Effectiveness of an online short compassion strengths course on nursing students compassion: A mixed methods non-randomised pilot study

BACKGROUND

Although student nurses are expected to demonstrate and show understanding of compassion in their learning and practice, literature suggests that this is not always the case. To address this, nursing students need to be introduced to the value and behaviours of compassion during their education.

OBJECTIVES

To evaluate the effectiveness of an online course to help nursing students develop their strengths and further validate the Bolton Compassion Strengths Indicators.

DESIGN

A pre-and post-mixed methods non-randomised pilot study.

SETTING

A university in the north west of England.

PARTICIPANTS

A sample of first year undergraduate nursing students (67), in two groups, with 33 in the online control and 34 in the on-site group.

METHODS

Both groups took part in the Short Compassion Strengths Course (SCSC). The online group took the course in their own time over a 3-week period, while the on-site group completed the course during their time at University. In both groups baseline assessments were carried out using the Bolton Compassion Strengths Indicator (BCSI). Post-test data were collected 3 weeks after in the online group and immediately after in the on-site group, for the BCSI and reflective accounts. Data were analysed using ANOVA in SPSS27.

RESULTS

The online group did not complete the course but filled out the questionnaires. The on-site group had significantly higher scores on all indicators but self-care and engagement.

CONCLUSIONS

The SCSC is an effective course for teaching and developing compassion strengths when delivered on-site. This paper adds further validity for the BCSI.

Use of technology for public health surveillance reporting: opportunities, challenges and lessons learnt from Kenya

BACKGROUND

Effective public health surveillance systems are crucial for early detection and response to outbreaks. In 2016, Kenya transitioned its surveillance system from a standalone web-based surveillance system to the more sustainable and integrated District Health Information System 2 (DHIS2). As part of Global Health Security Agenda (GHSA) initiatives in Kenya, training on use of the new system was conducted among surveillance officers. We evaluated the surveillance indicators during the transition period in order to assess the impact of this training on surveillance metrics and identify challenges affecting reporting rates.

METHODS

From February to May 2017, we analysed surveillance data for 13 intervention and 13 comparison counties. An intervention county was defined as one that had received refresher training on DHIS2 while a comparison county was one that had not received training. We evaluated the impact of the training by analysing completeness and timeliness of reporting 15 weeks before and 12 weeks after the training. A chi-square test of independence was used to compare the reporting rates between the two groups. A structured questionnaire was administered to the training participants to assess the challenges affecting surveillance reporting.

RESULTS

The average completeness of reporting for the intervention counties increased from 45 to 62%, i.e. by 17 percentage points (95% CI 16.14-17.86) compared to an increase from 49 to 52% for the comparison group, i.e. by 3 percentage points (95% CI 2.23-3.77). The timeliness of reporting increased from 30 to 51%, i.e. by 21 percentage points (95% CI 20.16-21.84) for the intervention group, compared to an increase from 31 to 38% for the comparison group, i.e.by 7 percentage points (95% CI 6.27-7.73). Major challenges for the low reporting rates included lack of budget support from government, lack of airtime for reporting, health workers strike, health facilities not sending surveillance data, use of wrong denominator to calculate reporting rates and surveillance officers having other competing tasks.

CONCLUSIONS

Training plays an important role in improving public health surveillance reporting. However, to improve surveillance reporting rates to the desired national targets, other challenges affecting reporting must be identified and addressed accordingly.

Risk of cardiovascular disease among women with endometrial cancer compared to cancer-free women in the Women's Health Initiative

BACKGROUND

The majority of women diagnosed with endometrial cancer (EC) have low cancer-specific mortality; however, a high prevalence of cardiovascular disease (CVD) risk factors places EC patients at high risk of developing CVD. In the Women's Health Initiative (WHI), we assessed the hypothesis that CVD risk was higher among women who developed EC compared with women who did not develop EC.

METHODS

We compared the incidence of fatal and non-fatal CVD events among 1,179 women who developed Type I EC, 211 women who developed Type II EC, and 92,217 women who did not develop EC. We first estimated univariable cause-specific hazard ratios (CHRs) and 95% confidence intervals (CIs) for the association between an EC diagnosis (overall and by EC type) with CVD risk using Cox proportional hazards regression. Potential confounders were examined using a risk factor modeling approach; final multivariable-adjusted models included covariates that changed univariable CHRs for EC diagnosis by≥5%.

RESULTS

In multivariable-adjusted models, CVD risk did not significantly differ between women who developed EC compared to women who did not develop EC (CHR=1.01, 95% CI=0.87-1.16), particularly for the subgroup of women who developed Type I EC (CHR=0.98, 95% CI=0.84-1.14); however, there was a positive but statistically nonsignificant association for Type II EC (CHR=1.32, 95% CI=0.88-1.97).

CONCLUSION

Despite our null findings, women with EC should still receive counseling and support to make lifestyle changes aimed at reducing weight as appropriate, given the high prevalence of CVD risk factors at diagnosis.

Cardiovascular disease mortality among women with endometrial cancer in the Iowa Women's Health Study

PURPOSE

Obesity is associated with endometrial cancer (EC) development and cardiovascular disease (CVD) mortality. As the number of obese EC survivors continues to increase, an examination of CVD mortality in this vulnerable population is warranted.

METHODS

In the Iowa Women's Health Study (1986-2011), we examined CVD mortality among 552 women with EC compared with 2,352 age- and body mass index-matched women without EC (controls). Hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD mortality were estimated using multivariable-adjusted Cox proportional hazards regression models stratified by an indicator for match set.

RESULTS

Compared to controls, women with EC more often reported a history of diabetes, hypertension, and never smoking. Compared with controls, women with EC had lower CVD mortality (HR 0.75, 95% CI 0.56-0.99), and higher all-cause mortality (HR 1.50, 95% CI 1.30-1.74).

CONCLUSIONS

Although some CVD risk factors were more common in women with versus without EC, CVD mortality was lower among the former group. Additional well-adjusted analyses with larger study populations are needed to understand interactions between CVD risk factors with CVD mortality among EC survivors. The CVD risk factor profile of EC survivors warrants emphasis on cardiovascular health.

Choosing appropriate comparison group participants in studies of veterans: Characteristics of orthopedically injured and uninjured Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veterans

INTRODUCTION

Research addressing deployment-related traumatic brain injury (TBI) is fairly complex due to a high prevalence of comorbid conditions, multiple exposures, and the lack of acute medical records. Therefore, there is a need for a well-defined, matching comparison group. This study compared deployment-related characteristics, everyday functioning, and cognitive performance in recently deployed veterans who had not sustained any injuries with those who had orthopedic injuries during deployment, but who were without a history of TBI.

METHOD

Participants included 45 individuals who had been deployed and who were without injuries and a group of 27 individuals who reported at least one orthopedic injury during deployment. The Mayo-Portland Adaptability Inventory-4, Community Integration Questionnaire, Veterans RAND 36 Item Health Survey, Brief Pain Inventory, Barratt Impulsiveness Scale-11, and posttraumatic stress disorder (PTSD) Checklist-Civilian (PCL-C) were used to assess daily functioning. Cognitive performance was measured using the Controlled Oral Word Association Test, Trail Making Test, Color-Word Interference Test, and Verbal Selective Reminding Test. The two groups were compared using t tests based on equal variances. The effect size was calculated.

RESULTS

There were no between-group differences, with all variables having p-values >.1 and small to medium effect sizes.

DISCUSSION

Orthopedic injuries sustained during deployment that did not require evacuation or hospitalization did not have any lasting effect on participants' health, cognition, and daily functioning relative to other deployed individuals with no history of injury. These results indicate the two groups are comparable and that their data could be potentially combined to create a single comparison group. Due to the small sample available for this study, the current results are considered preliminary, and further investigation is needed.

Identifying effective behavioural components of Intervention and Comparison group support provided in SMOKing cEssation (IC-SMOKE) interventions: a systematic review protocol

BACKGROUND

Systematic reviews of behaviour change interventions for smoking cessation vary in scope, quality, and applicability. The current review aims to generate more accurate and useful findings by (1) a detailed analysis of intervention elements that change behaviour (i.e. behaviour change techniques (BCTs)) and potential moderators of behaviour change (i.e. other intervention and sample characteristics) and (2) assessing and controlling for variability in support provided to comparison groups in smoking cessation trials.

METHODS

A systematic review will be conducted of randomized controlled trials of behaviour change interventions for smoking cessation in adults (with or without pharmacological support), with a minimum follow-up of 6 months, published after 1995. Eligible articles will be identified through the Cochrane Tobacco Addiction Group Specialized Register. Study authors will be asked for detailed descriptions of smoking cessation support provided to intervention and comparison groups. All data will be independently coded by two researchers. The BCT taxonomy v1 (tailored to smoking cessation interventions) and template for intervention description and replication criteria will be used to code intervention characteristics. Data collection will further include sample and trial characteristics and outcome data (smoking cessation rates). Multilevel mixed-effects meta-regression models will be used to examine which BCTs and/or BCT clusters delivered to intervention and comparison groups explain smoking cessation rates in treatment arms (and effect sizes) and what key moderators of behaviour change are. Predicted effect sizes of each intervention will be computed assuming all interventions are compared against comparison groups receiving the same levels of behavioural support (i.e. low, medium, and high levels). Multi-disciplinary advisory board members (policymakers, health care providers, and (ex-)smokers) will provide strategic input throughout the project to ensure the review's applicability to policy and practice.

DISCUSSION

By capturing BCTs in intervention and comparison groups, this systematic review will provide more accurate estimates of the effectiveness of smoking cessation interventions, the most promising BCTs and/or BCT clusters associated with smoking cessation rates in intervention and comparison arms, and important moderators of behaviour change. The results could set new standards for conducting meta-analyses of behaviour change interventions and improve research, service delivery, and training in the area of smoking cessation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015025251.

Comparison communities in a cluster randomised trial innovate in response to 'being controlled'

We conducted qualitative interviews among primary health care teams and community agencies in eight communities in Victoria, Australia which had (1) agreed to be part of a universal primary care and community development intervention to reduce post natal depression and promote maternal health; and (2) were randomised to the comparison arm. The purpose was to document their experience with and interpretation of the trial. Although 'control' in a controlled trial refers to the control of confounding of the trial result by factors other than allocation to the intervention, participants interpreted 'control' to mean restrictions on what they were allowed to do during the trial period. They had agreed not to use the Edinburgh Post Natal Depression Scale or the SF 36 in clinical practice and not to implement any of the elements of the intervention. We found that no elements of the intervention were implemented. However, the extension of the trial from three to five years made the trial agreement a strain. The imposition of trial conditions also encouraged a degree of lateral thinking and innovation in service delivery (quality improvement). This may have potentially contributed to the null trial results. The observations invite interrogation of intervention theory and consequent rethinking of the way contamination in a cluster trial is defined.

Comparison groups in yoga research: a systematic review and critical evaluation of the literature

OBJECTIVES

Comparison groups are essential for accurate testing and interpretation of yoga intervention trials. However, selecting proper comparison groups is difficult because yoga comprises a very heterogeneous set of practices and its mechanisms of effect have not been conclusively established.

METHODS

We conducted a systematic review of the control and comparison groups used in published randomized controlled trials (RCTs) of yoga.

RESULTS

We located 128 RCTs that met our inclusion criteria; of these, 65 included only a passive control and 63 included at least one active comparison group. Primary comparison groups were physical exercise (43%), relaxation/meditation (20%), and education (16%). Studies rarely provided a strong rationale for choice of comparison. Considering year of publication, the use of active controls in yoga research appears to be slowly increasing over time.

CONCLUSIONS

Given that yoga has been established as a potentially powerful intervention, future research should use active control groups. Further, care is needed to select comparison conditions that help to isolate the specific mechanisms of yoga's effects.