role in supporting the health and well-being of people with intellectual disabilities. Given their role and responsibilities, many family carers experience significant and ongoing stress and mental health difficulties. Programmes and interventions which provide training and support to family carers have been shown to have a positive impact on levels of stress and quality of life. However, these are often face to face which can create barriers to full participation. Online interventions have been shown to offer flexibility in delivery compared with traditional face-to-face approaches. The primary objective of this study is to determine the feasibility of delivering the Carers-ID online intervention, while the secondary outcome is improved mental health in family carers of people with intellectual disabilities.

METHODS

Family carers (n = 120) will be randomised to receive the intervention (n = 60) or assigned to a wait-list control (n = 60) group. The intervention ( www.Carers-ID.com ) consists of 14 modules which cover topics including the following: promoting resilience, providing peer support, reducing anxiety, managing stress, accessing local supports and managing family conflict and information for siblings who are carers. The intervention has been co-produced with voluntary sector organisations and family carers and tested for acceptability. Primary outcomes for this study include acceptability and feasibility of the outcome measures, recruitment, participation and retention rates and effect sizes. Secondary outcomes will be completed at three time points (baseline, following intervention completion and 3 months after completion). These include the following: the Depression, Anxiety and Stress Scale, the Warwick-Edinburgh Mental Well-being Scale, the Resilience Scale and the Social Connectedness Scale Revised. Participants (n = 12) who have taken part in the intervention arm of the research will be invited to participate in semi-structured interviews as part of the process evaluation.

DISCUSSION

The Carers-ID intervention provides an online resource for family carers to support their mental health and well-being and promote their resilience. It represents an affordable and accessible means of delivering such support. Testing the feasibility of the intervention and related trial procedures is required to determine whether a full-scale randomised controlled trial to evaluate the intervention's effectiveness is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov : NCT05737823.

Participatory research with carers: A systematic review and narrative synthesis

INTRODUCTION

As patient and public involvement (PPI) in research has become increasingly common, research-based recommendations on its principles and impacts have been established. The specifics of conducting PPI are likely to differ when involving different groups. Family/informal carers for those with health conditions or disabilities have a lot to contribute to research, but instances of their involvement have yet to be reviewed.

OBJECTIVE

To systematically review and synthesize studies where family/informal carers have been involved in the research process, to develop an understanding of the benefits, barriers and facilitating factors.

METHODS

A search of five electronic databases was conducted using a combination of terms relating to carers, involvement and research. A grey literature search, expert consultation and hand-searching were also used. Following screening, data extraction and quality assessment, a narrative synthesis incorporating thematic analysis was conducted.

FINDINGS

A total of 55 studies met the inclusion criteria, with diverse design and participatory approaches. Four themes were identified, relating to the outcomes, challenges, and practicalities of involving carers: (re) building relationships with carers; carers as equals not afterthoughts; carers have unique experiences; carers create change. Full involvement throughout the research was not always possible, due to barriers from the research world and responsibilities of the caring role. The literature demonstrated ways for carers to contribute in ways that suited them, maximizing their impact, while attending to relationships and power imbalances.

CONCLUSION

By summarizing the reported instances of carer involvement in research, this review brings together different examples of how successful research partnerships can be built with carers, despite various challenges. Carers are a heterogeneous group, and participatory approaches should be tailored to specific situations. Wider understanding of the challenges of conducting empowering research with carers, and the resources required to address these, are needed.

PATIENT AND PUBLIC INVOLVEMENT

The initial findings and themes were presented to a group of carers who had been involved in research and whose reflections informed the final synthesis.

The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration

Informal caregivers are the primary source of support for adults with chronic conditions and disabilities. Empirical research highlights chronic stress and other risks of adverse outcomes of caregiving. Acceptance and Commitment Therapy (ACT) is an emerging evidenced-based practice that shows promise in improving an array of outcomes, theoretically by increasing psychological flexibility as the primary process of change. Research has begun to evaluate ACT among informal caregivers of adult populations, and a systematic review is now needed to summarise this evidence base. Electronic searches from five databases, including PubMed, PsycInfo, Embase, CINAHL, and Cochrane Library, yielded an initial 7896 hits, which after screening for inclusion criteria, resulted in 21 clinical trials. Studies were coded to synthesise the feasibility, effectiveness, and quality of evidence. Findings show that ACT was reported to be largely feasible and acceptable. However, the efficacy of ACT was mixed, with a more consistent pattern for informal caregivers of people with dementia. Several methodological quality issues limited the findings. However, theoretical synthesis and preliminary evidence support the promising effect of ACT in subgroups of informal caregivers. Research on the process of change, as well as larger-scale, methodologically rigorous trials, are needed to consolidate these findings.

Roles, outcomes, and enablers within research partnerships: A rapid review of the literature on patient and public involvement and engagement in health research

BACKGROUND

Recent studies mention a need to investigate partnership roles and dynamics within patient and public involvement and engagement (PPIE) in health research, and how impact and outcomes are achieved. Many labels exist to describe involvement processes, but it is unknown whether the label has implications on partnerships and outcomes. This rapid review investigates how roles between patients, relatives and researchers in a broad variety of PPIE activities in health research are described in peer reviewed papers and explores what enables these partnerships.

METHODS

Rapid review of articles published between 2012 and February 2022 describing, evaluating, or reflecting on experiences of PPIE in health research. All research disciplines and research areas were eligible. Four databases (Medline, Embase, PsychInfo and CINAHL) were searched between November 2021 and February 2022. We followed PRISMA guidelines and extracted descriptive factors: year, origin, research area and discipline, study focus, framework used and co-authorship. On a selection of articles, we performed a narrative analysis of partnership roles using Smits et al.'s. Involvement Matrix. Lastly, we performed a meta synthesis of reported enablers and outcomes of the partnerships. Patients and Relatives (PRs) have been involved in the whole rapid review process and are co-authors of this article.

RESULTS

Seventy articles from various research disciplines and areas were included. Forty articles were selected for a narrative analysis of the role description of PRs and researchers, and a meta synthesis of enablers and outcomes. Most articles described researchers as decision-makers throughout the research cycle. PRs most often were partners when they were included as co-authors; they were mostly partners in the design, analysis, write-up, and dissemination stages. Enablers of partnerships included: PR training, personality of PRs and communication skills, trust, remuneration and time.

CONCLUSIONS

Researchers' decision-making roles gives them control of where and when to include PRs in their projects. Co-authorship is a way of acknowledging patients' contributions which may lead to legitimation of their knowledge and the partnership. Authors describe common enablers, which can help future partnership formation.

[Involving the seldom heard in participatory health research: challenges and strategies]

Hintergrund

Die partizipative Gesundheitsforschung gewinnt im Bereich Public Health zunehmend Anerkennung. Dabei werden Menschen, deren Leben oder Arbeit im Mittelpunkt der jeweiligen Forschung stehen, in die Projekte eingebunden. Die Integration des Wissens und der Perspektiven von Menschen, die bisher nur selten gehört wurden, eröffnet dabei die Möglichkeit, gesundheitliche Chancengleichheit in den jeweiligen Lebenswelten zu stärken. Partizipative Gesundheitsforschung (PGF) wird häufig mit Gemeinschaften (Communitys) durchgeführt. Jedoch stellt es eine besondere Herausforderung dar, Personen zu erreichen, die kaum oder keinen Zugang zu Netzwerken oder Angeboten haben. Deren Lebensbedingungen und -qualität müssen in der Forschung berücksichtigt werden. Im vorliegenden narrativen Übersichtsartikel wird diese Problematik beleuchtet und Lösungsansätze für die Forschungspraxis werden entwickelt.

Methodik

Es wurde auf eine umfangreiche Literaturrecherche der Katholischen Hochschule für Sozialwesen Berlin nach deutschsprachigen Artikeln zu partizipativer Forschung zurückgegriffen; ergänzend wurde internationale Literatur gesichtet. Darüber hinaus wurden Prozesse von 3 partizipativen Forschungsprojekten ausgewertet.

Ergebnisse und Diskussion

Die dargestellten Zugangswege zu „selten Gehörten“ beziehen sich auf die Reduzierung systemischer Barrieren und die Verbesserung lokaler Voraussetzungen. Beispielsweise wird vor Beginn der Forschung im engeren Sinn eine Vorbereitungsphase empfohlen. Diese kann für den Beziehungs- und Kooperationsaufbau genutzt werden, um die Distanz der Menschen aus der Lebenswelt gegenüber Forschung zu überbrücken.

Promoting Resilience Among College Student Veterans Through an Acceptance-and-Commitment-Therapy App: An Intervention Refinement Study

Military veterans' stigmatized views on mental disorders and traditional mental health care considerably reduce veterans' access to mental health services. The present study aimed to refine a previously developed non-stigmatizing smartphone-app intervention based on the principles of acceptance and commitment therapy for college student veterans with posttraumatic stress disorder (PTSD). To this end, we tested the acceptability of the developed prototype using a mixed-method study design. A total of nine student veterans participated in the study by using the app intervention and completing pre-post study measures and a post-intervention qualitative interview. The results showed that the intervention was highly acceptable. The results of the qualitative data analysis highlighted relevant themes related to strategies for improving the content, delivery, and structure of the intervention. The results also showed that, despite a decrease in the participants' adherence as the intervention progressed, there was a consistent improvement in the participants' resilience, PTSD, and rumination. Based on the results, the intervention was revised for prospective feasibility and efficacy testing. Our results highlight the need to use a collaborative approach in the early stage of the development of self-management PTSD interventions.

Mindfulness-based practices with family carers of adults with learning disability and behaviour that challenges in the UK: Participatory health research

BACKGROUND

Family carers of adults with learning disability and behaviours that challenge lead complex and stressful lives. Their caring role can leave them isolated and unsupported. In the UK, effective services designed to build resilience for people in long-term caring roles are lacking. There are none (to our knowledge) designed using a participatory health research (PHR) approach with family carers and professionals.

OBJECTIVE

With positive behaviour support (PBS) and mindfulness and acceptance and commitment therapy (ACT) as key elements, a PHR approach was used to understand the basis for a successful course that supported the capabilities and resilience of family members in long-term caring roles.

DESIGN

The research was guided by the principles of PHR with participation as the defining principle throughout. Central to the research were reflexive conversations (communicative spaces) where diverse knowledges were shared and critiqued.

FINDINGS

Mindfulness/ACT can change long-standing response behaviours and build personal resilience and improve mental health. Elements enabling positive change included a facilitation approach for collaborative reflexivity and the complementary, interactive approach to collaborative enquiry for learning and decision making afforded by PHR.

DISCUSSION

The use of PHR accessed knowledges that would have been lost to more traditional, professional-expert driven processes and facilitated change in constructs for action for both professionals and family carers. Findings challenge service providers to consider how experiential knowledge has agency in professional practice and service design. Reflection on the PHR process across the FaBPos project led to a re-consideration of quality issues in relation to PHR and participation.