Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery]

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

Efficacy of 12-step mutual-help groups other than Alcoholics Anonymous: a systematic review and meta-analysis

This paper offers a systematic review of quantitative and qualitative studies on the main twelve-step mutual-help (TSMH) groups (excluding Alcoholics Anonymous) and four meta-analyses exploring the correlation between (i) duration or involvement in TSMH groups and; (ii) severity of symptoms or quality of life. Systematic review was conducted following PRISMA guidelines. Searches of databases (MEDLINE, PsychInfo), a register (ClinicalTrials) and citations were conducted, from inception through November 01 2022. Fifty five articles were included (24 quantitative, 27 qualitative, 4 mixed-methods), corresponding to 47 distinctive studies. 68% of these studies were conducted in North America, 17% in Middle East, 11% in the European Union and 4% in Australia. The most studied TSMH group were Gamblers Anonymous (28% of the 47 studies), Narcotics Anonymous (26%), Double Trouble in Recovery (15%), Overeaters Anonymous (19%) and TSMH groups for compulsive sexual behaviors (11%). The four meta-analyses pooled data from 9 studies. Pooled mean age ranged from 36.5 to 40.5. 80-81% of participants were male. TSMH attendance and involvement were negatively correlated with severity of symptoms (high and medium levels of evidence) and positively correlated with quality of life (low levels of evidence). Twenty-one qualitative papers reported factors influencing recovery: Social (n = 15), emotional (n = 9), spiritual (n = 8), self-identification or psychological (n = 6) factors. Review provides characteristics of TSMH groups others than Alcoholics Anonymous, with implications for both research and healthcare practice. The perspective to implement TSMH groups targeting ontological addiction, at the root of all addiction, is discussed.Protocol registration: Prospero registration number: CRD42022342605.

Testing theory of change assumptions of health behavior change interventions: A blended approach exploring local contexts

This paper used a blended approach that involves multiple techniques to, first, test a set of assumptions around a health behavior change communication intervention theory of change (ToC) and, second, surface some unidentified assumptions involving the local context. The intervention was integrated with women's self-help groups (SHGs) in Uttar Pradesh, India. The key assumption tested in this paper was the linkage between SHG membership, program exposure, and maternal, newborn, and child health practices. Learnings were substantiated through empirical investigations, including structural equation modeling and mediation analysis, as well as 'co-learning' workshops within the community. The workshops aimed to capture and interpret the heterogeneity of local contexts through deep dialogs with the community and program implementers at various levels. Statistical analyses indicated a significant association between the amount of women's program exposure and their health practices. SHG membership was shown to affect maternal health practices; however, it did not have a direct effect on neonatal or child health practices. The 'co-learning' workshops revealed crucial aspects, such as prevailing socio-cultural norms, which prevented pregnant or recently delivered women from participating in SHG meetings. This paper encourages evaluators to work with the community to interpret and co-construct meaning in unpacking the contextual forces that seldom appear in the program ToC.

Effects of a structured exercise program on physical performance and function, quality of life and work ability of physically active breast cancer survivors : A retrospective data analysis

Background

Purpose of this retrospective data analysis was to depict the effects of a structured off-season conditioning program with breast cancer survivors competing in dragon boat paddling.

Methods

In this study 10 breast cancer survivors (mean age 52.0 ± 5.4 years) who had finished the primary cancer treatment and who were paddlers of the Vienna Pink Dragon self-help group underwent a structured 10-week exercise program as part of their routine supportive treatment. Upper extremity strength, endurance capacity, shoulder flexibility, quality of life and work ability were assessed at baseline and after completion of the exercise program.

Results

Out of 10 patients 8 completed more than 80% of the exercise sessions. A multivariate analysis of variance (MANOVA) of the pooled exercise effects showed a very large effect size (Η² = 0.982); however, the change from baseline to follow-up was non-significant (p = 0.363). In the European Organisation for Research and Treatment of Cancer Quality of Life of Cancer Patients Questionnaire (EORTC QLQ-C30) the exercise program led to a significant improvement of body image (p = 0.02) and less arm symptoms in the affected arm (p = 0.04).

Conclusion

A structured and well-planned exercise intervention program can have a large effect on the physical performance of pretrained breast cancer survivors. Moreover, it can increase the body image and decrease the arm symptoms in this population.

AS Patient: How to Cope with the Lifelong and Changing Disease Challenges

Being seriously affected by a rheumatic disease at the age of 16 seems a catastrophe that somehow must be learned to manage. And the challenges that come up when the illness worsens in the life course have to be coped with. So, this article tries to outline some of the points I have experienced and find relevant for patients with ankylosing spondylitis.

Educational Program in Complementary and Alternative Medicine for Cancer Self-Help Groups

BACKGROUND

The use of complementary and alternative medicine (CAM) among cancer patients is estimated to be approximately 40%. In self-help groups there is a need for information about CAM. This pilot study aimed to develop and evaluate a CAM educational program for cancer self-help groups.

METHODS

The educational program was developed in cooperation with health professionals and representatives of cancer self-help organizations. Participants were trained to increase their knowledge about CAM, to reflect their user behavior, and to use evidence-based information. Self-help group leaders were educated along the curriculum and motivated to carry out the course in their groups. Using questionnaires it was evaluated in terms of acceptance, feasibility, and satisfaction by participants.

RESULTS

A total of 171 self-help group leaders were educated. In a pilot run 7 implemented the course in their groups, with a total of 70 participants. Most of them (n = 60, 85.7%) appreciated its contents and material and would recommend it. Overall acceptance and satisfaction were high.

CONCLUSIONS

The educational program was implemented successfully in a small sample and showed positive results for acceptance and feasibility. In addition to consultation by experts, it can be a good option to inform cancer survivors about CAM.

[Participation in self-help groups: impact on self-management and knowledge]

BACKGROUND

Self-help groups (SHGs) are an inherent part of patient involvement and play an important role in the healthcare system. Until now, however, there has been a lack of systematic investigations and quantitative data about the individual impact of self-help for patients and relatives.

OBJECTIVES

This study presents the results of a comparison between members of SHGs and non-members. Thereby, the effects of self-help shall be described in terms of empowerment and self-management. The study is part of the project "Health-related Collective Self-Help in Germany" (Gesundheitsbezogene Selbsthilfe in Deutschland-SHILD) funded by the Federal Ministry of Health.

MATERIALS AND METHODS

The study was conducted with patients from five therapeutic areas (diabetes mellitus type 2, prostate cancer, multiple sclerosis, tinnitus, relatives of dementia patients). Participants administered a multidimensional questionnaire (paper-and-pencil or online). Of the 2870 participants in this analysis, 49% were active members of SHGs.

RESULTS

Statistical analysis showed some significant, but small differences between the two groups in five out of seven scales of the Health Education Impact Questionnaire (heiQ) in favour of the SHG members. Furthermore, SHG members performed better in specific knowledge tests. Members see the importance of their group especially in social inclusion, psychosocial relief, coping with the disease and new insights in dealing with the disease.

CONCLUSIONS

With respect to the study design we cannot rule out that differences might be based on personal characteristics influencing the decision to participate in a SHG or not. But as the results are controlled for confounders, the hypothesis that SHG participation has a positive impact on the outcomes rather than vice versa seems supported.

Forgiveness and Blame Among Suicide Survivors: A Qualitative Analysis on Reports of 4-Year Self-Help-Group Meetings

This article presents the qualitative analysis of reports obtained through participant observations collected over a 4-year period in a series of suicide survivor self-help group meetings. It analysed how grievers' healing was managed by their own support. The longitudinal study was focused on self/other blame and forgiveness. Results show how self-blame was continuously present along all the period and how it increased when new participants entered the group. This finding indicates that self-blame characterizes especially the beginning of the participation, and that any new entrance rekindles the problem. However, no participant had ever definitively demonstrated self-forgiveness, while a general forgiveness appeared when self-blame stopped. It is also suggested how to facilitate the elaboration of self-blame and forgiveness.

Associations of collective self-help activity, health literacy and quality of life in patients with tinnitus

OBJECTIVE

About 800 of the 13,000 members of the German Tinnitus Association (DTL) are active in self-help groups (SHGs). This study analyzes whether SHG-participation is associated with tinnitus-related Health Literacy (HLit) and Quality of Life (QoL).

METHODS

In a cross-sectional study 1108 tinnitus patients in- and outside of SHGs administered a questionnaire containing tinnitus-related burden, QoL, tinnitus knowledge, self-management, assessment of SHGs, and socio-demographics. Participants were divided into four subgroups: (1) active SHG-members (19.6%), (2) former SHG-members (10.6%), (3) DTL-members, but not in SHG (57.9%), (4) neither DTL- nor SHG-members (11.9%).

RESULTS

Participant were 59.7% male and 61.3 years on average. SHG-attendees are on average 5 years older than non-attendees, and have a lower education, while there are no differences in gender-distribution. Regression analyses show significant associations between SHG-participation and tinnitus knowledge, coping and self-esteem. QoL, however, is not associated with SHG-participation. SHG-members report considerable further benefits from SHG-membership.

CONCLUSIONS

Despite the limitations through the cross-sectional design, it seems more likely that tinnitus-related HLit and other benefits are a result of SHG-participation than vice versa.

PRACTICE IMPLICATIONS

Health care providers should inform their patients about SHGs and encourage them to consider a SHG as a possible option for their self-management.

[Mutual self-help and patient participiation: current developments in Austria]

In Austria, health-related self-help groups and organisations have been growing continuously over the past decades. They are increasingly demanding to be accepted as partners of the professional health system and to be involved in health policy decisions.Practice shows that "self-help friendly hospitals" are widespread in Austria. Although some self-help groups/organisations have gained access to health policy committees, research indicates that they find the system unresponsive to their interests. Public support for self-help organisations is particularly lacking at the national level as are conducive conditions for collective patient participation.A recent initiative by the Social Health Insurance Funds, the Ministry of Health and the National Health Promotion Agency seeks to tackle these problems. A plan for public support of self-help groups/organisations, primarily those operating at the national level, has been developed in collaboration with representatives of self-help organisations. It provides financial support for the activities of indication-specific self-help organisations at regional and national levels aiming at strengthening their autonomy. In addition, two institutions were founded: an umbrella organisation of indication-specific self-help organisations and a professional national support agency. The implementation of the new concept offers opportunities for closer cooperation between system stakeholders and self-help groups/organisations, and a new stimulus for patient participation is expected from these two new institutions.

Assessing the feasibility of integration of self-care for filarial lymphoedema into existing community leprosy self-help groups in Nepal

BACKGROUND

Lymphatic filariasis (LF) and leprosy are disabling infectious diseases endemic in Nepal. LF infection can lead to lymphoedema and hydrocoele, while secondary effects of leprosy infection include impairments to hands, eyes and feet. The disabling effects of both conditions can be managed through self-care and the supportive effects of self-help groups (SHGs). A network of SHGs exists for people affected by leprosy in four districts in Nepal's Central Development Region, however no such service exists for people affected by LF. The aim of this study was to determine the feasibility of integrating LF affected people into existing leprosy SHGs in this area.

METHODS

A survey was conducted using a semi-structured questionnaire to elicit information on: (i) participant characteristics, clinical manifestation and disease burden; (ii) participants' knowledge of management of their condition and access to services; and (iii) participants' knowledge and perceptions of the alternate condition (LF affected participants' knowledge of leprosy and vice versa) and attitudes towards integration.

RESULTS

A total of 52 LF affected and 53 leprosy affected participants were interviewed from 14 SHGs. On average, leprosy affected participants were shown to have 1.8 times greater knowledge of self-care techniques, and practiced 2.5 times more frequently than LF affected participants. Only a quarter of LF affected participants had accessed a health service for their condition, compared with 94.3% of leprosy affected people accessing a service (including SHGs), at least once a week. High levels of stigma were perceived by both groups towards the alternate condition, however, the majority of LF (79%) and leprosy (94.3%) affected participants stated that they would consider attending an integrated SHG.

CONCLUSIONS

LF affected participants need to increase their knowledge of self-care and access to health services. Despite stigma being a potential barrier, attitudes towards integration were positive, suggesting that the SHGs may be a good platform for LF affected people to start self-care in this area.

TRIAL REGISTRATION

This is not a registered trial.

Care-seeking behaviors for maternal and newborn illnesses among self-help group households in Uttar Pradesh, India

BACKGROUND

India has made large strides in reducing maternal mortality ratio and neonatal mortality rate, yet care-seeking behavior for appropriate care is still a challenge. We conducted a qualitative study to understand the process of recognition and care-seeking for maternal and newborn illnesses in rural India where a health intervention through women's self-help groups (SHG) to improve maternal and newborn health behaviors is implemented by a non-governmental organization, the Rajiv Gandhi Mahila Vikas Pariyojana. The study aimed to understand the process of recognition and care-seeking for maternal and newborn illnesses from SHG and non-SHG households in the intervention area.

METHODS

Thirty-two illness narratives, 16 of maternal deaths and illness and 16 of newborn illnesses and deaths, were conducted. Women, their family members, and other caretakers who were present during the event of illness or death were included in the interviews. About 14 key informants, mainly frontline health workers (FLWs), were also interviewed. The interviews were conducted by two Population Council staff using a pre-tested guideline in Hindi.

RESULTS

Our findings suggest that perceptions of causes of illness as "supernatural" or "medical" and the timing of onset of illness influence the pathway of care-seeking. Deep-rooted cultural beliefs and rituals guided care-seeking behavior and restricted new mothers and newborns' mobility for care-seeking. Though families described experience of postpartum hemorrhage as severe, they often considered it as "normal." When the onset of illness was during pregnancy, care was sought from health facilities. As the step of care for maternal illness, SHG households went to government facilities, and non-SHG households took home-based care. Home-based care was the first step of care for newborn illnesses for both SHG and non-SHG households; however, SHG households were prompt in seeking care outside of home, and non-SHG households delayed seeking care until symptoms were perceived to be severe.

CONCLUSION

Our findings indicate that care-seeking behavior for maternal and newborn morbidities could be improved by interventions through social platforms such as SHGs.

What helps in self-help? A qualitative exploration of interactions within a borderline personality disorder self-help group

Background: Self-help groups can have a large impact on individuals well-being and could reduce costs for healthcare services. Previous research supports the effectiveness of self-help groups, but explanations for this are lacking. Identifying the active ingredients which encourage positive change could inform effectiveness of these groups producing the best outcomes for members.Aim: This research investigated how members and facilitators of a borderline personality disorder self-help group (BPD SHG)interacted and made sense of their experiences in group meetings, to determine what aspects of interaction were helpful.Method: Naturalistic data was collected from 10 participants via audio recording and analysed using interpretative phenomenological analysis.Results: Three emergent themes are discussed: humour, praise and experiential knowledge.Conclusion: These are suggested to be active ingredients which are critical for the effectiveness of this BPD SHG, with particular focus on the facilitator's contribution.

Face-to-face vs. online peer support groups for prostate cancer: A cross-sectional comparison study

BACKGROUND

As social media are evolving rapidly online support groups (OSG) are becoming increasingly important for patients. Therefore, the aim of our study was to compare the users of traditional face-to-face support groups and OSG.

PATIENTS AND METHODS

We performed a cross-sectional comparison study of all regional face-to-face support groups and the largest OSG in Germany. By applying validated instruments, the survey covered sociodemographic and disease-related information, decision-making habits, psychological aspects, and quality of life.

RESULTS

We analyzed the complete data of 955 patients visiting face-to-face support groups and 686 patients using OSG. Patients using OSG were 6 years younger (65.3 vs. 71.5 years; p < 0.001), had higher education levels (47 vs. 21%; p < 0.001), and had higher income. Patients using OSG reported a higher share of metastatic disease (17 vs. 12%; p < 0.001). Patients using OSG reported greater distress. There were no significant differences in anxiety, depression, and global quality of life. In the face-to-face support groups, patient ratings were better for exchanging information, gaining recognition, and caring for others. Patients using OSG demanded a more active role in the treatment decision-making process (58 vs. 33%; p < 0.001) and changed their initial treatment decision more frequently (29 vs. 25%; p < 0.001).

CONCLUSIONS

Both modalities of peer support received very positive ratings by their users and have significant impact on treatment decision-making.

IMPLICATIONS FOR CANCER SURVIVORS

Older patients might benefit more from the continuous social support in face-to-face support groups. OSG offer low-threshold advice for acute problems to younger and better educated patients with high distress.

TRIAL REGISTRATION

www.germanctr.de , number DRKS00005086.

A qualitative exploration of a family self-help mental health program in El Salvador

Background

There is a significant gap in our knowledge regarding community-based self-help groups and their benefits for persons living with mental conditions and their family caregivers in low and middle income countries. This study describes a such a program in El Salvador and explores participants’ perceptions of program effectiveness and benefits.

Case description

The Family Education, Support and Empowerment Program is a multi-component program in the capital that is facilitated by nonprofit professionals but carried out primarily by volunteers. A focus group methodology to build evaluation and research capacity in the organization was used. The study consisted of a questionnaire completed by participants individually, followed by two focus group sessions with the same ten people.

Results

The study found perceptions of multiple benefits across social, functional, and economic dimensions and a variety of achievements at organizational and national levels.

Discussion

This study identified a family self-help program in El Salvador as a potentially highly beneficial program for its participants. This appears to be the first study to explore benefits across micro, mezzo and macro social levels and to include discussion of more diverse potential benefits such as individual and organizational social capital, leadership, and advocacy. These factors should be explored in future quantitative studies to help determine the relative importance and usefulness of such programs in meeting World Health Organization goals for access to mental health treatment and quality community-based services.

Electronic supplementary material

The online version of this article (doi:10.1186/s13033-016-0058-6) contains supplementary material, which is available to authorized users.

Effect of combining a health program with a microfinance-based self-help group on health behaviors and outcomes

Objectives

Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program.

Design

A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka.

Methods

A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions.

Results

Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21–21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02–5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76–3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42–1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported.

Conclusion

Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women.

•

Combining a health program with SHGs is associated with an improvement in key health behaviours in the study population.

•

However, the program led to no significant improvement in diarrhoea among children, and no effect on spending on treatment.

•

The structure of SHGs and duration of association played a role in promoting trust between members and the host organization.

•

Working with SHGs provides a basis for addressing the gap in health attainment for women and their children.

The experience of cancer survivors in community-based psycho-social support activities in Shanghai, China: a qualitative study

PURPOSE

Cancer survivors are often embroiled in various physical and psycho-social issues as a consequence of cancer diagnosis and treatment. Psycho-social support activities in the phase of rehabilitation were provided to enhance their quality of life. This study seeks to explore and understand their experience of engagement in Shanghai Cancer Rehabilitation Club (SCRC).

METHODS

Sixty-eight participants attended eight semi-structured focus group interviews. Data were transcribed verbatim, and thematic analysis framework was adopted for data analysis.

RESULTS

The participants reported benefits such as psychological support, informational provision and tangible support in the activities. Public services were reported to have restored their dignity and enabled them to rediscover their own meaning of life. Participants also pointed out challenges on functioning and opportunity for development of SCRC.

CONCLUSIONS

The psycho-social support activities of SCRC had influenced cancer survivor's life. Public health resources and supportive policies should be in place to support local self-help cancer rehabilitation groups.

The Effect of Self-help Tai Chi Over 16 Weeks in Community Program for Older Adults Korean American Women

PURPOSE

The purpose of this study was to examine the effects of a 16-week Self-help Tai Chi for Arthritis (SHTC) combined with health education for Korean American older women.

METHODS

This research was a designed quasi-experimental pre-posttest. Forty one women aged 55~79 were recruited 20 in SHTC group 21 in control group and, but twelve in SHTC group and thirteen in control group were left after 16 weeks. SHTC group was educated for 1 hour health education and 1hour TCA, once a week during 16 wks. Measurements for comparison were taken three times, at baseline, 8 wks and 16wks. The effect were evaluated with self-efficacy, shoulder flexibility, back flexibility, both hand grip strength and standing balance with closed eyes.

RESULTS

All variables except for left hand grip strength at baseline had significant homogeneity between both groups. After 16 weeks intervention, there was a significant interaction effect of time and group on right hand grip strength by repeated measure of ANOVA (F=3.398, p=.044). No significant interaction effects were found on self-efficacy, shoulder and back flexibility, left hand grip strength and standing balance with closed eyes.

CONCLUSION

I can suggest this self-help Tai Chi program may be effective partially, but further research is needed to establish the best times and periods to intervene for a better effect.