Self-help and self-help groups for people with long-lasting health problems or mental health difficulties in a Nordic context: a review

Prospective analysis of the attendance behaviour of the participants of a facilitated support group for patients after allogeneic hematopoietic cell transplantation

PURPOSE

Support groups might help survivors of allogeneic hematopoietic cell transplantations (HCT) to cope with medical, psychological, and social challenges. The aim of this project was (1) to establish a facilitated post-HCT support group and (2) to assess the participation behaviour.

METHODS

From 11/2013 until 7/2017, all adult patients who had received a HCT at our centre were invited to participate in a professionally facilitated support group. The format of the group was unstructured without any rules regarding regular attendance. The attendance was prospectively minuted by the facilitator. Reasons for non-attendance were assessed by a survey.

RESULTS

During the observation period, 53 group meetings were scheduled. Nine meetings were cancelled because of low attendance. Altogether 23 different patients (F: n=10; M: n=13) and 10 spouses (F: n=9; M: n=1) participated. Median participation was 5 [range 2-11]. With respect to all HCT patients who had the theoretical opportunity to attend, the mean participation rate was 7%. Thirteen patients and four spouses attended more than one meeting. The median count of participations among those participants was 8 [2-32]. The median interval from the first until the last participation was 16 months. The main reason reported for non-participation was the effort to get to the venue of the support group.

CONCLUSIONS

To our knowledge, this is the first analysis on the attendance behaviour of the participants of a support group for HCT survivors. The results provide guidance for the organization of future support groups and indicate what participation rates can be expected and how they might be increased.

Psychological Well-being Structure of Indonesian Soldiers: Systematic Review

BACKGROUND. Work-related stress can increase maladaptive coping behavior, like smoking behavior, in Indonesian soldiers. Pressure to achieve maximum performance might affect psychological condition of soldiers at work place. Most research results discuss negative psychological well-being, while positive well-being of Indonesian soldiers is still rarely discussed. OBJECTIVE. to elaborate structure of psychological well-being of Indonesian soldiers regarding their coping ability during military duty. METHOD. Research method used in this research is systematic review. Sources of database are retrieved from Google Scholar, Medline, PubMeds, Wiley Library, ScienceDirect, and Emerald with limitation in articles published between 2010 and 2018. Inclusion criteria of scientific articles reviewed are articles about soldiers, who are active-duty and retired, which are written in English and Indonesian. RESULTS. In 11 articles regarding psychological well-being in Indonesian soldiers that can elaborate six structures: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. These six structures of psychological well-being can explain adaptive and maladaptive coping skills in Indonesian soldiers while they do military duty. CONCLUSION. Structure of positive psychological well-being based on evidence in Indonesian soldiers is critically needed during military duty. Improving adaptive coping skill in soldiers might be able to banish negative thoughts in order to maintain their mental health.    

An intervention of sustainable weight change: Influence of self-help group and expectations

Background

Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self‐help groups enable individuals to share expectations and experiences on an equal basis.

Objective

The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme.

Methods

Persons with a BMI >30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self‐help group was initiated. The participants were encouraged to express their expectations before each step in the study.

Results

Our findings showed that those who had joined a self‐help group had reduced their weight significantly (−6.0 kg) compared with those who had not (−1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (−6.1 kg) than those who expressed low expectations (−3.7 kg).

Patient or public contribution

Participants expressed their thoughts and views, which were considered and included in the programme.

Conclusions

Our findings indicate that the self‐help group can be an essential part of a weight reduction programme. The self‐help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.

Practicing in a person-centred environment - self-help groups in psycho-social rehabilitation

AIM

The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabilities. In this study, we explore person-centred support in which participants in self-help groups are undergoing rehabilitation to develop their knowledge, skills and confidence necessary to handle life's challenges.

METHOD

The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilitation clients aged between 20 and 60 years; eight were men and twenty-six were women.

RESULTS

Three main categories emerged as being important self-help processes that were likely to promote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives.

CONCLUSION

Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.IMPLICATIONS FOR REHABILITATIONSelf-help groups may support the process of rehabilitation.Participating in self-help groups provides an enabling context for individuals to address challenges and limitations.Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote adjustment, and facilitate the establishment of new skills.Participating in peer led self-help groups can assist with the transfer of learning to new environments, including development of potential work capacity.

The disciplining of self-help: Doing self-help the Norwegian way

We explore how Norwegian self-help groups are defined and managed to create a particular form of health system governmentality. Self-help groups are typically framed as therapeutic communities where participants define the agenda creating a space where open and equal interaction can produce individual learning and personal growth. In Norway, however, self-help groups are managed in a way that integrates them in to the health system but insulates them from clinical medicine; an approach that disciplines participants to act in a particular way in relation to the health system. We draw on the analysis of 1456 pages of public documents and websites from the National Nodal Point for Self-Help (NPSH), the organisation that manages self-help groups, and central government including individual testimonies from participants published between 2006 and 2014. We argue, drawing on Foucault, that self-help premised on lay-leadership and self-determination is at odds with the centrally defined regulation apparent in the model adopted in Norway and an example of disciplining that reinforces health system governmentality and serves the interests of the medical profession and the state. Further we propose that this illustrates the contestation between the pastoral power of medics, the National Nodal Point for Self-Help and the Ministry of Health. Our analysis of Norwegian self-help as a mechanism to create a particular form of health system governmentality helps explain the expansion of self-help and self-management within developed health systems and provides an explanation for why self-help within health systems, is typically situated adjacent to, rather than integrated into, clinical medicine.

Are there also negative effects of social support? A qualitative study of patients with inflammatory bowel disease

OBJECTIVE

Social support is considered an important resource in coping with chronic conditions. By conducting a series of interviews with people who suffer from inflammatory bowel disease (IBD), we received the impression that social support in face-to-face or online communication could also be a source of stress and strain. The aim of our study was to better understand and describe possible negative effects of social support.

DESIGN

This is a secondary analysis of narrative interviews. The interviewees were selected using a maximum-variation sampling approach. Grounded theory and the 'OSOP' (one sheet of paper) method were applied to categorise those parts of the interviews that touched on the negative effects of social support.

SETTING

The open-end interview collection took place throughout Germany from September 2011 to June 2012. Most of the participants were interviewed in their homes, some in the Department of General Practice in Göttingen.

PARTICIPANTS

42 patients with IBD.

RESULTS

Two interrelated categories emerged: (1) unwanted confrontation and (2) undesirable reactions. The interviewees perceived social support as negative, especially if they felt overwhelmed and/or if they had not asked for it. Consequently, some of our interview partners developed strategies to prevent coming into social contact with others or stopped talking entirely about their disease.

CONCLUSION

While social support is usually conceptualised and perceived as a positive resource in chronic disease, it sometimes turns into a negative experience and may end in social isolation and deteriorate health. This process also happens in online support groups and increases anxiety when exchanging with other people on the internet. Before motivating ill people to seek contact with others, they should know about the negative effects of social support.

Music as a way out: How musicking helped a collaborative rock band of ex-inmates

This article explores how the members of Me and THE BAND, a rock band consisting of three ex-inmates and a music therapist, experienced playing together, how it helps them, and whether and how this can be related to the concept of self-help. Focus group interviews were conducted to explore the members’ experiences, analysis was grounded in a hermeneutic philosophical understanding and the theoretical framework is based in a community music therapy approach. The study indicates how musicking helped the band members of Me and THE BAND’its to create agency, structure, meaning and community. The band appeared to function through collaborative processes, and the music therapists as facilitator need to prepare the qualities of equality, mutuality and participation. As a conclusion, the members of Me and THE BAND’its do not identify as being a self-help group, although they clearly report that musicking helps them. The crux of this paradox is that it is important for the group members to identify as a band, but they still include self-help concepts and traditions. They maintain their own uniqueness and independence, while making musicking a possible way out of criminality.

Relationship between patient group participation and self-care agency among patients with a history of cardiac surgery: A cross-sectional study

BACKGROUND

Little is known regarding the influence of participation in patient groups on self-care in patients with a cardiac surgery history.

OBJECTIVES

To investigate the relationship between patient group participation and self-care among patients with a cardiac surgery history.

METHODS

Participants were 956 patients with cardiac surgery history from a patient group. Information on self-care agency, patient group participation, and health status was collected through a self-administered questionnaire.

RESULTS

There were 566 valid responses. Participants were mostly male (76.4%), and the mean age was 70.6 years. A high social support level from a patient group was associated with each subscale of the self-care agency as follows: self-care operations (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.12), adjusting one's condition (OR 1.04, 95% CI 1.01-1.07), and attention to self-care (OR 1.05, 95% CI 1.02-1.07).

CONCLUSIONS

Patient group participation may promote self-care performance in patients with a cardiac surgery history.

Coping with mental health issues: subjective experiences of self-help and helpful contextual factors at the start of mental health treatment

Background: Self-help strategies and various contextual factors support recovery. However, more in-depth knowledge is needed about how self-help strategies and supportive environments facilitate the recovery process.

Aims: To explore what individuals who have recently been referred to a specialist Community Mental Health Center experience as helpful and what they do to help themselves.

Method: Ten service users participated in in-depth interviews within a collaborative-reflexive framework. A hermeneutic-phenomenological approach was used.

Results: Participants described a variety of helpful strategies and environmental supports. Four relevant main themes were identified: helpful activities, helpful people and places, self-instruction and learning about mental problems and medication and self-medication.

Conclusions: The process of recovery is initiated before people become users of mental health services. This study confirms that recovery takes place within the person’s daily life context and involves the interplay of contextual factors, such as family, friends, good places, work and other meaningful activities. The coping strategies reported may represent an important focus for attention and clinical intervention.

Self-determination theory: a framework for clubhouse psychosocial rehabilitation research

The Clubhouse model is a widely used approach to psychosocial rehabilitation that has been a pioneer in supporting recovery-oriented programmes. Little consideration has been given however, to the theories that guide research of the recovery practices used by Clubhouses. In this paper, we provide a description of self-determination theory, including its philosophical background followed by explanation of its relevance to health care and Clubhouse contexts. We argue that self-determination theory provides a robust social constructionist theoretical framework that is well-suited to informing research related to psychosocial rehabilitation, recovery-oriented practices and the Clubhouse model.

Implementing 'self-help friendliness' in German hospitals: a longitudinal study

In Germany, the term 'self-help friendliness' (SHF) describes a strategy to institutionalize co-operation of healthcare institutions with mutual aid or self-help groups of chronically ill patients. After a short explanation of the SHF concept and its development, we will present findings from a longitudinal study on the implementation of SHF in three German hospitals. Specifically, we wanted to know (i) to what degree SHF had been put into practice after the initial development phase in the pilot hospitals, (ii) whether it was possible to maintain the level of implementation of SHF in the course of at least 1 year and (iii) which opinions exist about the inclusion of SHF criteria in quality management systems. With only minor restrictions, the findings provide support for the usefulness, practicability, sustainability and transferability of SHF. Limitations of our empirical study are the small number of hospitals, the above average motivation of their staff, the small response rate in the staff-survey and the inability to get enough data from members of self-help groups. The research instrument for measuring SHF was adequate and fulfils the most important scientific quality criteria in a German context. We conclude that the implementation of SHF leads to more patient-centredness in healthcare institutions and thus improves satisfaction, self-management, coping and health literacy of patients. SHF is considered as an adequate approach for reorienting healthcare institutions in the sense of the Ottawa Charta, and particularly suitable for health promoting hospitals.

The structure of social exchange in self-help support groups: development of a measure

Self-help support groups are indigenous community resources designed to help people manage a variety of personal challenges, from alcohol abuse to xeroderma pigmentosum. The social exchanges that occur during group meetings are central to understanding how people benefit from participation. This paper examines the different types of social exchange behaviors that occur during meetings, using two studies to develop empirically distinct scales that reliably measure theoretically important types of exchange. Resource theory informed the initial measurement development efforts. Exploratory factor analyses from the first study led to revisions in the factor structure of the social exchange scales. The revised measure captured the exchange of emotional support, experiential information, humor, unwanted behaviors, and exchanges outside meetings. Confirmatory factor analyses from a follow-up study with a different sample of self-help support groups provided good model fit, suggesting the revised structure accurately represented the data. Further, the scales demonstrated good convergent and discriminant validity with related constructs. Future research can use the scales to identify aspects of social exchange that are most important in improving health outcomes among self-help support group participants. Groups can use the scales in practice to celebrate strengths and address weaknesses in their social exchange dynamics.