The Not-So-Good Cancer: Psychosocial Challenges for YA Thyroid Cancer Patients and Survivors and the Creation of a YA Thyroid Cancer Support Group

Thyroid cancer (TC) has been deemed "the good cancer" owing to its slow growth, availability of targeted treatment, and low mortality rates. Inconsistent with this name, survivors of TC have similar or poorer quality of life than individuals with other types of cancer. Furthermore, young adults (YAs; age 18-35) with TC are at risk for additional psychosocial challenges. Support groups have been identified as a mechanism for improving quality of life among other YAs with cancer. A YA TC group is warranted given the unique experiences of TC survivors. Discussion points from a newly developed YA TC support group are reviewed.

The Development of a Bereavement Support Group Curriculum for Bereaved Parents of Young Adult Children: Bridging the Gap

Purpose: There is limited research addressing the bereavement needs of parents whose young adult (YA) children have died from cancer. Research within oncology about the impact of child loss has tended to focus on parents of pediatric aged children. We adapted a general bereavement support group curriculum used with adults to address the unique needs of bereaved parents of YAs. Methods: Using a quality improvement framework, 25 bereaved parents of YA children participated in one of three 6-session bereavement support group programs during 2020 and 2021. Due to the coronavirus disease 2019 (COVID-19) pandemic, the programs were offered virtually. The participants provided feedback and completed an evaluation. Results: Nineteen mothers and six fathers participated with 20 (80%) completing the evaluation. The median time since the death of their child was 6 months. The participants evaluated the program highly, reporting that they felt less isolated (4.25/5 on a 5-point Likert scale); that their concerns were similar to others (4.45/5); and the discussion topics were relevant (4.20/5). Other topics that were identified included the impact on the family of losing a YA child, and how other relationships change. Forty-five percent of participants expressed a preference for a hybrid delivery model, incorporating in-person and virtual sessions. The majority also wished to continue meeting monthly, given they had little contact with other bereaved parents of YAs. Conclusion: The general bereavement support group curriculum was readily adapted for use with bereaved parents of YA children who died from cancer. A hybrid delivery model was the preferred method for future groups.

How Do Care Partners of People with Rare Dementia Use Language in Online Peer Support Groups? A Quantitative Text Analysis Study

We used quantitative text analysis to examine conversations in a series of online support groups attended by care partners of people living with rare dementias (PLWRD). We used transcripts of 14 sessions (>100,000 words) to explore patterns of communication in trained facilitators' (n = 2) and participants' (n = 11) speech and to investigate the impact of session agenda on language use. We investigated the features of their communication via Poisson regression and a clustering algorithm. We also compared their speech with a natural speech corpus. We found that differences to natural speech emerged, notably in emotional tone (d = -3.2, p < 0.001) and cognitive processes (d = 2.8, p < 0.001). We observed further differences between facilitators and participants and between sessions based on agenda. The clustering algorithm categorised participants' contributions into three groups: sharing experience, self-reflection, and group processes. We discuss the findings in the context of Social Comparison Theory. We argue that dedicated online spaces have a positive impact on care partners in combatting isolation and stress via affiliation with peers. We then discuss the linguistic mechanisms by which social support was experienced in the group. The present paper has implications for any services seeking insight into how peer support is designed, delivered, and experienced by participants.

Evaluation of the Impact of a Midwife-Led Breastfeeding Group Intervention on Prevention of Postpartum Depression: A Multicentre Randomised Clinical Trial

Postpartum depression is a significant health issue affecting both mothers and newborns during the postpartum period. Group support interventions during this period have proven effective in helping women cope with depression and improving breastfeeding rates. This study aimed to assess the effectiveness of a midwife-led breastfeeding support group intervention on breastfeeding rates, postpartum depression and general self-efficacy. This was a multicentric cluster randomised controlled trial with control and intervention groups and was not blinded. It was conducted in Andalusia (southern Spain) from October 2021 to May 2023. A total of 382 women participated in the study. The results showed a significant difference in exclusive breastfeeding rates at 4 months postpartum between the groups (control 50% vs. intervention 69.9%; p < 0.001). Additionally, there was a lower mean score on the Edinburgh Postnatal Depression Scale in the intervention group (12.49 ± 3.6 vs. 13.39 ± 4.0; p = 0.044). Similarly, higher scores of general self-efficacy were observed among breastfeeding women at 2 and 4 months postpartum (77.73 ± 14.81; p = 0.002 and 76.46 ± 15.26; p < 0.001, respectively). In conclusion, midwife-led breastfeeding support groups enhanced self-efficacy, prolonged breastfeeding and reduced postpartum depression 4 months after giving birth.

Virtual parent-led peer support groups for parents of children with eating disorders: A mixed methods feasibility study

OBJECTIVE

To examine the feasibility of a virtual parent-led peer support group (vPLPSG) intervention for parents of children with eating disorders (EDs).

METHODS

Forty-four parents were invited to attend 2-h-long vPLPSG sessions every other week for 6 months. A convergent mixed methods design was used to integrate quantitative survey data (collected at three timepoints and analyzed using repeated measures ANOVA) and qualitative interview data (collected at 6 months and analyzed using content analysis) to assess intervention feasibility. Feasibility was comprised of acceptability (e.g., recruitment and retention rates, desire to continue attending the groups) and preliminary effectiveness (e.g., change in parents' self-reported burden).

RESULTS

The recruitment rate (67%), retention rate (77%), and attendance rate (60%) demonstrated adequate acceptability. All parents expressed their recommendation of this group to other parents, and most wanted to continue attending vPLPSG sessions. Participants qualitatively reported less isolation and burden as well as improvements in skills and confidence to manage their child's symptoms. These preliminary effectiveness findings were corroborated by quantitative data, with participants reporting a significant decrease in burden [mean difference (MD) = 6.61; p < .004], increase in confidence (MD = 11.17; p < .001), and decrease in unmet needs (MD = 5.03; p < .001) from baseline to 6-months.

DISCUSSION

The vPLPSG intervention demonstrated feasibility with respect to acceptability and improvements in preliminary parental outcomes. Future research should evaluate the effectiveness of this intervention using a larger, more diverse sample.

PUBLIC SIGNIFICANCE

Dedicated efforts to support caregivers, such as through virtual parent-led peer support groups, have the potential to increase confidence and decrease burden for parents managing their child's eating disorder.

Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study

BACKGROUND

The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion.

OBJECTIVE

This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022).

METHODS

Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), and participants' quality of life (abbreviated World Health Organization Quality of Life assessment). A 9-answer option questionnaire and open-ended questions also assessed the group's perceived positive and negative outcomes.

RESULTS

The total sample comprised 32 participants. Most (23/32, 72%) were doctoral students. Credibility and expectancy scores were high. Participants' satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants' experiences (T2: 29/32, 91%; T3: 27/32, 84%) and felt encouraged to take better care of themselves (T2: 22/32, 69%; T3: 24/32, 75%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87).

CONCLUSIONS

Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants' quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances.

Head and Neck Cancer Online Support Groups: Disparities in Participation and Impact on Patients

Objective

To characterize the users of the head and neck cancer (HNC) online support group (OSG) and describe the perceived benefits of membership.

Study Design

Cross-sectional.

Setting

Online.

Methods

An administered survey with questions asking about demographics, cancer history, treatment choices, and feelings about OSGs was posted on the 5 largest HNC OSGs on Facebook.

Results

A total of 97 participants completed the survey. Mean age was 57.8 years old (standard deviation = 10.7 years). Most participants were female (50.5%) and Caucasian (92.8%). This cohort was well educated with 65.5% holding at least a college degree. Annual income was high with 41.8% reporting annual income of $100,000 or greater. The most common treatment modality was radiation (88.7%). The most common surgery was neck dissection (46.4%). Most participants preferred OSGs (70.8%) over other support group types. OSGs were heavily utilized with our cohort reporting using the OSG at least several times a week (80.0%). The top reasons for joining the OSG were sharing one's experience of HNC (76.3%) and gaining support from others with HNC (85.6%). OSGs were ranked as the #3 source of medical information for HNC behind otolaryngologists and oncologists. Membership in a HNC OSG had a minimal impact on decision-making.

Conclusion

HNC OSGs appear to provide a beneficial community for HNC patients. Otolaryngologists should consider incorporating HNC OSG as a possible supplemental resource for their HNC patients.

An Exploratory Analysis of the Chronic Rhinosinusitis Online Support Community

Objective

To characterize the users of the largest chronic rhinosinusitis (CRS) online support communities (OSCs), describe the perceived benefits of OSCs for their users, and understand how patient medical decision making is affected by membership in OSCs.

Study Design

Cross-sectional online survey.

Setting

Online.

Methods

A cross-sectional online survey was adapted from the existing literature on patient support groups and modified for CRS patients. The survey was posted on multiple Facebook/Reddit groups aimed at providing support toward patients with CRS. Survey data was collected over 3 months and analyzed thereafter.

Results

There were 127 total participants. The majority were female (65.35%), white (76.98%), and the median age was 38 years. Just under half of patients had nasal polyps (48.67%) and 54.54% had undergone surgery. Many participants (69.42%) reported engaging in the OSC at least multiple times per month. The most common reason for joining an OSC was to learn tips on how to manage CRS (89.7%) and the most achieved goal from membership was hearing from others undergoing a similar experience (79.5%). Involvement in an OSC impacted knowledge of CRS in 87.41% of participants. Most users (81.1%) would recommend membership in an OSC and 54.33% reported the OSC influenced their medical decision-making.

Conclusion

A majority of patients with CRS who frequently engage in an OSC for CRS have a positive experience. OSCs are a resource that CRS patients utilize to manage their disease.

The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial

BACKGROUND

While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored.

OBJECTIVE

In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress.

METHODS

We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period.

RESULTS

After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=-0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period.

CONCLUSIONS

Engagement in a mobile app-based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481.

Creating a Comprehensive Pandemic Response to Decrease Hospitalist Burnout During COVID-19: Intervention vs Control Results in 2 Comparable Hospitals (HOSP-CPR)

BACKGROUND

Physician burnout increased during the COVID-19 pandemic.

OBJECTIVE

To evaluate the effectiveness of a multimodal workplace intervention designed to reduce hospitalist burnout.

DESIGN

Participants and setting: Our intervention group was composed of internal medicine hospitalists at Providence Portland Medical Center (64 providers including 58 physicians and 6 nurse practitioners). Our control was composed of internal medicine hospitalists at Providence St Vincent's Hospital (59 physicians and 6 nurse practitioners).

MEASUREMENTS

Two surveys were given during, before, and after a 12-month intervention period (October 2020 and again in October 2021). Surveys included demographics, job satisfaction, the Maslach Burnout Inventory, the Pandemic Experiences Survey, and 2 questions about leaving the job.

INTERVENTIONS

Three hospitalists designated as wellness warriors created weekly COVID group meetings, providing up-to-date information about COVID-19 infection rates, treatments, and work-flow changes. Discussions included coping and vaccine hesitancy, difficult case debriefs, and intensive care unit updates. Individual coaching was also offered. Meeting minutes were taken and sessions were recorded for asynchronous access.

RESULTS

No site differences in burnout or job satisfaction were evident pre-intervention. Post-intervention, the intervention group reported 32% burnout while controls reported 56% (p = .024). Forty-eight percent of the intervention group reported high wellness support vs. 0% of the controls (< .001). Intervention participants attributed 44% of wellness support to Providence alone, vs. controls at 12% (< .001). Regressions controlling sex, work hours, experience, race, and children in the home showed the intervention's positive effects on burnout and job satisfaction remained significant (all p < .02).

LIMITATIONS

For privacy reasons, all survey responses were anonymous, meaning that individual pre-post changes could not be tracked.

CONCLUSION

We believe the intervention resulted in substantial burnout prevention and is feasible for adoption in most hospitals and clinics.

A Thematic Analysis of Online Uveitis Support Groups

PURPOSE

To report the availability and activity of online uveitis support groups.

METHODS

An online search was conducted for support groups for uveitis. Member count and activity were recorded. Posts and comments were graded along five themes: emotional or personal story sharing, information seeking, offer of outside information, emotional support, and expressions of gratitude.

RESULTS

An online search resulted in 32 support groups for uveitis. Across all groups, there was a median membership of 725 (IQR 1410.5). Of the 32 groups, five were active and accessible at the time of study. In these five groups, 337 posts and 1406 comments were made within the past year. The most prevalent theme in posts consisted of information seeking (84%) while the most prevalent theme in comments consisted of emotion or personal story sharing (65%).

CONCLUSIONS

Online uveitis support groups provide a unique space for emotional support, information sharing, and community building.Abbreviations: OIUF - Ocular Inflammation and Uveitis Foundation.

Effect of a novel pilot support group on distress and quality of life in breast cancer patients in Nigeria

OBJECTIVE

To assess the effect of a new breast cancer support group (BCSG) on breast cancer patients' self-reported distress and quality of life.

METHODS

A single arm pre-post trial providing an eight session healthcare provider led BCSG. Primary outcome variables were distress and quality of life assessed using the National Comprehensive Cancer Network Distress Thermometer (DT) and The Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACT-B+4), respectively. Topics in each session addressed a wide range of issues some of which were pre-selected by the patients themselves.

DATA ANALYSIS

Paired sample t-test was used for data analysis on International Business Machine Statistical Package for the Social Sciences 21.

RESULTS

The participants (N = 18) had a mean age of 51. Most had secondary school level education (54%), were traders (59%) and had stage 3 or 4 disease (67%). A larger proportion (78% or n = 14) of the patients lived in rural areas, while 4 (22%) of the patients lived in Ibadan. Out of the 8 sessions, 12 (67%) of the participants attended 1-3 sessions while 6 (33%) attended 4-8 sessions. There were, significant improvements in emotional wellbeing (t = -4.253; p < 0.05) and functional wellbeing (t = -2.191; p < 0.05) on the FACT-B+4. There was a significant reduction in the DT score (t = 2.345; p < 0.05) but the number of items on the problem list were not significantly reduced (t = 1.191; p > 0.05). Majority (75%) of the patients rated the support group activities as satisfactory.

CONCLUSION

These data show that the support group can benefit breast cancer patients in terms of reduced distress levels along with satisfaction and improvement in the functional and emotional wellbeing indices of quality of life.

Knowledge of patients with sarcoma about their illness-a cross-sectional questionnaire-based study (KNOWSARC)

Objective

To explore the knowledge of Indian patients with sarcoma about their illness in the sarcoma medical oncology clinic of a tertiary care centre.

Method

This prospective cross-sectional questionnaire-based study was done on patients attending the adult sarcoma clinic at the All India Institute of Medical Sciences, New Delhi. Patients aged between 18 and 60 years who gave consent and could understand Hindi or English were recruited for the study. A questionnaire (bilingual - English/Hindi) was given to the patients in the language they understood. The questionnaire captured the knowledge of patients about their illness (cancer/sarcoma), sub-type of sarcoma, the occurrence of the disease (common or rare), origin (bone or soft tissue), metastatic or non-metastatic and the understanding of the possibility of recurrence/progression.

Result

There were 102 patients in the study with a median age of 31.5 years. About 62% of patients had soft tissue sarcomas, and the rest had bone sarcomas. The most common sarcoma in the studied population was Ewing's sarcoma (23.5%). Metastatic disease was present in 48 (47.1%) of the total patients studied. About 87.2% of patients were aware that they had some form of cancer, and only 62 (69.9%) patients said that they had sarcoma. Only 55 of the 102 patients (56%) knew that the illness was rare. About 70.6% of patients knew about their disease's actual stage. More patients with metastatic disease understood the stage correctly (35 of 54 patients) as compared to patients with the non-metastatic disease (37 of 48 patients) (77% versus 64.8%, p = 0.001). About 77% of patients reported the site of origin of cancer correctly. The patients who had a higher level of education and belonged to a higher socioeconomic status had significantly better knowledge regarding the diagnosis, stage, rarity and prognosis of the disease.

Conclusion

Our patients have poor knowledge about different types of sarcomas, and very few patients know that sarcoma is a rare malignancy. The most crucial factor that influenced the knowledge was the level of education. Through this study, we could identify the sub-group wherein the knowledge gap was significant. Thus, active patient education programmes can help these patients to identify their illness and henceforth therapeutically manage it more wisely.

'It's made me feel less isolated because there are other people who are experiencing the same or very similar to you': Men's experiences of using mental health support groups

This article explores men's experiences of using peer support groups for coping with mental distress. Support groups are organised groups in which people come together to mutually support each other with a shared health concern. There has been increasing research on men's mental health help seeking, but men's use of support groups for mental health difficulties, and the ways support groups could benefit men, is not well understood. Drawing upon 19 interviews from a South Wales, UK qualitative study which explored men's mental health help seeking, coping and management, this article explores the perceived benefits of support groups for men experiencing emotional difficulties. Findings highlight how men who attended groups valued the sense of shared understanding of experiences and the mutual respect that group settings presented them with. Support groups provided a safe space with opportunities to reconstruct traditional masculine norms through reciprocating unique and tailored mental health support to others and developing a certain role within that group. This gave men a sense of purpose which further facilitated mental health management. Findings also indicated the social benefits that support groups can have to men who may have limited social networks or be experiencing isolation. This article adds to the growing literature that focuses on men's mental health experiences and illustrates the benefits of support groups for men in distress. The author suggests that primary services need to be aware of how support groups can positively support men and promote them as an opportunity for connection and unique support.

Virtual Intervention for Caregivers of Persons With Lewy Body Dementia: Pilot Quasi-Experimental Single-Arm Study

BACKGROUND

Compared to other types of dementia, family caregivers of people with Lewy body dementia (LBD) report higher stress levels and more severe depressive symptoms. Although several digital support interventions for caregivers of persons with dementia exist, few target LBD specifically or leverage a fully remote and asynchronous approach suitable for pandemic circumstances.

OBJECTIVE

We performed a pilot evaluation of a digital intervention designed to help caregivers of people with LBD address challenges they have experienced, with the end goal of reducing psychological distress in this population.

METHODS

We recruited 15 family caregivers of people with LBD to participate in the quasi-experimental, single-arm, mixed methods study titled Virtual Online Communities for Aging Life Experience-Lewy Body Dementia (VOCALE-LBD). The study offers an 8-week web-based intervention that uses a digital discussion platform and involves moderation, peer-to-peer support, didactic training, and problem-solving skill enactment.

RESULTS

Participants' baseline characteristics were the following: mean age 66 (SD 8) years; 14 of 15 (93%) of them were female; all (15/15, 100%) were White; and 8 (53%) of them had at least a postgraduate degree. Throughout the intervention, participants engaged in weekly web-based discussions, generating a total of 434 posts (average 4 posts per week). Attrition was 20% (3/15). Upon study exit, participants showed the following average improvements: 3.0 (SD 6.0) in depression, 8.3 (SD 16.7) in burden, 2.9 (SD 6.8) in stress, and 0.3 (SD 0.8) in loneliness. When looking at the proportion of participants with clinically significant improvement versus those with a worsening of ≥0.5 SD for each outcome, we observed net improvements of 50% (6/12), 33% (4/12), 25% (3/12), and 25% (3/12) in depression, loneliness, burden, and stress, respectively. In terms of the benefits of participation, participants reported that participation helped them "a great deal" to (1) improve their understanding of LBD (9/12, 75%), (2) gain confidence in dealing with difficult behaviors of the care recipient (6/12, 50%), and (3) improve in one's abilities to provide care to the care recipient (4/12, 33%).

CONCLUSIONS

The study generated promising feasibility and preliminary efficacy data for a low-cost, web-based intervention designed for caregivers of persons with LBD. Though the study was not powered for significance, we observed nominal average and net improvements in important psychological outcomes. Moreover, many caregivers reported that study participation helped them better understand the disease, feel more confident in dealing with difficult behaviors of the care recipient, and improve their ability to care for the care recipient. If validated in future studies, the intervention could be an accessible, on-demand resource for caregivers, enabling them to engage in moderated remote discussions with peers at their own convenience in terms of location, time of the day, and frequency.

Integrating Natural Language Processing and Interpretive Thematic Analyses to Gain Human-Centered Design Insights on HIV Mobile Health: Proof-of-Concept Analysis

BACKGROUND

HIV mobile health (mHealth) interventions often incorporate interactive peer-to-peer features. The user-generated content (UGC) created by these features can offer valuable design insights by revealing what topics and life events are most salient for participants, which can serve as targets for subsequent interventions. However, unstructured, textual UGC can be difficult to analyze. Interpretive thematic analyses can preserve rich narratives and latent themes but are labor-intensive and therefore scale poorly. Natural language processing (NLP) methods scale more readily but often produce only coarse descriptive results. Recent calls to advance the field have emphasized the untapped potential of combined NLP and qualitative analyses toward advancing user attunement in next-generation mHealth.

OBJECTIVE

In this proof-of-concept analysis, we gain human-centered design insights by applying hybrid consecutive NLP-qualitative methods to UGC from an HIV mHealth forum.

METHODS

UGC was extracted from Thrive With Me, a web app intervention for men living with HIV that includes an unstructured peer-to-peer support forum. In Python, topics were modeled by latent Dirichlet allocation. Rule-based sentiment analysis scored interactions by emotional valence. Using a novel ranking standard, the experientially richest and most emotionally polarized segments of UGC were condensed and then analyzed thematically in Dedoose. Design insights were then distilled from these themes.

RESULTS

The refined topic model detected K=3 topics: A: disease coping; B: social adversities; C: salutations and check-ins. Strong intratopic themes included HIV medication adherence, survivorship, and relationship challenges. Negative UGC often involved strong negative reactions to external media events. Positive UGC often focused on gratitude for survival, well-being, and fellow users' support.

CONCLUSIONS

With routinization, hybrid NLP-qualitative methods may be viable to rapidly characterize UGC in mHealth environments. Design principles point toward opportunities to align mHealth intervention features with the organically occurring uses captured in these analyses, for example, by foregrounding inspiring personal narratives and expressions of gratitude, or de-emphasizing anger-inducing media.

The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation

Background

People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic.

Objective

We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups.

Methods

We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed.

Results

The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions.

Conclusions

The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35376

Survivors' experiences of informal social support in coping and recovering after the 2017 Manchester Arena bombing

BACKGROUND

Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.

AIMS

We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?

METHOD

Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.

RESULTS

Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.

CONCLUSIONS

We recommend that people who respond to survivors' psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.

Convenient Access to Expert-Reviewed Health Information via an Alexa Voice Assistant Skill for Patients With Multiple Myeloma: Development Study

Background

Patients with multiple myeloma (MM) have high information needs due to the complexity of the disease and variety of treatments. Digital voice assistants provide support in daily life and can be a convenient tool that even older patients can use to access health information. Voice assistants may therefore be useful in providing digital health services to meet the information needs of patients with MM.

Objective

We aim to describe and report on the development, content, and functionality of the first Amazon Alexa voice assistant skill for patients with MM in Germany with the goal of empowering and educating patients. Further, we share data on skill usage and first learnings.

Methods

In a cocreation workshop with MM patient organizations and MM medical experts in Germany, Takeda Oncology discussed the development and content of the Alexa skill Multiple Myeloma. Patient information on MM disease, diagnostics, and therapy was presented in a question-and-answer format, reviewed by experts, and programmed into the skill. Additionally, a search function for finding patient support groups within a perimeter of 200 km around the users and a myeloma quiz functionality with multiple-choice questions were integrated into the skill. Aggregated retrospective data on the total number of skill installations and skill usage were retrieved from an Amazon Alexa developer account, and a web-based patient survey was conducted on the Takeda Oncology website.

Results

The Alexa skill Multiple Myeloma was launched in September 2019. It was available free of charge on the German Amazon Alexa skill store between September 2019 and March 2022 and could be used with devices featuring the Amazon Alexa voice assistant. Since the launch in September 2019 and up to July 2021, a total of 141 users have installed the skill. Between July 2020 and July 2021, a total of 189 skill sessions with 797 utterances were analyzed. The most popular inquiries were searches for patient support groups near the users (58/797, 7.3%), followed by inquiries about information on MM disease (53/797, 6.6%) and the quiz (43/797, 5.4%). The web-based survey on voice assistant usage and the feedback on the Alexa skill Multiple Myeloma were collected from 24 participants and showed that 46% (11/24) of participants would recommend the Alexa skill. Nonusers of voice assistants (11/24, 46%) stated that data protection concerns (7/11, 64%) and a lack of need (6/11, 55%) were the most important factors of not using voice assistants.

Conclusions

The Alexa skill Multiple Myeloma offers patient-friendly and expert-reviewed answers and explanations for medical terms related to MM disease, diagnostics, and therapy, as well as connections to patient support groups and a quiz functionality. In the future, the skill can be extended with new content and functionalities, such as medication adherence support.

Increasing support group attendance for metabolic and bariatric surgery patients with online groups

Support group attendance for patients undergoing metabolic and bariatric surgery has been shown to improve outcomes. Finding meaningful ways to engage as many patients as possible with these group sessions is important. Attendance records of 120 in-person and 48 virtual support groups that took place over 6-years were reviewed and compared from a metabolic and bariatric surgery (MBS) program in the USA. No significant difference in attendance for in-person groups or the first year of virtual support groups was found. The second consecutive year of virtual support groups were found to have a significant increase in patient attendance when compared to in-person groups and also the first year of virtual groups. Support groups for MBS patients are valuable experiences. Offering these virtually can help increase the number of patients that attend groups after the first year.

Implementing a telehealth-delivered psychoeducational support group for care partners of individuals with primary progressive aphasia

Background

Primary progressive aphasia (PPA) is a language-prominent dementia that fundamentally impacts the lives of not only the person with the diagnosis, but also their family members. While assuming a caregiving role, care partners are vulnerable to negative health and psychosocial consequences of their own. Support groups are one way to meet the needs of care partners, providing opportunities for individuals with common experiences to socialize, obtain knowledge about disorders, and learn coping strategies. Given that PPA is rare and that in-person support groups are sparse in the United States, there is a need for alternative meeting modalities, to overcome the limitations imposed by relative scarcity of potential participants, lack of appropriately-trained clinical professionals, and the logistical demands faced by overburdened care providers. Telehealth-based support groups provide care partners with opportunities to connect virtually with other care partners; however, research regarding their feasibility and benefit is limited.

Aims

This pilot study investigated whether a telehealth-based support group for care partners of persons with PPA is feasible and yields benefits in psychosocial functioning.

Methods & Procedures

Ten care partners of persons with PPA (7 females; 3 males) participated in a group intervention comprising psychoeducation about relevant topics, followed by group discussion. Meetings were held twice monthly for four months via teleconference. All participants completed pre- and post-intervention measures to examine support group satisfaction as well as psychosocial functioning, including quality of life, coping, mood, and caregiving perception.

Outcomes & Results

Consistent group member participation across study phases supports the feasibility of this intervention model. Quantitative results from paired-samples permutation tests indicate no significant changes from pre- to post-intervention on psychometrically validated psychosocial measures. Qualitatively, results from an in-house Likert-type survey indicate positive outcomes in quality of life, social support, caregiving skills, and psychoeducation. Relatedly, post-intervention themes derived from a thematic analysis of written survey responses included: Enhancing knowledge about PPA, feeling connected and mutually supported, and desire for more time together.

Conclusions

Consistent with existing literature evaluating virtually-delivered care partner support groups in dementia and other acquired medical conditions, findings from this study support the feasibility and benefit of telehealth-based support groups for care partners of persons with PPA.

Comparing the effect of education based on PRECEDE - PROCEED model in person-centered and supportive group methods on women's psychological well-being in the menopausal period

BACKGROUND

Positive psychology introduce mental health as a positive psychological functioning and represent it as well-being psychology. From this point of view, psychological health is more supposed to be known as having positive characteristics such as self-esteem, positive social relationships, and satisfaction. This study was conducted to compare the effect of education in two methods of person-centered and supportive group based on the PRECEDE-PROCEED model on women's psychological well-being during menopause.

MATERIALS AND METHODS

The present study was a clinical trial. One hundred and ten menopausal women have been placed in two groups (tests and control). The training program was designed according to the PRECEDE-PROCEED model. The educational intervention was implemented for two groups (person-centered and the supportive group) and the control group did not receive any training. Data analysis was used by descriptive statistics and in the case of normal distribution of alternative tests such as Kruskal-Wallis test, Man-Whitney test, Wilcoxon, spearman correlation, Spearman correlation was used.

RESULTS

Results of variance analysis showed that awareness, attitude, self-efficacy, enabling factors, reinforcement, support, behavioral environment, six psychological well-being factors were significantly different from the individual group and control group. Furthermore, the overall score of the psychological well-being was significantly higher than the control group.

CONCLUSIONS

As a result of the design and deployment of health care monitoring system, building and reform of community beliefs toward women's status in decision making and their role in menopause, the design and development of support group meetings in women's health care system and enhancing women's access to specialist and heterogeneous health services tailored to the needs of the menopause.

Lessons Learned From VHA's Rapid Implementation of Virtual Whole Health Peer-Led Groups During the COVID-19 Pandemic: Staff Perspectives

BACKGROUND

Committed to implementing a person-centered, holistic (Whole Health) system of care, the Veterans Health Administration (VHA) developed a peer-led, group-based, multi-session "Taking Charge of My Life and Health" (TCMLH) program wherein Veterans reflect on values, set health and well-being-related goals, and provide mutual support. Prior work has demonstrated the positive impact of these groups. After face-to-face TCMLH groups were disrupted by the COVID-19 pandemic, VHA facilities rapidly implemented virtual (video-based) TCMLH groups.

OBJECTIVE

We sought to understand staff perspectives on the feasibility, challenges, and advantages of conducting TCMLH groups virtually.

METHODS

We completed semi-structured telephone interviews with 35 staff members involved in the implementation of virtual TCMLH groups across 12 VHA facilities and conducted rapid qualitative analysis of the interview transcripts.

RESULTS

Holding TCMLH groups virtually was viewed as feasible. Factors that promoted the implementation included use of standardized technology platforms amenable to delivery of group-based curriculum, availability of technical support, and adjustments in facilitator delivery style. The key drawbacks of the virtual format included difficulty maintaining engagement and barriers to relationship-building among participants. The perceived advantages of the virtual format included the positive influence of being in the home environment on Veterans' reflection, motivation, and self-disclosure, the greater convenience and accessibility of the virtual format, and the virtual group's role as an antidote to isolation during the COVID-19 pandemic.

CONCLUSION

Faced with the disruption caused by the COVID-19 pandemic, VHA pivoted by rapidly implementing virtual TCMLH groups. Staff members involved in implementation noted that delivering TCMLH virtually was feasible and highlighted both challenges and advantages of the virtual format. A virtual group-based program in which participants set and pursue personally meaningful goals related to health and well-being in a supportive environment of their peers is a promising innovation that can be replicated in other health systems.

Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study

Background

Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management.

Objective

The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations.

Methods

This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed.

Results

Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs.

Conclusions

Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958

Facebook Support Groups for Pediatric Rare Diseases: Cross-Sectional Study to Investigate Opportunities, Limitations, and Privacy Concerns

BACKGROUND

Because of the nature of rare diseases with affected individuals being widely geographically dispersed, finding an in-person/offline support group itself can be a challenge. Affected individuals therefore turn to social networking platforms such as Facebook for online support groups.

OBJECTIVE

We aim to put into perspective the opportunities Facebook offers as a tool for pediatric rare disease support groups by investigating its use, advantages, and limitations including privacy concerns. We analyze group accessibility and usage, advantages specific to rare diseases, perceived privacy, and views on using Facebook for communication between health professionals and parents, pharmaceutical companies, and study recruitment.

METHODS

We contacted 12 Facebook support groups for 12 respective rare diseases with pediatric onset and invited group members to participate in a cross-sectional online survey.

RESULTS

Of 231 respondents, 87.0% (n=201) of respondents were female, 12.6% (n=29) were male, and 0.4% reported another sex (n=1). Respondents' mean age was 41.56 years (SD 9.375); 91.3% (n=211) of respondents were parents (183 mothers, 27 fathers, 1 other sex); 59.7% (n=138) reported a self-initiated search for the Facebook group, 24.2% (n=56) received recommendations from their health professionals, and 12.6% (n=29) recommendations from someone else affected by the disease. On average, support group members visited Facebook at least once a day, visited and passively participated (read/liked posts) several times a week, and participated actively (commented/posted) once a month. As much as 79.2% (183/231) agreed that they would like to have health professionals as members of the respective Facebook group. Group members expressed more concern about privacy issues on Facebook in general than in their respective Facebook support groups, with concerns mostly related to Facebook itself and nongroup members.

CONCLUSIONS

Our study confirmed that Facebook enhances support group accessibility for parents of children with rare diseases. Group participants perceive a reduction and elimination of distance, a common challenge in rare disease, and Facebook support groups create an environment of perceived privacy. The group's privacy setting can be a critical factor for active support group participation. Sharing personal information and pictures on Facebook is very common among group participants, which shows the importance of discussing and protecting children's privacy rights in this context.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00016067; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016067.

Telecollaboration in gerontology service learning: Addressing isolation & loneliness in a pandemic

Social isolation and loneliness present significant challenges for the mental and physical health of older adults. Social distancing, mask wearing, and other precautions necessitated by the COVID-19 pandemic add to these challenges. This article details a telecollaborative service-learning project to engage older adults online and provide applied experiences for students. From March through October 2020, 54 students from Social Work (Master, Bachelor), the College of Osteopathic Medicine (COM; DO), and Occupational Therapy (Master) provided telephone support and Zoom™ based programming for older adults affiliated with the University of New England. Creative offerings were piloted weekly and debriefed on Friday afternoons in the spring, leading to more structured 8-week schedules in summer and fall. Peer-to-peer support took place between older adults with experience in video meetings and those willing to learn. Bidirectional and intergenerational benefits were noted as older adults and students navigated the exigencies of the pandemic and learned important lessons with and from each other to advance knowledge and improve quality of life.

Educational and Psychological Support Combined with Minimally Invasive Surgical Technique Reduces Perioperative Depression and Anxiety in Patients with Bladder Cancer Undergoing Radical Cystectomy

Radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) is an extensive and morbid operation, often associated with permanent alteration of body image and disability. Combined with the aggressive malignant potential of MIBC and considerable risk of complications, it poses a serious threat to the psychological well-being of patients. Educational deficiencies causing uncertainty and confusion aggravate surgery-related anxiety and may lead to depression along with further social disability. We conceived a preoperative supportive program named “Cystocare” held by urologists, psychologists, stoma therapists and cancer survivors to facilitate patients’ adaptation and coping. We aimed to evaluate whether participation in Cystocare meetings would alleviate emotional distress in patients undergoing RC. We included 95 consecutive patients who filled Hospital Anxiety and Depression Score questionnaires before RC and on discharge. The intervention arm (A) comprised 32 Cystocare participants. The remaining 63 patients who received standard preparation constituted the control arm (B). Whilst there were no differences in median anxiety and depression scores preoperatively, in postoperative measurement, the intervention arm showed a lower median depression score than controls: 3 vs. 8 points, p = 0.015. On multivariate analysis we confirmed lower risk of postoperative depression in Cystocare participants: OR = 0.215 (95%CI: 0.066–0.699), p = 0.011, along with lower odds of preoperative anxiety in patients undergoing laparoscopic RC: OR = 0.365 (95%CI: 0.136–0.978), p = 0.045, and higher risk of prolonged hospital stay in patients experiencing postoperative anxiety OR = 17.114 (95%CI: 1.283–228.234) p = 0.032. Preoperative educational and supportive intervention complements laparoscopic RC in the alleviation of surgery-related anxiety and depression. The support group meetings provide an attractive and cost-effective opportunity to moderate emotional response in patients undergoing RC, and as such, deserve widespread adoption.

Learn to Live Again

The COVID-19 pandemic has claimed more than 4.5 million lives so far throughout the world. These sudden, unnatural, and unexpected deaths have led to complicated grief reactions as families did not get time to prepare for death. I describe the experience of my family in India during the disastrous second wave of the pandemic. The experience of many such families of COVID-19 casualties is like a horror story that will continue to scare them each day of their life. These families have already suffered a serious and long-lasting harm and are at greater risk of suffering from prolonged grief disorder, post-traumatic stress disorder, depression, emotional distress, adult separation disorder, and generalized anxiety disorder for a long period of time. Creating support groups, empowering primary-care physicians to help and counsel their patients, providing them access to cognitive behavioral therapy, help with opening up and venting out some of their feelings, and training to develop resilience are some of the measures to help our grieving patients.

Integrating online community support into outpatient breast cancer care: Mayo Clinic Connect online platform

Introduction

Mayo Clinic Connect is an online community of over 100,000 members who support each other through sharing lived experience when facing and managing new diagnoses. The community is moderated by Mayo Clinic staff and volunteer patient mentors.

Methods

Mayo Clinic breast clinic patients undergoing evaluation received a binder of support resources including a brochure about Mayo Clinic Connect at visits between January and May of 2019. Surveys were distributed at subsequent visits between May and December of 2019 to assess patient awareness about the online resource, participation frequency, purpose of use, and benefits for members, as well as reasons for not joining (non-members). The primary aim was to assess patient resilience, coping, and self-management after joining the online community.

Results

Nine hundred surveys were distributed, and 102 participants completed surveys between May and December 2019. Forty-five percent (n = 46) had heard about Mayo Clinic Connect; 34% (n = 15) through a brochure. The remainder heard about the community from a Mayo Clinic provider (43%; n = 19) or other resources (22%, n = 10; no response n = 2). Twenty percent (n = 20) of survey participants registered as Breast Cancer group members, and most of this subgroup (55%; n = 11) reported understanding diagnosis, treatment plans, and finding peer support as reasons for joining. Seventy-five percent of Mayo Clinic Connect participants (n = 15) reported the community met or exceeded expectations.

Conclusion

This pilot study reveals the potential positive impact of introducing an online peer support group into clinical care plans for patients coping with a new and anxiety-provoking cancer diagnosis.

An integrative review on mothers' experiences of online breastfeeding peer support: Motivations, attributes and effects

Information on the experiences surrounding online breastfeeding peer support among breastfeeding mothers and its effects on breastfeeding outcomes is growing yet to be synthesized. The aim of this review was to synthesize the evidence of mothers' experiences of online breastfeeding peer support. An integrative review was conducted. Five electronic databases were searched. Two reviewers independently screened the articles for inclusion. The inclusion criteria were (1) involved original data focusing on mothers' experiences of online breastfeeding peer support, (2) participants who were mothers who were breastfeeding or had experiences of breastfeeding and (3) studies focusing on interaction and communication among mothers through online communities. In total, 14 publications met the inclusion criteria. Breastfeeding mothers turned to online groups when they felt isolated, lacked professional support or preferred online support over face-to-face support. Online breastfeeding peer support was characterized as a virtual community, with easy access, availability and a wealth of resources from actual experiences of mothers. It empowered breastfeeding mothers and resulted in changes in breastfeeding outcomes and perceptions. The positive aspects of online breastfeeding peer support have recently garnered more attention. This review provided baseline data and evidence to supplement and improve the current breastfeeding support system for breastfeeding mothers. The evidence on the effectiveness of online breastfeeding peer support for influencing breastfeeding outcomes remains inconclusive. Further empirical studies with rigorous study designs are warranted.

Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers

BACKGROUND

Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services.

OBJECTIVE

To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use.

METHODS

California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users.

RESULTS

Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services.

CONCLUSION

Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.

Impact and Effectiveness of Group Strategies for Supporting Breastfeeding after Birth: A Systematic Review

Despite the multiple benefits of breastfeeding both for the mother and for the infant, during the first months there is a progressive decline in the number of mothers who continue breastfeeding, with most countries reporting lower than recommended figures. The objective of this review is to analyse the most effective group support practices for breastfeeding, as well as the characteristics associated to their success in maintaining breastfeeding. A systematic review has been conducted in the 2015–2020 period, in the following databases: MedLine, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library and LILACS. The findings were summarized in narrative and table formats. A total of thirteen articles were included, eight of them being experimental studies and five observational. The findings show high heterogeneity regarding the characteristics of the interventions and their periodicity. The most successful group strategies to support and maintain breastfeeding during postpartum are those that combine peer support with the leadership or counselling of a health professional or IBCLC. However, more studies are necessary, randomized and with interventions of similar characteristics, which allow for better data comparison.

"We Thought We Were Alone": The Subjective Experience of the Siblings of Anorexic Adolescent Patients

Objective: The siblings of patients suffering from Anorexia Nervosa (AN) are potentially affected by a disturbed emotional experience that often remains undetected. In order to bring them a psychological support, the Maison de Solenn proposed a support group program for these siblings. The current research explores their mental representations of AN and their emotional experience in the support group named "sibling group." Method: This exploratory study is based on a phenomenological and inductive qualitative method. Four girls and three boys aged between 6 and 19 participating in the "sibling group" were included in a one-time focus group session using a semi-structured interview guide. The thematic data analysis was performed by applying the methods of interpretative phenomenological analysis. Results: Themes that emerged from the interview fall into four categories: AN explained by siblings; the individual emotional experience of siblings; the family experience of siblings and the experience inside the "sibling group." Discussion: According to our participants, the "sibling group" thus functions as a good compromise between keeping an active role in the anorexic patient's care and taking a step back to avoid being eaten up by the illness. Sibling-group participants retrieved a sense of belonging, which is normally one of the functions of being a sibling. It is important to note that the "sibling group" is part of the comprehensive (or global) family-based approach included in an institutional multidisciplinary integrative care framework.

Understanding and Enhancing Support Group Participation Among Adolescent and Young Adult Cancer Survivors: The Impact of Integrating Adolescent and Young Adult Cancer Navigation Services

This quality improvement initiative aimed to (1) explore the impact of adolescent and young adult (AYA)-specific navigation on attendance at a monthly peer support group for survivors aged 18-39 at a large comprehensive cancer center, and (2) better understanding attendees' preferences for group structure. Group attendance significantly increased following integration of AYA navigation. Using an online survey, we identified priority topics for discussion and desired changes to group organization, leading to modifications to group structure. Results highlight the value of having dedicated staff who proactively orient patients to resources tailored to their unique needs, and the importance of flexible program development that incorporates stakeholder input.

Twitter-Based Social Support Added to Fitbit Self-Monitoring for Decreasing Sedentary Behavior: Protocol for a Randomized Controlled Pilot Trial With Female Patients From a Women's Heart Clinic

Background

Prolonged sitting is an independent risk behavior for the development of chronic disease. With most interventions focusing on physical activity and exercise, there is a separate need for investigation into innovative and accessible interventions to decrease sedentary behavior throughout the day. Twitter is a social media platform with application for health communications and fostering of social support for health behavior change.

Objective

This pilot study aims to test the feasibility, acceptability, and preliminary efficacy of delivering daily behavior change strategies within private Twitter groups to foster peer-to-peer support and decrease sedentary behavior throughout the day in women. The Twitter group was combined with a Fitbit for self-monitoring activity and compared to a Fitbit-only control group.

Methods

In a 2-group design, participants were randomized to a Twitter + Fitbit treatment group or a Fitbit-only control group. Participants were recruited via the Stanford Research Repository System, screened for eligibility, and then invited to an orientation session. After providing informed consent, they were randomized. All participants received 13 weeks of tailored weekly step goals and a Fitbit. The treatment group participants, placed in a private Twitter support group, received daily automated behavior change “tweets” informed by theory and regular automated encouragement via text to communicate with the group. Fitbit data were collected daily throughout the treatment and follow-up period. Web-based surveys and accelerometer data were collected at baseline, treatment end (13 weeks), and at 8.5 weeks after the treatment.

Results

The initial study design funding was obtained from the Women’s Heart Clinic and the Stanford Clayman Institute. Funding to run this pilot study was received from the National Institutes of Health’s National Heart, Lung, and Blood Institute under Award Number K01HL136702. All procedures were approved by Stanford University’s Institutional Review Board, #32127 in 2018, prior to beginning data collection. Recruitment for this study was conducted in May 2019. Of the 858 people screened, 113 met the eligibility criteria, 68 came to an information session, and 45 consented to participate in this pilot study. One participant dropped out of the intervention, and complete follow-up data were obtained from 39 of the 45 participants (87% of the sample). Data were collected over 6 months from June to December 2019. Feasibility, acceptability, and preliminary efficacy results are being analyzed and will be reported in the winter of 2021.

Conclusions

This pilot study is assessing the feasibility, acceptability, and preliminary efficacy of delivering behavior change strategies in a Twitter social support group to decrease sedentary behavior in women. These findings will inform a larger evaluation. With an accessible, tailorable, and flexible platform, Twitter-delivered interventions offer potential for many treatment variations and titrations, thereby testing the effects of different behavior change strategies, peer-group makeups, and health behaviors of interest.

Trial Registration

ClinicalTrials.gov NCT02958189, https://clinicaltrials.gov/ct2/show/NCT02958189

International Registered Report Identifier (IRRID)

DERR1-10.2196/20926

Facebook Support Groups for Rare Pediatric Diseases: Quantitative Analysis

BACKGROUND

Loneliness, social isolation, and feeling disconnected from society are commonly experienced by parents of children with rare diseases and are, among others, important reasons for special supportive care needs. Social networking platforms are increasingly used for health communication, information exchange, and support. In the field of rare pediatric diseases, qualitative studies have shown that Facebook online support groups are utilized by and beneficial for persons affected by rare pediatric diseases. Nonetheless, the extent of this usage has not been investigated.

OBJECTIVE

This study aims to provide a comprehensive quantitative analysis of the extent of Facebook usage as a tool for rare pediatric disease support groups and to explore factors that influence a disease's representation on Facebook. These results potentially offer important insights for future public health initiatives and give direction to further research that can give much needed support to parents of children with rare diseases.

METHODS

We determined rare pediatric diseases using the inventory of the online portal Orphanet. Facebook support groups were identified by searching 5 synonymous disease descriptions using the group category search bar. Disease- and group-describing parameters were statistically analyzed using standard descriptive statistical methods.

RESULTS

6398 Facebook support groups, representing 826 diseases (19.5% of all searched diseases), were found. 69% are private groups. Group type, size, activity (sum of posts, comments, and reactions calculated by Facebook), new memberships, and language varied largely between groups (member count: minimum 1, maximum 23,414; activity last 30 days: minimum 0, maximum 3606). The highest percentage of awareness and information groups was found for teratogenic diseases (18/68, 26%). The odds of finding a Facebook group increased according to the level of information available about the disease: known prevalence (odds ratio [OR] 3.98, 95% CI 3.39-4.66, P<.001), known disease type (OR 3.15, 95% CI 2.70-3.68, P<.001), and known inheritance mode (OR 2.06, 95% CI 1.68-2.52, P<.001) were all associated with higher odds of finding a Facebook group, as was dominant compared to nondominant inheritance (OR 2.05, 95% CI 1.74-3.42, P<.001). The number of groups per disease increased with higher prevalence.

CONCLUSIONS

Facebook is widely used as a tool for support groups for rare pediatric diseases and continues to be relevant. Two-thirds of the groups are private groups, indicating group participants' need for privacy, which should be further explored. The advantages and limitations of Facebook as a tool for support groups in the field of rare diseases should be further investigated as it will allow health professionals to use Facebook more meaningfully in their counseling and guidance of affected individuals and their family members.

The Development of a Bereavement Support Group Curriculum for Young Adults Dealing with the Death of a Partner: A Quality Improvement Project

Purpose: Little is known about the bereavement needs of young adults (YAs) whose partners have died from cancer. Historically, research about the impact of widowhood has focused on adults in later life. We adapted a bereavement support group curriculum used with older adults to address the unique needs of younger bereaved partners. Methods: Applying a quality improvement framework, nine bereaved YAs whose partners had recently died participated in a 6-session bereavement support group program. The participants completed an evaluation and provided feedback throughout the program. Results: The participants were six females and three males (30-43 years). The average time since the death of their partner was 7 months and four participants had dependent children. The participants evaluated the program highly, reporting they felt less isolated (4.75/5 on a 5-point Likert Scale); their concerns were similar to others (5/5); and the discussion topics were relevant to their situation (4.75/5). Additional topics for the next version of the curriculum included maintaining a relationship with in-laws, being a "solo parent," and dating. The participants also wanted the program to be extended given they had little contact with other bereaved partners. Based on this feedback, we converted the program into a drop-in group format meeting every 3 weeks, accepting new participants on a rolling basis. In parallel with the drop-in group, we plan to offer a revised 8-session bereavement support group twice a year. Conclusion: This pilot demonstrated that the bereavement support group curriculum for older bereaved adults was readily adapted for use with younger bereaved partners.

Support groups for family caregivers of persons with dementia in India

A caregiver support group was initiated at the Schizophrenia Research Foundation, Chennai, India. The study aimed to evaluate this service for 100 caregivers of persons with dementia, identify the needs met and explore the facilitating factors and barriers for participation. The support group met the information, emotional and counselling needs of caregivers. Trust between members was a key facilitating factor. Lack of help at home to support the person with dementia, distance from the venue and work commitments were barriers to caregiver participation. The study found that support groups fulfil an important need for caregivers by providing information and peer support.

A History of #BCSM and Insights for Patient-Centered Online Interaction and Engagement

Purpose

Participation in cancer support groups can provide a sense of community and may better prepare patients for interactions with their health care team. Online interactions may overcome some barriers to in-person support group participation. #BCSM (breast cancer social media), the first cancer support community established on Twitter, was founded in 2011 by two breast cancer survivors. The aims of this study are to describe the growth and changes in this community and to discuss future directions and lessons that may apply to other online support communities.

Methods

Symplur Signals was used to obtain all #BCSM Twitter data from January 1, 2011, to January 1, 2020 (00:00:00 Coordinated Universal Time for both). Hashtag use by selected stakeholder groups, user locations, weekly tweet chat activity, and topics were determined.

Results

From year 1 (2011) to year 9 (2019), tweets using the #BCSM hashtag increased by 424%. Tweets by patient advocates increased by 226%, with a peak in 2016. Impressions, a measure of potential tweet views, by patient advocates increased by 517%. Tweets by doctors and nonphysician health care professionals increased by 693%. Weekly #BCSM tweet chat activity peaked in 2013, increasing by 58.1% from 2011. Chat topics have included survivorship, metastatic breast cancer, death and dying, advocacy, and highlights from national breast cancer meetings.

Conclusions

#BCSM has experienced tremendous growth since 2011, although there are challenges to community sustainability. The weekly chats, as well as discussions utilizing the hashtag but occurring outside of scheduled chat times, serve as an important resource for patients and offer physicians an opportunity to both support and learn from patients.

Promoting Resilience in Medicine: The Effects of a Mind-Body Medicine Elective to Improve Medical Student Well-being

Background

Poor mental health is common among medical students. In response, some medical schools have implemented wellness interventions. The University of Florida College of Medicine recently introduced a mind–body medicine elective, Promoting Resilience in Medicine (PRIMe), based on the Georgetown University School of Medicine course. PRIMe teaches meditation techniques including mindfulness, biofeedback, art, and journaling in a faculty-facilitated small group setting.

Methods

First- and second-year medical students (N = 24) who participated in the 11-week elective (3 cohorts over 2 years) completed anonymous surveys regarding their experiences. Measures included the Freiberg Mindfulness Inventory (FMI), Perceived Stress Scale-10 item (PSS-10), and a series of multiple-choice and free-response questions developed for this study. The study was approved by the University of Florida Institutional Review Board.

Results

Among students with available pre- and posttest scores, the average PSS-10 score at pretest was 14.4 (SD = 6.17, range = 3–26) and at posttest was 14.2 (SD = 4.17, range = 8–22), suggesting no change in perceived stress. However, average scores on the FMI improved from 34.4 (SD = 6.10, range = 24–47) at pretest to 41.8 (SD = 4.81, range = 33–49) at posttest. The overwhelming majority of participants (95.8%) described the course as “definitely” worth it. The greatest improvements were noted in mindfulness, relationships with peers, and having a safe place in medical school to receive support. Learning mindfulness/meditation skills and increasing social support were noted as the primary factors impacting student well-being.

Conclusion

A mind–body medicine elective course may be a practical method to improve medical student well-being and improve ability to care for patients. Future studies should include follow-up testing to determine if benefits are sustained over time. In addition, more work is needed to understand the cost–benefit of providing instruction in mind–body medicine techniques to all medical students.

Communal responsibility: a history of health collectives in Australia

Healthcare encompasses multiple discourses to which health professionals, researchers, patients, carers and lay individuals contribute. Networks of patients and non-professionals often act collectively to build capacity, enhance access to resources, develop understanding and improve provision of care. This article explores the concept of health collectives and three notable examples that have had an enduring and profound impact in the Australian context.

Considerations for Developing Online Bereavement Support Groups

The loss of a family member or friend can have profound psychological and physical implications, particularly for individuals without bereavement support services. Online support groups can be an effective means of extending services beyond the traditional modes of delivery. This is especially true for populations that include isolated individuals and those with limited support networks, limited transportation, challenging time commitments, or reside in communities with limited services available. The literature over the last 10 years was reviewed to discern the potential opportunities and challenges of providing online bereavement support group services. Discussed are challenges for recruitment of participants, availability of technology resources, addressing privacy and confidentiality issues, participants' knowledge of technical equipment, legal considerations, ethical considerations, accessibility, and other best practices. Diverse populations such as adolescents, older adults, and rural communities must be uniquely considered when using online support groups.

Comparing the effect of two health education methods, self-directed and support group learning on the quality of life and self-care in Iranian postmenopausal woman

BACKGROUND

Women during menopause stages experience many symptoms, for which they lack enough knowledge to manage them. This study aimed to compare the effect of self-directed and support group health education on the quality of life (QOL (and self-care of postmenopausal women.

MATERIALS AND METHODS

This field trial study was carried out with three groups. One hundred and eight menopause women were selected through convenient sampling method based on the inclusion criteria from three comprehensive health centers. Health centers were randomly assigned to support (n = 36), self-directed (n = 36), and control groups (n = 36). In the self-directed group, education was provided through educational package, and the control group received routine care from the health center. The support group received education through four group sessions by trained healthy volunteers. Data were collected by menopause-specific QOL and self-care standard questionnaire.

RESULTS

Immediately after the intervention, the mean scores of QOL in the self-directed group, support group, and control group were 41.82 ± 7.61, 40.31 ± 4.80, and 48.17 ± 8.45, respectively (P < 0.05). In addition, the mean scores of self-care were significantly different between the self-directed (40.67 ± 7.36) and support (36.50 ± 3.36) groups compared to the control group (47.83 ± 8.47) (P < 0.05). After 1 month from intervention, QOL scores in the self-directed group (40.67 ± 7.36), support group (36.50 ± 3.36), and control group (47.83 ± 8.47) were significantly different (P < 0.05). In addition, the mean scores of self-care were 64 ± 6.79 and 65 ± 8.32 in the self-directed and support groups, respectively, compared to the control group (49.09 ± 9.43). Post hoc test (least significant difference) revealed higher effectiveness of the support group (P < 0.001).

CONCLUSIONS

Results indicated QOL and self-care in menopause women in self-directed and support groups improved. However, the support group provided higher effectiveness. Therefore, we recommended paying more attention to the capabilities of healthy volunteers for the promotion of QOL in menopause women.

Randomized controlled trial of a sibling support group: Mental health outcomes for siblings of children with autism

LAY ABSTRACT

Typically developing siblings of a child with autism spectrum disorder may show mental health difficulties. A support group is one approach to help typically developing siblings. During support groups, typically developing siblings discuss their feelings, learn coping strategies and problem-solving skills, and develop a peer network. We compared a support group to participation in a similar group without a focus on the sibling with autism spectrum disorder. Some areas of mental health improved. Improvements were also impacted by autism spectrum disorder symptom severity in the sibling with autism spectrum disorder. Findings suggest continuing to examine how support groups can help typically developing siblings and for which siblings support groups might be particularly effective.

Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period

BACKGROUND

The primary goal of the present study is to describe the psychosocial support services provided at our institution and the evolution of such programming through time. This study will also report the demographics and injury patterns of patients using available resources.

METHODS

Trauma Recovery Services (TRS) is a social and psychological support program that provides services and resources to patients and families admitted to our hospital. It includes a number of different services such as emotional coaching from licensed counselors, educational materials, peer mentorship from trauma survivors, monthly support groups, post-traumatic stress disorder (PTSD) screening and programming for victims of crime. Patients using services were prospectively recorded by hired staff, volunteers and students who engaged in distributing programming. Demographics and injury characteristics were retrospectively gathered from patient's medical records.

RESULTS

From May of 2013 through December 2018, a total of 4977 discrete patients used TRS at an urban level 1 trauma center. During the study period, 31.4% of the 15 640 admitted adult trauma patients were exposed to TRS and this increased from 7.2% in 2013 to 60.1% in 2018. During the period of 5.5 years, 3317 patients had 'direct contact' (coaching and/or educational materials) and 1827 patients had at least one peer visit. The average number of peer visits was 2.7 per patient (range: 2-15). Of the 114 patients who attended support groups over 4 years, 55 (48%) attended more than one session, with an average of 3.9 visits (range: 2-10) per patient. After the establishment of PTSD screening and Victims of Crime Advocacy and Recovery Program (VOCARP) services in 2017, a total of 482 patients were screened for PTSD and 974 patients used VOCARP resources during the period of 2 years, with substantial growth from 2017 to 2018.

CONCLUSIONS

Hospital-provided resources aimed at educating patients, expanding support networks and bolstering resiliency were popular at our institution, with nearly 5000 discrete patients accessing services during a period of 5.5 years. Moving forward, greater investigation of program usage, development, and efficacy is necessary.

LEVEL OF EVIDENCE

Level II therapeutic.

The Use of Web-Based Support Groups Versus Usual Quit-Smoking Care for Men and Women Aged 21-59 Years: Protocol for a Randomized Controlled Trial

Background

Existing smoking cessation treatments are challenged by low engagement and high relapse rates, suggesting the need for more innovative, accessible, and interactive treatment strategies. Twitter is a Web-based platform that allows people to communicate with each other throughout the day using their phone.

Objective

This study aims to leverage the social media platform of Twitter for fostering peer-to-peer support to decrease relapse with quitting smoking. Furthermore, the study will compare the effects of coed versus women-only groups on women’s success with quitting smoking.

Methods

The study design is a Web-based, three-arm randomized controlled trial with two treatment arms (a coed or women-only Twitter support group) and a control arm. Participants are recruited online and are randomized to one of the conditions. All participants will receive 8 weeks of combination nicotine replacement therapy (patches plus their choice of gum or lozenges), serial emails with links to Smokefree.gov quit guides, and instructions to record their quit date online (and to quit smoking on that date) on a date falling within a week of initiation of the study. Participants randomized to a treatment arm are placed in a fully automated Twitter support group (coed or women-only), paired with a buddy (matched on age, gender, location, and education), and encouraged to communicate with the group and buddy via daily tweeted discussion topics and daily automated feedback texts (a positive tweet if they tweet and an encouraging tweet if they miss tweeting). Recruited online from across the continental United States, the sample consists of 215 male and 745 female current cigarette smokers wanting to quit, aged between 21 and 59 years. Self-assessed follow-up surveys are completed online at 1, 3, and 6 months after the date they selected to quit smoking, with salivary cotinine validation at 3 and 6 months. The primary outcome is sustained biochemically confirmed abstinence at the 6-month follow-up.

Results

From November 2016 to September 2018, 960 participants in 36 groups were recruited for the randomized controlled trial, in addition to 20 participants in an initial pilot group. Data analysis will commence soon for the randomized controlled trial based on data from 896 of the 960 participants (93.3%), with 56 participants lost to follow-up and 8 dropouts.

Conclusions

This study combines the mobile platform of Twitter with a support group for quitting smoking. Findings will inform the efficacy of virtual peer-to-peer support groups for quitting smoking and potentially elucidate gender differences in quit rates found in prior research.

Trial Registration

ClinicalTrials.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028

International Registered Report Identifier (IRRID)

DERR1-10.2196/16417

Parent experience with volunteers and support groups in a multidisciplinary DSD clinic

Objective

Despite recommendations that clinics for children with a difference of sex development (DSD) should include peer support, information on how to provide this support is lacking. We utilized a mixed-methods program evaluation to evaluate family satisfaction with our clinic-based volunteers (who either have DSD themselves or are a parent of a child with DSD) and to understand the experience of these volunteers.

Methods

Parents (n=29) of a child with DSD completed an electronic survey. Interviews were conducted with three clinic volunteers.

Results

Most participants (72%) met with a clinic volunteer and majority (81%) rated their interaction as helpful. Most common topics discussed between parents and volunteers included: connecting to support groups (81%), their child's future (62%), and learning about their child's diagnosis (48%). Half of parents (48%) attended an after-clinic support group lunch, and 43% of these attendees rated the lunch session as helpful. Parents who attended a lunch liked the experience because they met other families with a child with a similar medical condition (100%), met volunteers with a similar medical condition (64%), and it helped them think more positively about their child's future (64%). Those who did not attend a lunch cited logistical reasons for not attending.

Conclusions

Incorporating clinic volunteers into a multidisciplinary DSD clinic is associated with high reported rates of satisfaction by families and volunteers.

[Support groups: talking with others to talk with oneself]

While the benefits of support groups are proven, caregivers are still a little wary of them. There are multiple reasons for this reticence. However, wherever they take place, talking becomes freer, relationships become more fluid and cooperation is facilitated.