COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study

BACKGROUND

In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living.

METHODS

A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation.

RESULTS

Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity.

CONCLUSIONS

Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.

CE: Providing Care for Caregivers During COVID-19

ABSTRACT

Care for the Caregiver is a peer-to-peer program that provides support and guidance to clinicians who have experienced an unexpected and emotionally distressing event. Its development was preceded by communication and resolution programs that were endorsed by the Joint Commission in 2001, subsequently introduced at several U.S. medical centers, and in 2009 were incorporated within demonstration projects funded by the Agency for Healthcare Research and Quality. In August 2014, the authors introduced the Care for the Caregiver program across the MedStar Health System, which includes seven hospitals in Maryland and three in the District of Columbia. Here, they describe how the program was initially conceived and structured-and how it evolved in response to the current pandemic.

Potential of organizing unmarried adolescent girls and young women into self-help groups for a better transition to adulthood: Findings from a cross-sectional study in India

It is essential to equip adolescents with the right information and appropriate skills for a quality transition to their adulthood. This study examines the individual agency of unmarried adolescent girls and young women (AGYW) who were organized into self-help groups (SHG) as compared to those who were not in groups. The paper uses data from a cross-sectional survey conducted with 872 unmarried AGYW aged 15-21 years from 80 villages across two districts of Uttar Pradesh, India. The dependent variables were AGYW's financial independence, collective action, decisionmaking, mobility, self-expression, generalized perceived self-efficacy, gender norms attitudes, and attitudes toward violence. The primary independent variables were group membership and the duration of the membership. Bivariate and multiple logistic regression analyses were conducted to examine the relationship between group membership and various components of individual agency. More than half of the respondents, with an average age of 18 years were enrolled in school or college and one-third had 12 or more years of education. The group members, compared to non-members, were significantly more likely to be financially independent (odds ratio [OR] = 2.29, p<0.01), to take collective action for entitlements (OR = 3.80, p<0.01), and to have progressive attitudes toward gender roles and norms (OR = 1.43, p<0.05). A longer duration of group membership increases the likelihood of financial independence, collective action, and decisionmaking ability. The study highlights the need for further investment in adolescent girls' programming and highlights the potential of organizing AGYW into SHG and using the 'platform' to bring change in their lives and consequential individual agency.

The Pandemic's Toll-A Case for Clinician Support

Healthcare providers perform lifesaving work in unusually stressful work environments due to the challenges and related risks of battling the unprecedented COVID-19 pandemic. The potential personal and professional toll is substantial. This article describes how one healthcare facility benefited from existing peer support resources to address workforce well-being, ensuring that resources were available to support workforce resilience throughout the protracted COVID response.

Assisting Faith-Based Organizations Increase Sense of Belonging during the Covid-19 Pandemic

The Covid-19 pandemic has negatively affected the three basic needs of individuals. Faith-based organization leaders are carrying the additional weight of stewardship of members during these challenging times. Many Faith-based organization leaders feel a sense of responsibility to create environments where members feel a sense of belonging. Five considerations for Faith-based organization leaders hoping to increase belonging are discussed below. Specifically, low-cost options are presented that could be implemented in small-to-large Faith-based organizations.

The complex geographies of telelactation and access to community breastfeeding support in the state of Ohio

The availability of breastfeeding support resources, including those provided by Baby-Friendly Hospitals, International Board Certified Lactation Consultants, breastfeeding counselors and educators, and volunteer-based mother-to-mother support organizations, such as La Leche League, are critically important for influencing breastfeeding initiation and continuation for the mother-child dyad. In addition, the emergence of community support options via information and communication technologies such as Skype and Facetime, social media (e.g., Facebook), and telelactation providers are providing mothers with a new range of support options that can help bridge geographic barriers to traditional community support. However, telelactation services that use information and communication technologies to connect breastfeeding mothers to remotely located breastfeeding experts require reliable, affordable, high-quality broadband connections to facilitate interaction between mothers and their support resources. The purpose of this paper is to explore the complex spatial landscape of virtual and face-to-face breastfeeding support options for mothers in the state of Ohio (U.S.), identifying barriers to support. Using a range of spatial and network analytics, the results suggest that a divide is emerging. While urban areas in Ohio benefit from both a density of face-to-face breastfeeding support resources and robust broadband options for engaging in telelactation, many rural areas of the state are lacking access to both. Policy implications and several potential strategies for mitigating these inequities are discussed.

Participation in microfinance based Self Help Groups in India: Who becomes a member and for how long?

INTRODUCTION

Microfinance is a widely promoted developmental initiative to provide poor women with affordable financial services for poverty alleviation. One popular adaption in South Asia is the Self-Help Group (SHG) model that India adopted in 2011 as part of a federal poverty alleviation program and as a secondary approach of integrating health literacy services for rural women. However, the evidence is limited on who joins and continues in SHG programs. This paper examines the determinants of membership and staying members (outcomes) in an integrated microfinance and health literacy program from one of India's poorest and most populated states, Uttar Pradesh across a range of explanatory variables related to economic, socio-demographic and area-level characteristics.

METHOD

Using secondary survey data from the Uttar Pradesh Community Mobilization project comprising of 15,300 women from SHGs and Non-SHG households in rural India, we performed multivariate logistic and hurdle negative binomial regression analyses to model SHG membership and duration.

RESULTS

While in general poor women are more likely to be SHG members based on an income threshold limit (government-sponsored BPL cards), women from poorest households are more likely to become members, but less likely to stay members, when further classified using asset-based wealth quintiles. Additionally, poorer households compared to the marginally poor are less likely to become SHG members when borrowing for any reason, including health reasons. Only women from moderately poor households are more likely to continue as members if borrowing for health and non-income-generating reasons. The study found that an increasing number of previous pregnancies is associated with a higher membership likelihood in contrast to another study from India reporting a negative association.

CONCLUSION

The study supports the view that microfinance programs need to examine their inclusion and retention strategies in favour of poorest household using multidimensional indicators that can capture poverty in its myriad forms.

The journey of sensemaking and identity construction in the aftermath of trauma: Peer support as a vehicle for coconstruction

Sensemaking is rooted in identity construction and it is a particularly interpersonal process. Moreover, traumatic experiences are known to cause people to engage in sensemaking processes and identity construction. However, knowledge of how this works in an interpersonal, community setting, is lacking. The aim of this study is to assess how peer support contributes to the sensemaking processes and identity construction in the aftermath of trauma. Data from an observational study of organised peer support groups for (co)victims of serious crimes and survivors of traumatic loss were analysed using inductive thematic analysis. Results show how participants of peer support groups move through several phases of sensemaking and identity construction in a fluid, dynamic, way. Identity work is collectively done. Through coconstruction of their identities, participants are able to make sense of a traumatic experience and progress towards a more self-aware and self-centred identity.

A peer support and peer mentoring approach to enhancing resilience and empowerment among refugees settled in southern Spain

This study aims to analyze the processes of resilience and empowerment experienced by refugees in southern Spain during their participation in a community-based intervention. Intervention design covered two phases over 15 weeks: (a) accompanying a group of 10 settled refugees to become mentors, making use of a peer-support-group format; and (b) holding four cultural peer-support groups made up of newly arrived refugees led by the previously trained settled refugees, following a peer-mentoring format. We analyzed the mentors' narratives and written evaluations produced over the course of the intervention program. Mentor resilience increased during the first program phase and remained high and stable during the second phase. Mentor empowerment steadily increased throughout the duration of the program, and was fueled when participants became mentors to newly arrived refugees during the second phase. This study highlights how a peer-support and peer-mentoring approach is useful for enhancing the resilience and empowerment of refugees in receiving societies.

Breast cancer patient advocacy: A qualitative study of the challenges and opportunities for civil society organizations in low-income and middle-income countries

BACKGROUND

Breast cancer advocacy movements, driven by advocate-led civil society organizations (CSOs), have proven to be a powerful force for the advancement of cancer control in high-income countries (HICs). However, although patient advocacy movements are growing in low-income and middle-income countries (LMICs) in response to an increasing cancer burden, the experiences and needs of advocate-led breast cancer CSOs in LMICs is understudied.

METHODS

The authors conducted a qualitative study using in-depth interviews and focus group discussions with 98 participants representing 23 LMICs in Eastern Europe, Central Asia, East and Southern Africa, and Latin America.

RESULTS

Despite geographic, cultural, and socioeconomic differences, the common themes that emerged from the data across the 3 regions are strikingly similar: trust, knowledge gaps, stigma, sharing experiences, and sustainability. The authors identified common facilitators (training/education, relationship building/networking, third-party facilitators, and communication) and barriers (mistrust, stigma, organizational fragility, difficulty translating HIC strategies) to establishing trust, collaboration, and advancing cancer advocacy efforts. To the authors' knowledge, the current study is the first to describe the role that coalitions and regional networks play in advancing breast cancer advocacy in LMICs across multiple regions.

CONCLUSIONS

The findings of the current study corroborate the importance of investing in 3-way partnerships between CSOs, political leaders, and health experts. When provided with information that is evidence-based and resource appropriate, as well as opportunities to network, advocates are better equipped to achieve their goals. The authors propose that support for CSOs focuses on building trust through increasing opportunities for engagement, disseminating best practices and evidence-based information, and fostering the creation of platforms for partnerships and networks.

New problems of a new health system: the creation of a national public policy of rare diseases care in Brazil (1990s-2010s)

This study discusses actors and institution movements leading to the disclosure in 2014 of Resolution 199 by the Brazilian Ministry of Health, which establishes the National Policy for the Comprehensive Care of Persons with Rare Diseases. Taking as sources the mainstream newspapers, drafts law, and secondary literature on the subject, we begin our analysis in the early 1990s when the first patient associations were created in Brazil - mainly for claiming more funds for research on genetic diseases - and arrive at the late 2010s when negotiations for a national policy are taking place in the National Congress. Resolution 199 is part of an ongoing process and the path towards its disclosure and the complications that followed have given us elements to discuss contemporary aspects of the Brazilian public health. Based on the references of the history of the present time and the social studies of science, we argue that two aspects have been fundamental to creating a national policy: framing different illnesses within the terminology "rare diseases" and the construction of a public perception about the right of health which is guaranteed by the 1988 Brazilian Constitution.

Prolonged Grief Disorder and Positive Affect Improved by Chinese Brush Painting Group in Bereaved Parents: A Pilot Study

Traditional Chinese art practices such as brush painting and calligraphy are thought to promote self-development through holistically engaging both physical and mental health. This pilot study investigated the beneficial effects of a community-based self-help group incorporating Chinese art practices as a culturally adapted bereavement intervention. Twenty-six Chinese parents aged over 49 years and who had lost their only child participated in a 20-session Chinese brush painting group over a 6-month period. Ten bereaved parents from the same community who did not participate in the art course but received living support were recruited as a control group. Compared with the control group, the art practice group exhibited a pre-post intervention effect in terms of promoting positive affect and preventing deterioration of prolonged grief symptoms, particularly through the improvement of accessory grief symptoms (e.g., "emotional numbness due to the loss", and "feeling that life is unfulfilling, empty or meaningless after the loss"). No effect was found on negative affect. These findings indicate that a culturally adapted community-based art group may be an effective means of improving grief-related health.

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.

Experiences of Occupational Performance in Survivors of Stroke Attending Peer Support Groups

BACKGROUND.

Survivors of stroke often experience environmental isolation and decreased occupational performance after discharge from the hospital. Peer groups benefit psychological, social, and cognitive functioning, though few studies have examined their influence on occupational performance of survivors of stroke.

PURPOSE.

This study explores the experiences of occupational performance in survivors of stroke attending an outpatient peer support group.

METHOD.

An interpretive qualitative study using semi-structured interviews was conducted with seven survivors of stroke attending an outpatient peer support group. Data was thematically analyzed.

FINDINGS.

Four themes related to the experience of peer support on occupational performance emerged: finding hope to return to meaningful occupation, a place for belonging, problem-solving occupational concerns, and finding purpose beyond oneself.

IMPLICATIONS.

This research adds to the existing literature that peer support groups help survivors of stroke reengage in meaningful occupations, manage their stroke experience, and move positively through recovery.

Protocol for a partially nested randomized controlled trial to evaluate the effectiveness of the Scleroderma Patient-centered Intervention Network Support Group Leader EDucation (SPIN-SSLED) Program

BACKGROUND

Some people with rare diseases rely on peer-led support groups for disease-specific education and emotional and practical support. Systemic sclerosis (SSc), or scleroderma, is a rare autoimmune connective tissue disease. Many people with SSc cannot access support groups, and, when support groups exist, they may not be sustained due to challenges that could be addressed via leader training. The Scleroderma Patient-centered Intervention Network (SPIN), along with SSc patient organization partners, developed a training program for SSc patient support group leaders, the Scleroderma Support group Leader EDucation (SPIN-SSLED) Program. We recently completed a feasibility trial in which we successfully delivered the program to two groups of support group leaders who reported a high level of satisfaction with the program and its delivery. The primary objective of the full-scale SPIN-SSLED trial is to evaluate the effect of the program on support group leaders' self-efficacy for carrying out their leadership role. Secondary objectives include evaluating effects on leader burnout, leader satisfaction (participation efficacy), and emotional distress.

METHODS/DESIGN

The SPIN-SSLED trial is a pragmatic randomized controlled trial (RCT) in which 180 support group leaders will be randomly allocated to training groups of 6 participants each or to a waitlist control. We will use a partially nested RCT design to reflect dependence between individuals in training groups, but not in the waitlist control. Participants allocated to the training program will receive the 13-module SPIN-SSLED Program, delivered via webinar over the course of 3 months in weekly 60-90-min sessions. The primary outcome is leader self-efficacy, measured by the Scleroderma Support Group Leader Self-efficacy Scale post-intervention. Secondary outcomes are leader self-efficacy at 3 months post-intervention, and leader burnout, volunteer job satisfaction (participation efficacy), and emotional distress post-intervention and at 3 months post-intervention.

DISCUSSION

The SPIN-SSLED trial will test whether a training program for SSc patient support group leaders increases the self-efficacy of group leaders to carry out leadership tasks. The program has the potential to significantly improve the effectiveness and sustainability of existing SSc support groups, to increase the number of available support groups, and to be adapted for other chronic diseases.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03965780. Registered on 29 May 2019.

"I'm not alone": Women's experiences of recovery oriented occupational therapy groups following depression

BACKGROUND.

Occupational therapy groups have been carried out as interventions in mental health settings across a variety of populations. Limited research explores the lived experience of individuals with depression following participation in recovery oriented occupational therapy groups.

PURPOSE.

To better understand how recovery oriented occupational therapy groups shape participants' personal experience of daily life, including recovery.

METHOD.

Five individuals who had previously completed at least one recovery oriented occupational therapy group each participated in two in-depth semi-structured interviews. Analyses of the transcripts were completed using interpretative phenomenological analysis (IPA).

FINDINGS.

Participants' experiences of the recovery oriented occupational therapy groups ranged from positive to negative, with variable impacts on their lived experiences. Two major themes emerged: (a) participants' perception of "normal" and (b) navigation of meaningful participation.

IMPLICATIONS.

Increased understanding of what aspects of recovery oriented occupational therapy groups are meaningful to individuals with depression can help support their personal recovery process.

Temporalities of mental distress: digital immediacy and the meaning of 'crisis' in online support

The Internet is increasingly used to seek support by those suffering with mental distress (Bauman, S. and Rivers, I. Mental Health and the Digital Age. Basingstoke: Palgrave Macmillan; 2015). Drawing on research on a major online peer support forum, we analyse discussions around acute distress, self-harm and suicide. The paper argues that new temporalities of mental health 'crisis' are emerging through the intersection of the immediacy of online support, the chronicity of underlying distress and the punctuated nature of professional support. Online support adds a layer of temporal immediacy that does not traditionally feature in other forms of support (e.g. professional in-person services). This shifts the meaning of a mental health 'crisis' from acute to processual, and can lead to definitions of 'crisis' being used when not desired nor necessarily accurate. By attending to the layering of temporalities at the intersections of professional in-person, and online support, we demonstrate how parameters of crisis support are set - by whom, for whom and in relation to whose bodies. This has implications for professional clinical practice internationally in relation to the increased digitisation of support and the meanings of 'crisis' that emerge.

'I don't feel like I'm in this on my own': Peer support for mothers of children with intellectual disability and challenging behaviour

This article reports on the peer support experiences of mothers with a son or daughter with intellectual disability and challenging behaviour. Engagement in parent peer support programs can improve family quality of life and may have multifaceted benefits at the interpersonal, intra-individual self-change and sociopolitical levels. Thirteen mothers were interviewed about their experiences of participating in a parent peer support program. Thematic analysis focused on the process elements of the program that contributed to its effectiveness in providing support to parents. There were three process-related themes: the role of a paid coordinator, diversity of engagement strategies and matching of peer support partners. Mothers appreciated the opportunities provided to engage in a range of strategies tailored to individual preferences, time and capacity constraints, supported by the paid coordinator. One-to-one peer support proved difficult to sustain given the challenges mothers faced in their day-to-day lives.

Measuring coordination between women's self-help groups and local health systems in rural India: a social network analysis

OBJECTIVES

To assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.

DESIGN

A pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.

SETTING

The study was conducted in 18 villages located in three districts in Uttar Pradesh, India.

INTERVENTION

To improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.

PARTICIPANTS

A purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).

MAIN OUTCOME MEASURES

Social network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.

RESULTS

The health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.

CONCLUSIONS

The creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

Perspectives of Patients With Dermatofibrosarcoma Protuberans on Diagnostic Delays, Surgical Outcomes, and Nonprotuberance

IMPORTANCE

Dermatofibrosarcoma protuberans (DFSP) may have a deceptively benign clinical appearance, including a nonprotuberant presentation. Patients with DFSP often perceive misdiagnoses and delays in receiving a diagnosis. Use of existing, patient-designed Facebook patient support groups (FBSGs) to recruit large numbers of patients with rare diseases may be an effective novel research method.

OBJECTIVES

To collaborate with patients with rare disease through social media and answer questions important to both patients and the medical field, including sources of diagnostic delay, risk of recurrence, and flat presentation of DFSP.

DESIGN, SETTING, AND PARTICIPANTS

A multiple-choice survey created by a team of medical practitioners and patients with DFSP was administered to 214 patients with DFSP or family members from international DFSP FBSGs and a nonprofit foundation patient database via Lime Survey from October 30 to November 20, 2015. The survey asked questions designed to determine risk of recurrence and metastasis, surgical outcomes, sources of diagnostic delay, symptoms of recurrence, number of recurrences, scar size, and number of clinicians seen before biopsy. Statistical analysis was performed from January 1, 2016, to April 1, 2019.

MAIN OUTCOMES AND MEASURES

The study goal was to collect at least 200 survey responses.

RESULTS

Of 214 survey respondents (169 females and 45 males; mean [SD] age, 40.7 [12.1] years; range, <1 to 72 years), 199 were patients with DFSP and 15 were family members. Delays occurred between the patient noticing the DFSP lesion and receiving a diagnosis of DFSP (median, 4 years; range, <1 to 42 years). Most patients (112 [52.3%]) believed that they received a misdiagnosis at some point: by dermatologists (35 of 107 [32.7%]), primary care clinicians (80 of 107 [74.8%]), or another type of physician (27 of 107 [25.2%]). The most frequent prebiopsy clinical suspicion included cyst (101 [47.2%]), lipoma (30 [14.0%]), and scar (17 [7.9%]). Many patients first noticed their DFSP as a flat plaque (87 of 194 [44.8%]). Of these lesions, 73.6% (64 of 87) became protuberant eventually. Surgical treatments included Mohs micrographic surgery (56 of 194 [28.9%]), wide local excision (122 of 194 [62.9%]), and conservative excision (16 of 194 [8.2%]). The reported rate of recurrence was 5.4% (3 of 56) for Mohs micrographic surgery, 7.4% (9 of 122) for wide local excision, and 37.5% (6 of 16) for conservative excision. The higher rate of recurrence for conservative excision was significant (P = .001); there was no significant difference in the rate of recurrence between Mohs micrographic surgery and wide local excision (P = .76).

CONCLUSIONS AND RELEVANCE

This study reports what appears to be disease-relevant statistics from the largest survey of patients with DFSP to date. Because of the dissonance between the name of the neoplasm and its clinical presentation, the alternative term dermatofibrosarcoma, often protuberant is proposed. This study suggests that FBSGs are useful tools in medical research, providing rapid access to large numbers of patients with rare diseases and enabling synergistic collaborations between patients and medical researchers.

Using a six-step co-design model to develop and test a peer-led web-based resource (PLWR) to support informal carers of cancer patients

OBJECTIVE

To co-design and test the acceptability of a peer-led web-based resource (PLWR) for cancer carers to provide practical and emotional advice on common issues.

METHODS

A six-step co-design model informed PLWR development. Content was developed through three cancer carer workshops and monthly meetings with an expert advisory team (n = 12). User-testing was conducted via web-based survey and telephone interview. Descriptive statistics and thematic analysis were utilised. Google analytics explored site visits, commonly used components, and time spent using the PLWR.

RESULTS

The PLWR was developed to deliver cancer carer information tailored to each stage of the illness trajectory regardless of cancer type, in the form of videoed personal experiences. From November to May 2018, there were 2789 unique visits to the PLWR with 743 returners. The majority of time was spent on the full unclipped peer stories (414 views), and diagnosis-specific information (159 views), with less time spent on bereavement, cancer treatment, or self-care (120 views each). Fifty-five individuals completed the resource evaluation, with 10 participating in telephone interviews. Fifty-four carers rated the resource as excellent, useful, and easy to use. The web-based videos were regarded as convenient as and less burdensome than written information. The resource provided relevant information, potentially reducing isolation and uncertainty.

CONCLUSION

The content and design of the PLWR appear acceptable to cancer carers. The co-design model is an effective way to develop appropriate information for service users and could be utilised as a framework for development of other interventions in a variety of disease groups.

Survey of family doctors' attitudes towards statin treatment in patients with type 2 diabetes

AIMS

Clinical guidelines advocate that cardiovascular benefits of statin treatment overweigh the risk of impairment of glucose metabolism. The aim of the study was to examine the attitudes of family doctors towards statin treatment in patients with type 2 diabetes.

METHODS

We disseminated a questionnaire examining doctors' attitudes to existing clinical guidelines and the factors leading to a doctor's decision to prescribe statins to diabetic patients.

RESULTS

Clinical policy and guidelines were defined by doctors as having the greatest influence on the decision to prescribe statins for diabetic patients particularly by salaried doctors in comparison to self-employed doctors (χ² = 9.138, df = 3, p ≤ 0.01). When considering the ways healthcare services can assist cholesterol control, monetary compensation yielded higher importance by young doctors compared to mature doctors (χ² = 8.15, df = 2, p ≤ 0.01), while nursing services in the clinic yielded higher importance by mature doctors in comparison to younger doctors(χ² = 13.7, df = 2, p ≤ 0.01).

CONCLUSIONS

Doctors defined a list of priorities for organizational support mechanisms that are likely to lead to the formation of an intervention plan for increasing the percentage of balanced cholesterol levels in patients with diabetes.

Post Your Journey: Instagram as a Support Community for People With Fibromyalgia

Fibromyalgia is a chronic illness with primary symptoms of widespread pain and fatigue. Social media applications have become a recent resource allowing individuals with fibromyalgia to interact in a virtual community devoted to the illness. This study explores how such a community develops and maintains itself on Instagram and the ways it creates social capital for its users. Data are derived from Instagram posts and open-ended questionnaires completed by users living with fibromyalgia who use the application. Using content analysis and semiotic methodology, the study analyzes the diverse ways in which users shared their experiences with fibromyalgia, the management of its symptoms, and issues encountered in accessing health care systems. Instagram aids in the development of a community by facilitating intimate and supportive interactions about the illness and the creation of personalized day-to-day narratives accessible to all. Norms of trust, acceptance, and reciprocity characterize the diversity of interactions in this community.

"I'm not in this alone" the perspective of parents mediating a physical activity intervention for their children with autism spectrum disorder

BACKGROUND AND AIMS

Web-based, parent-mediated interventions have shown to be beneficial for children with autism spectrum disorder (ASD) in a variety of domains. We aimed to examine how parents of children with ASD perceive mediating a physical activity intervention delivered via a private Facebook group.

METHODS

Thirteen families participated in a four-week trial of Project CHASE. Inductive thematic analysis of semi-structured interviews and interactions within the Facebook group were conducted to elicit the perspective of the parents.

OUTCOMES AND RESULTS

Thematic analysis resulted in three themes emerging: (1) 'Remembering to Act' encompassed the participants' perspectives of Project CHASE as being an intervention that reminded them of the importance of physical activity, and served as a prompt for them to take action; (2) 'A sharing community' included the subthemes of 'sharing success and struggles' and 'sharing ideas'; and, (3) 'Taking control: possibilities and problems' encapsulates the dichotomy between participants who spoke of embracing and rising to the challenge of taking control, with the parents who spoke of the need for more support, direction, and guidance.

CONCLUSION AND IMPLICATION

The current study suggests parent-mediated, web-based interventions may have the potential for improving the effectiveness of physical activity interventions for children with ASD.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATIONS

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

Family Support Groups for Family Members of Mentally Ill Offenders: Family Expectations and Experiences

Family Support Groups (FSGs) are developed for family members of mentally ill offenders. This study investigates family treatment expectations and experiences of an FSG. Family members were interviewed before ( n = 20) and after ( n = 17) attending an FSG. Results show that family members hesitated or were curious about the FSG, expected to receive peer support and universality of problems, to receive information and advice and thought about the safety and respect of the group. Family members experienced the treatment as helpful because it was supportive, they gained new insights and they felt relieved and satisfied. Many family members see the guidance of the therapists and the differences in family and gender roles as an added value of attending an FSG. However, considering the limitations of the study, future studies should gain insight in and stress the importance of the meaning of therapeutic processes for family members confronted with different psychiatric disorders and/or situations.

"Patients Are Not Following the [Adherence] Club Rules Anymore": A Realist Case Study of the Antiretroviral Treatment Adherence Club, South Africa

There is growing evidence that differentiated care models employed to manage treatment-experienced patients on antiretroviral therapy could improve adherence to medication and retention in care. We conducted a realist evaluation to determine how, why, for whom, and under what health system context the adherence club intervention works (or not) in real-life implementation. In the first phase, we developed an initial program theory of the adherence club intervention. In this study, we report on an explanatory theory-testing case study to test the initial theory. We conducted a retrospective cohort analysis and an explanatory qualitative study to gain insights into the important mechanisms activated by the adherence club intervention and the relevant context conditions that trigger the different mechanisms to achieve the observed outcomes. This study identified potential mitigating circumstances under which the adherence club program could be implemented, which could inform the rollout and implementation of the adherence club intervention.

Mutual support groups for family caregivers of people with amyotrophic lateral sclerosis in Italy: A pilot study

Family caregivers of people with amyotrophic lateral sclerosis (ALS) live stressful lives in which they spend most of their time caring for their loved ones and managing difficult situations, thereby reducing the time spent in taking care of themselves. This situation may last several years. Previous literature has widely highlighted that this situation reduces caregivers' quality of life and increases their psychological distress and risk of health problems, but there is a lack of studies that focus on psychological interventions for these situations. This qualitative study examined a pilot experience of two mutual support groups for family caregivers of people with ALS. The aim was to identify caregivers' needs, the prominent aspects of their experience, and to understand whether and how this intervention strategy might help them. Six partners (four men and two women) and six adult children (five women and one man) participated in the groups, which were conducted in northern Italy. After the support groups finished, participants underwent semi-structured interviews. The authors conducted a content analysis of the transcripts of the interviews and the 20 group sessions. The thematic areas identified were "caregiving," "being the son/daughter of a person with ALS," "being the partner of a person with ALS," "group experience" and "group evaluation." The caregiving experience was profoundly different depending on whether the caregiver was a son/daughter or a partner of a patient with ALS. Moreover, comparison with peers and mutual support helped participants to better cope with ALS and its consequences, to improve their care for their relatives and to overcome typical caregiver isolation. These results suggest the usefulness of involving communities in caregiver support in order to create new networks and activate personal and social resources for well-being.

Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation

BACKGROUND

In 2011, a decision was made to scale up a pilot innovation involving 'adherence clubs' as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation.

RESULTS

Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a 'tipping point' at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches.

CONCLUSIONS

We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of differentiated care. Further research is needed to assess the equity and quality outcomes of a differentiated care model and to ensure the inclusive distribution of the benefits to all categories of people living with HIV.

Filling the Void: Hospital Palliative Care and Community Hospice: A Collaborative Approach to Providing Hospital Bereavement Support

Bereavement services are often provided as components of hospice and palliative care plans, including emotional, psychosocial, and spiritual support provided to individuals and families to assist with grief, loss, and adjustment after the death of a loved one. Patient- and family-centered care is a hallmark of palliative care. Moreover, bereavement counseling is offered as a hospice care benefit that is covered by Medicare and various private insurance plans. However, not all hospital-based palliative care programs offer bereavement support. Many bereaved persons whose loved one dies in the hospital while receiving palliative care services may not have access to a bereavement support program. This practice concept article describes an innovative bereavement program designed to offer support to individuals whose loved one died in the hospital while receiving palliative care. The bereavement team, including clinical professionals from the inpatient palliative care team and two community hospices, developed the University of Florida (UF) Health Bereavement Program. The interprofessional team includes social workers, volunteers, chaplains, nurses, nurse practitioners, and physicians. The Bereavement Program incorporates grief support workshops, follow-up with participants, via postal mail at timed intervals, website access to grief resources, staff education, and an annual evening of remembrance program. Finally, interagency collaboration has extended the reach of bereavement services beyond UF Health into our community at large.

Self-Help, Mutual Aid and Chronic Patients' Clubs in Croatia, Yugoslavia: Discussion Paper

This paper describes the clubs for patients with hypertension which have operated effectively in parts of Croatia and Slovenia (Yugoslavia) for more than 15 years, with many thousands of patients enrolling voluntarily. Based on the principle of self-help, yet involving the regular participation of members of a patient's own primary health team, they increase compliance with long-term treatment regimens and improve the quality of life.

Such programmes are capable of reducing the amount of time devoted by a medical practitioner while increasing the effectiveness of treatments. If they are to succeed, it is essential to ensure regular club meetings, social activities and encouragement to each individual member to find a role and to continue attending for as long as possible. A new life style and consequent benefits to health are obtained only through long membership.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

This is not a registered trial.

First, Do No Harm: Referring Primary Care Patients with Depression to an Internet Support Group

BACKGROUND

Internet Support Groups (ISGs) offer people easy access to information regarding depression as well as support from others who are either currently suffering from depression or have previously suffered from depression. The safety and efficacy of ISGs for people with depression have not been thoroughly studied.

INTRODUCTION

The safety and helpfulness of a depression ISG were assessed by analyzing pre- and postintervention depressive symptoms, other psychological outcomes, and participant ratings of helpfulness.

MATERIALS AND METHODS

Participants were recruited through self-referral from six primary care offices. Participants were given access to a depression ISG and participated in an ISG for 6 weeks.

RESULTS

Thirty-four (n = 34) participants enrolled in the study (mean age = 32.53, standard deviation [SD] = 16.10). Depressive symptoms approached significance for decreasing over time and self-efficacy increased over time. No self-harm occurred over the course of the study, but two participants developed self-harm ideation. Ratings of ISG helpfulness were mixed.

DISCUSSION

Primary care patients participating in depression ISGs reported few adverse experiences directly related to the ISG. Depressive symptoms and self-efficacy have beneficial findings while ratings of helpfulness were mixed.

CONCLUSIONS

Primary care patients can benefit from the use of an ISG. This could be particularly pertinent to people in rural settings where mental health resources are not as available. An ISG offers a low-cost and easily accessible resource for primary care patients with depression.

Online support for transgender people: an analysis of forums and social networks

Transgender people face a range of personal and social conflicts that strongly influence their well-being. In many cases, the Internet can become the main resource in terms of finding support. The aim of this study was to understand how transgender people give and receive help online. Between 2013 and 2015, 122 online community conversations were collected on Italian forums and Facebook groups involving transgender people, and online interviews were conducted with 16 users of these communities. A qualitative content analysis was conducted by using the software package, NVivo10. The main categories that emerged were: motivations to join an online community, online help, differences between online and offline interactions, status, conflicts and professional help. Results indicate that participation in online communities often derives from the users' need for help. This help can be given by peers who have had similar experiences, and by professionals who participate in the discussions as moderator. The need to test one's own identity, to compare oneself with others and to share one's personal experiences made online communities at risk of exposing users to invalidation and transphobic messages. Administrators and moderators try to ensure the safety of users, and suggest that they ask for professional help offline and/or online when over-specific medical advice was sought. This study confirms that transgender people might find benefit from an online platform of help and support and might minimise distance problems, increase financial convenience and foster disinhibition.

Circles of Support and Accountability for Sex Offenders: A Systematic Review of Outcomes

We conducted a systematic review of studies reporting on the effectiveness of Circles of Support and Accountability (Circles). Circles use volunteers to provide support for sex offenders living in the community. We searched 10 databases up to the end of 2013 and identified 3 relevant outcome studies. An additional 12 papers or reports were identified by searching reference lists, Google, and contacting key authors and Circles providers to obtain unpublished data. These 15 studies comprised one randomized controlled trial, three retrospective cohorts with matched controls, and 11 case series. The majority reported measures of recidivism, particularly reconviction. The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences. Few studies examined changes in risk or psychosocial outcomes. A number of methodological issues are discussed. Longer term, prospective follow-up studies with control groups are required to address these issues.

Pragmatic, consensus-based minimum standards and structured interview to guide the selection and development of cancer support group leaders: a protocol paper

INTRODUCTION

Across the globe, peer support groups have emerged as a community-led approach to accessing support and connecting with others with cancer experiences. Little is known about qualities required to lead a peer support group or how to determine suitability for the role. Organisations providing assistance to cancer support groups and their leaders are currently operating independently, without a standard national framework or published guidelines. This protocol describes the methods that will be used to generate pragmatic consensus-based minimum standards and an accessible structured interview with user manual to guide the selection and development of cancer support group leaders.

METHODS AND ANALYSIS

We will: (A) identify and collate peer-reviewed literature that describes qualities of support group leaders through a systematic review; (B) content analyse eligible documents for information relevant to requisite knowledge, skills and attributes of group leaders generally and specifically to cancer support groups; (C) use an online reactive Delphi method with an interdisciplinary panel of experts to produce a clear, suitable, relevant and appropriate structured interview comprising a set of agreed questions with behaviourally anchored rating scales; (D) produce a user manual to facilitate standard delivery of the structured interview; (E) pilot the structured interview to improve clinical utility; and (F) field test the structured interview to develop a rational scoring model and provide a summary of existing group leader qualities.

ETHICS AND DISSEMINATION

The study is approved by the Department Human Ethics Advisory Group of The University of Melbourne. The study is based on voluntary participation and informed written consent, with participants able to withdraw at any time. The results will be disseminated at research conferences and peer review journals. Presentations and free access to the developed structured interview and user manual will be available to cancer agencies.

Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial

IMPORTANCE

Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women.

OBJECTIVE

To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months.

DESIGN, SETTING, AND PARTICIPANTS

A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016.

INTERVENTIONS

Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics.

MAIN OUTCOMES AND MEASURES

The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet.

RESULTS

Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group).

CONCLUSIONS AND RELEVANCE

Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01408147.

Development of an acceptable and feasible self-management group for children, young people and families living with Type 1 diabetes

AIMS

This study developed an acceptable and feasible self-management intervention that addresses the self-identified needs of children and young people with Type 1 diabetes and their parents.

METHODS

Phase 1 reviewed previous interventions and interviewed the clinical team, young people and families. Phase 2 ran three age-matched focus groups with 11 families of children aged 8-16 years. Feedback was used to modify the workshop. Phase 3 evaluated feasibility of delivery, as well as the effects on metabolic control, quality of life and fear of hypoglycaemia, measured at baseline and 1-3 months post intervention.

RESULTS

Eighty-nine families were invited to take part. Twenty-two (25%) participated in seven pilot groups (median age of young people 10 years, 36% girls). The intervention comprised a developmentally appropriate workshop for young people and parents addressing: (1) blood glucose control, (2) the potential impact of long-term high HbA_1c , (3) the effects of 'hypos' and 'hypers', (4) self-management techniques and (5) talking confidently to people about diabetes. Participants were enthusiastic and positive about the workshop and would recommend it to others. Young people liked sharing ideas and meeting others with diabetes, while parents enjoyed listening to their children talk about their diabetes knowledge.

CONCLUSIONS

Families living with Type 1 diabetes participated in developing a self-management group intervention. Although we demonstrated acceptability and feasibility, the pilot study results do not support the development of a randomized control trial to evaluate the effectiveness in improving HbA_1c .

The Barnstaple Leg Club, Devon

Andrew Kingsley, Sylvie Hampton, Ellie Lindsay and Roland Renyi discuss how the social model of care has proved its worth in the South West of England.

Increasing the Capacity of Primary Care Through Enabling Technology

Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow.

Diagnostic needs for rare diseases and shared prediagnostic phenomena: Results of a German-wide expert Delphi survey

Background

Worldwide approximately 7,000 rare diseases have been identified. Accordingly, 4 million individuals live with a rare disease in Germany. The mean time to diagnosis is about 6 years and patients receive several incorrect diagnoses during this time. A multiplicity of factors renders diagnosing a rare disease extremely difficult. Detection of shared phenomena among individuals with different rare diseases could assist the diagnostic process. In order to explore the demand for diagnostic support and to obtain the commonalities among patients, a nationwide Delphi survey of centers for rare diseases and patient groups was conducted.

Methods

A two-step Delphi survey was conducted using web-based technologies in all centers for rare diseases in Germany. Moreover, the leading patient support group, the German foundation for rare diseases (ACHSE), was contacted to involve patients as experts in their disease. In the survey the experts were invited to name rare diseases with special need for diagnostic improvement. Secondly, communal experiences of affected individuals were collected.

Results

166 of 474 contacted experts (35%) participated in the first round of the Delphi process and 95 of 166 (57%) participated in the second round. Metabolic (n = 74) and autoimmune diseases (n = 39) were ranked the highest for need for diagnostic support. For three diseases (i.e. scleroderma, Pompe’s disease, and pulmonary arterial hypertension), a crucial need for diagnostic support was explicitly stated. A typical experience of individuals with a rare disease was stigmatization of having psychological or psychosomatic problems. In addition, most experts endured an ‘odyssey’ of seeing many different medical specialists before a correct diagnosis (n = 38) was confirmed.

Conclusion

There is need for improving the diagnostic process in individuals with rare diseases. Shared experiences in individuals with a rare disease were observed, which could possibly be utilized for diagnostic support in the future.

Piloting a Coping Skills Group Intervention to Reduce Depression and Anxiety Symptoms in Patients Awaiting Kidney or Liver Transplant

The authors evaluated the use of a coping skills group (CSG) therapy intervention to decrease depression and anxiety and increase healthy coping skills in a population of kidney and liver transplant candidates. The study, using a pre-posttest design, piloted a CSG with a convenience sample of 41 consenting participants on a waiting list or in workup for kidney or liver transplant. Two transplant social workers led five eight-week closed psychoeducational groups. Coping skills, depression symptoms, and anxiety symptoms were assessed preintervention, postintervention, and at follow-up one month later. Results suggest that the CSG group created significant changes in some coping areas, such as decreasing the use of denial and self-blame and increasing the use of acceptance, religion, and instrumental supports. In this study, instrumental supports are strategies such as seeking assistance, finding information, or asking for advice about what to do. The effects on instrumental supports did not sustain at the one-month follow-up. Anxiety and depression scores were significantly reduced, and these changes were sustained at one-month follow-up. This study supports the use of a group-based psychosocial intervention for the pretransplant population and will be most relevant to social workers practicing in the transplant field.

Opinion Leaders in Online Cancer Support Groups: An Investigation of Their Antecedents and Consequences

With a focus on the nature and dynamic process of social interactions among breast cancer patients, this study argues that the notion of opinion leaders can be another crucial factor in explaining positive psychosocial health outcomes within computer-mediated social support (CMSS) groups. This study investigates the relationship between opinion leaders and their psychosocial health benefits by considering two overarching questions: (a) Who are the opinion leaders? (b) What role do these opinion leaders play in explaining health outcomes? The data analyzed in this study resulted from merging human-coded content analysis of discussion group messages, action log data analysis of interactive health system usage, and longitudinal survey data. Surveys were administered to 221 women with breast cancer; participants were provided free access to and training for the CMSS groups developed by the Comprehensive Health Support System (CHESS) project. The findings suggest that opinion leaders obtained psychosocial health benefits, such as higher levels of cancer information competence, breast cancer knowledge, and better problem-focused coping strategies. Those who had a higher baseline level of breast cancer knowledge and optimism in coping with challenges in their life were more likely to act as opinion leaders. Implications for research and improving psychosocial interventions for people with health concerns are discussed.