Evaluation of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women: A randomised controlled trial

Objective

This study investigated the effects of an interpersonal-psychotherapy-oriented childbirth psychoeducation programme on postnatal depression, psychological well-being and satisfaction with interpersonal relationships in Chinese first-time childbearing women.

Method

A randomised, controlled trial was conducted in the maternity clinic of a regional hospital in China. The intervention was based on the principles of interpersonal psychotherapy, and consisted of two 90-min antenatal classes and a telephone follow-up within 2 weeks after delivery. One hundred and ninety-four first-time pregnant women were randomly assigned to the intervention group (n = 96) or a control group (n = 98). Outcomes of the study included symptoms of postnatal depression, psychological well-being and satisfaction with interpersonal relationships, which were measured by the Edinburgh Postnatal Depression Scale (EPDS), General Health Questionnaire (GHQ) and Satisfaction with Interpersonal Relationships Scale (SWIRS), respectively.

Results

Women receiving the childbirth psychoeducation programme had significantly better psychological well-being (t = −3.33, p = 0.001), fewer depressive symptoms (t = −3.76, p = 0.000) and better interpersonal relationships (t = 3.25, p = 0.001) at 6 weeks postpartum as compared with those who received only routine childbirth education.

Conclusion

An interpersonal-psychotherapy-oriented childbirth psychoeducation programme could be implemented as routine childbirth education with ongoing evaluation. Replication of this study with more diverse study groups, such as mothers with high risks to depression, those with multiple, complicated or multiparas pregnancies, would provide further information about the effects of the programme.     

Effects of a cultural competence education programme on clinical nurses: A randomised controlled trial

BackgroundThe cultural competence education programme for health professionals aimed to ensure that all people receive effective health care, particularly those from culturally diverse backgrounds.ObjectivesThe purpose of this study was to investigate the effect of a cultural competence educational course on nurses' self-assessment of their cultural competence.DesignA single-blind, randomised control trial design was employed.Participants and settingsEligible nurses were recruited from a northern Taiwan medical centre with 2089 beds.MethodsA permuted block of four was used to randomly assign participants to the experimental (n = 47) and control groups (n = 50). The educational course comprised four units and was conducted once weekly for four weeks, with each session lasting 3 h.ResultsA significant group-time interaction was identified regarding self-learning cultural ability, verifying the education intervention's effect on self-learning cultural ability after a two-month intervention. In addition, a significant main effect over time was discovered for total cultural competence; there was no significant interaction effect.ConclusionsThe study provided evidence that an educational programme effectively improved cultural competence in clinical nurses. The results provide a reference for health care providers to design in-service cultural competence education for improving quality of care.     

The effectiveness of a self-efficacy-enhancing intervention for Chinese patients with colorectal cancer: A randomized controlled trial with 6-month follow up

Background

Colorectal cancer is a major public health problem. There is growing support for colorectal cancer survivors who are experiencing problems after cancer treatment to engage in self-management programs to reduce symptom distress. However, there is inconclusive evidence as to the effectiveness of such program especially in Asian region.

Objectives

This study tested the effects of a six-month nurse-led self-efficacy-enhancing intervention for patients with colorectal cancer, compared with routine care over a six-month follow up.

Design

A randomized controlled trial with repeated measures, two-group design.

Setting

Three teaching hospitals in Guangzhou, China.

Participants:

One hundred and fifty-two Chinese adult patients with a diagnosis of colorectal cancer were recruited. The intervention group (n = 76) received self-efficacy-enhancing intervention and the control group (n = 76) received standard care.

Method

The participants were randomized into either intervention or control group after baseline measures. The outcomes of the study (self-efficacy, symptom distress, anxiety, depression and quality of life) were compared at baseline, three and six months after the intervention.

Results

Sixty-eight participants in the intervention group and 53 in the control group completed the study. Their mean age was 53 (SD = 11.3). Repeated measure MANOVA found that the patients in the intervention group had significant improvement in their self-efficacy (F = 7.26, p = 0.003) and a reduction of symptom severity (F = 5.30, p = 0.01), symptom interference (F = 4.06, p = 0.025), anxiety (F = 6.04, p = 0.006) and depression (F = 6.96, p = 0.003) at three and six months, compared with the control group. However, no statistically significant main effect was observed in quality of life perception between the two groups.

Conclusions

The nurse-led self-efficacy enhancing intervention was effective in promoting self-efficacy and psychological well-being in patients with colorectal cancer, compared with standard care. The intervention can be incorporated into routine care. Future empirical work is required to determine the longer term effects of the intervention.     

The effectiveness of an osteoporosis prevention education programme for women in Hong Kong: a randomized controlled trial

Aims. The purpose of this study was to evaluate whether a nurse‐initiated education programme on four specific osteoporosis‐prevention related behaviours leads to their adoption or positive attitude changes compared with women who did not participate in this programme. Research method. The design was a randomized controlled design and the setting was a local private beauty clinic. Outcome measures. Pre‐, post‐ and follow‐up education data compared attitudes and consumption frequency before and after the education programme. Results. The results showed significant increases in the reported follow‐up for each behaviour: consumption of soya foods (mean = 4·3, SD = 0·5), milk (mean = 4·2, SD = 0·8), more exercise (mean = 4·3, SD = 0·5) and vitamin D/exposure to sunlight (mean = 4·2, SD = 0·9) for subjects in the case group compared with control group subjects (soya foods: mean = 3·3, SD = 0·9, P < 0·001; milk: mean = 3·0, SD = 0·9, P < 0·001; more exercise: mean = 3·4, SD = 1·0, P = 0·003; vitamin D/sunlight: mean = 2·7, SD = 0·9, P < 0·00). Most of the participants either disagreed (n = 11, 55·0%) or strongly disagreed (n = 9, 45·0%) that there was not enough information provided in the education programme to motivate them to change. On the satisfaction score, they rated the nurse's performance as either satisfactory (n = 11, 55·0%) or very satisfactory (n = 9, 45·0%) on presentation and ability to answer their questions and either satisfactory (n = 12, 60·0%) or very satisfactory (n = 8, 40·0%) on ability to describe each behaviour clearly. Conclusion. A targeted education programme conducted with Hong Kong women resulted in significantly increased consumption of calcium including soya‐based foods, milk and vitamin D. According to the reported attitudinal and behavioural intentions, participants’ positive feedback suggests that women who participated in this educational programme were motivated to make changes and benefited from the support of this nurse‐initiated education programme. Relevance to clinical practice. Osteoporosis was a serious health concern that most commonly affected women. As indicated by the results of this study, this educational programme can act as simple but effective nursing intervention to promote women's attitudinal and behavioural intentions towards osteoporosis‐prevention.     

Development and evaluation of a childbirth education programme for Malawian women

AIM: This paper is a report of a study to develop and evaluate a childbirth educational programme for Malawian women. BACKGROUND: Providing parent education is integral to the midwife's role. Malawian midwives face a challenge in fulfilling this role, with no existing childbirth education programme to facilitate this process. METHOD: A mixed method approach was used for this three-phase study. In Phase 1, childbirth information needs of Malawian women were determined from literature and interviews with midwives. In Phase 2, a structured childbirth education programme was developed. In Phase 3, a quasi-experimental design using sequential sampling was conducted to evaluate the education programme. Participants were pregnant women who attended antenatal clinics in 2002, with 104 in the control group and 105 in the intervention group. Changes in childbirth knowledge were determined over a 6-week period. FINDINGS: The childbirth education programme included information, teaching strategies and a schedule for implementation for content relevant to the antenatal, labour and birth and postnatal time periods. Results revealed no significant difference in knowledge in the control group between pretest and post-test scores. For the intervention group, however, an overall significant increase in knowledge across all time periods was demonstrated (P < 0.01). CONCLUSION: A childbirth education programme, developed for the Malawian context, was associated with important increases in maternal knowledge about antenatal, labour and birth and postnatal topics. The findings have implications for midwives in other developing countries and offer an example of a midwifery-led initiative to provide formal childbirth education to these vulnerable women.     

The effectiveness of a Chinese midwives’ antenatal clinic service on childbirth outcomes for primipare: A randomised controlled trial

Background

Antenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China.

Objective

(1) To develop and implement a model of Chinese midwives’ antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae.

Design and methods

Two-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives’ antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives’ antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives’ antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared.

Setting

The midwives’ antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.

Participants

55 women, attending the midwives’ antenatal clinic (the intervention group) and 55 women, entering the control group.

Results

Women in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69–41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2 h post partum.

Conclusion and implications for practice

The midwives’ antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.     

Breast cancer follow up: A randomised controlled trial comparing point of need access versus routine 6-monthly clinical review

AimTo examine a model of care for breast cancer patients based on the concept of point of need access and investigate the effectiveness of this model compared to routine 6-monthly clinical reviews.DesignA parallel randomised controlled trial was used to examine point of need access to specialist care via the nurse specialist, compared to routine hospital based 6-monthly clinical review at year two post breast cancer diagnosis. A total of 237 patients were recruited to the study.MethodsOutcome measures at baseline, 9 and 18 months included psychological morbidity using the GHQ12 questionnaire, quality of life using the FACT-B plus endocrine subscale, fear and isolation. An analysis of covariance was used to detect changes over time. Recurrences and methods of detection were recorded as secondary outcome measures.ResultsTwo hundred and fourteen patients completed the study. Overall patients were not exposed to risks of increased psychological morbidity (p = 0.767) or decline of quality of life (p = 0.282) when routine review was discontinued and no significant differences were detected during an 18-month period. Patients not receiving regular review did not feel isolated, and at the end of 18 months did not wish to return to 6-monthly clinical reviews. The presentation of recurrences and short symptom history demonstrate that the recurrences observed were unlikely to have been detected at a routine visit.ConclusionsPoint of need access is acceptable to the majority of patients. Although a third of patients may wish to maintain a regular review, patient choice is important. Findings suggest that after 2 years following the diagnosis of breast cancer there is no evidence to support the view that regular clinical review improves psychological morbidity or quality of life. Patients do not appear to be compromised in terms of early detection of recurrence. Point of need access can be provided by suitably trained specialist nurses and provides a fast, responsive management system at a time when patients really need it.     

Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial

Aims and objectives. To evaluate the effect of a group‐based multi‐professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi‐professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R² = 0·35) and depression (p = 0·021, R² = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). Conclusion. Improved disease‐related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.     

The effectiveness of manual-guided,problem-solving-based self-learning programme for family caregivers of people with recent-onset psychosis: A randomised controlled trial with 6-month follow-up

BackgroundFamily intervention for psychotic disorders is an integral part of psychiatric treatment with positive effects on patients’ mental state and relapse rate. However, the effect of such family-based intervention on caregivers’ psychological distress and well-being, especially in non-Western countries, has received comparatively much less attention.ObjectivesTo test the effects of guided problem-solving-based manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis over a 6-month period of follow-up, when compared with those in usual family support service.DesignA single-centre randomised controlled trial, which was registered at ClinicalTrials.gov (NCT02391649), with a repeated-measures, two-arm (parallel-group) design.SettingsOne main psychiatric outpatient clinic in the New Territories of Hong Kong.ParticipantsA random sample of 116 family caregiverss of adult outpatients with recent-onset psychosis.MethodsFollowing pre-test measurement, caregivers were assigned randomly to one of two study groups: a 5-month self-help, problem-solving-based manual-guided self-learning (or bibliotherapy) programme (in addition to usual care), or usual family support service only. Varieties of patient and caregiver health outcomes were assessed and compared at baseline and at 1-week and 6-month post-intervention.ResultsOne hundred and eleven (96%) caregivers completed the 6-month follow-up (two post-tests); 55 of them (95%) completed ≥4 modules and attended ≥2 review sessions (i.e., 75% of the intervention). The family participants’ mean age was about 38 years and over 64% of them were female and patient's parent or spouse. Multivariate analyses of variance indicated that the manual-guided self-learning group reported significantly greater improvements than the usual care group in family burden [F(1,110) = 6.21, p = 0.006] and caregiving experience [F(1,110) = 6.88, p = 0.0004], and patients’ psychotic symptoms [F(1,110) = 6.25, p = 0.0003], functioning [F(1,110) = 7.01, p = 0.0005] and number of hospitalisations [F(1,110) = 5.71, p = 0.005] over 6-month follow-up.ConclusionsProblem-solving-based, manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis can be an effective self-help programme and provide medium-term benefits to patients’ and caregivers’ mental health and duration of patients’ re-hospitalisations.     

Effects of a postdischarge transitional care programme for patients with coronary heart disease in China: a randomised controlled trial

Aim. To test the effects of a postdischarge transitional care programme among patients with coronary heart disease. Background. Coronary heart disease is a leading cause of death worldwide. Effective postdischarge care can help patients maintain a healthy lifestyle and thereby control the risk factors. Transitional care is under‐developed in mainland China. Design. A randomised controlled trial. Method. The control group (n = 100) received routine care and the study group (n = 100) received the postdischarge transitional care programme, which consisted of predischarge assessment, structured home visits and telephone follow‐ups within four weeks after discharge. Subjects were recruited in 2002–2003, with data collected at baseline before discharge, two days and four and 12 weeks after discharge. Results. Participants in the study group had significantly better understanding in diet, medications and health‐related lifestyle behaviour at day 2 and in weeks 4 and 12 and better understanding in exercise at weeks 4 and 12. There were significant differences between the control and study groups in diet and health‐related lifestyle at day 2 and weeks 4 and 12, in medication at weeks 4 and 12 and exercise at week 12. There was no difference in hospital readmission between the two groups. The study group was very satisfied with the care. There was no difference in willingness to pay for nurse follow‐up services between groups. Conclusion. This study is an original effort to establish and test a nurse‐led transitional care model in China. Results demonstrate that transitional care is effective in mainland China, concurring with studies done elsewhere. Relevance to clinical practice. This study has constructed a transitional care model for patients with coronary heart disease in the context of the Chinese population which is effective in enhancing healthy lifestyle among these patients.     

Effects of a water-based program on women 65 years and over: a randomised controlled trial

The purpose of this study was to assess the effects of a water-based exercise and self-management program on balance, fear of falling, and quality of life in community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis. Fifty women with an average age of 73.3 years (range 65.5-82.4, SD 3.9) were randomised to intervention or control groups. The intervention group received a 10-week water-based exercise and self-management program compiled by Community Physiotherapy Services and conducted by a physiotherapist at an aquatic centre twice a week for one hour. The control group did not receive any instructions and were not encouraged to change their physical activity, activities of daily living or social habits during the study. Change in balance, measured using the step test, from baseline to follow-up differed between intervention and control groups, with mean (95% CI) between-group differences of 1.7 (0.9 to 2.6) and 2.1 (1.1 to 3.1) steps on the left and right sides respectively. Between-group differences in score changes were also significant in four of the eight domains of quality of life measured using the Short Form 36 questionnaire (SF36; physical function 8.6 (0.4 to 16.8), vitality 12.0 (2.3 to 21.8), social function, and 14.1 (0.6 to 27.7) mental health 10.2 (2.0 to 18.4)), but not fear of falling measured using the modified falls efficacy scale (0.25 (-0.3 to 0.81). It is concluded that a water-based exercise and self-management program produced significant changes in balance and quality of life, but not fear of falling, in this group of community-dwelling women 65 years of age or older with a diagnosis of osteopenia or osteoporosis.     

Parents Plus parenting programme for parents of adolescents with intellectual disabilities: A cluster randomised controlled trial

Objective

This study evaluated the effectiveness of the Parents Plus Special Needs (PPSN) programme, a seven-week parenting group intervention for parents of adolescents with intellectual disabilities.

Method

In a cluster randomised controlled trial, 24 intellectual disability services supporting families of adolescents with an intellectual disability were assigned to PPSN (12 services; 141 parents) or waitlist control group (12 services; 136 parents). Primary outcomes were parent-reported parenting practices, family adjustment, problem behaviours, emotional problems, and prosocial behaviours. Secondary outcomes were parental satisfaction, parental self-efficacy, and goal attainment.

Results

Compared to the waitlist group, participants in the PPSN group reported improvements in parenting practices, problem behaviours, parental satisfaction, parental self-efficacy and goal attainment, which were retained at 3-month follow-up. There were additional gains for family adjustment at follow-up.

Conclusion

The PPSN is effective in improving parenting behaviour, family relationships, and problem behaviours in adolescents, but not in improving emotional difficulties.     

The effectiveness of mutual support group intervention for Chinese families of people with schizophrenia: A randomised controlled trial with 24-month follow-up

Background

Positive effects on the relapse from illness and compliance with medication by patients have been observed from family intervention for schizophrenia. However, little attention has been paid to the effects on family members, particularly those in non-Western countries. Inconsistent and inconclusive findings were found on the family-related outcomes and longer-term effects of family intervention.

Objective

This study tested the effects of a nine-month family-led mutual support group for Chinese people with schizophrenia, compared with a psycho-education group and standard psychiatric care over a 24-month follow-up.

Design

A randomised controlled trial [registered with ClinicalTrials.gov (NCT00940394)] with repeated-measures, three-group design.

Settings

Two regional psychiatric outpatient clinics in Hong Kong.

Participants

One hundred and thirty-five Chinese family caregivers and their patients with schizophrenia were randomly recruited, of whom 45 family dyads received family-led mutual support group, a psycho-education group, or standard care.

Methods

After completing the pre-test questionnaire, the participants were randomly assigned into one of the three study groups. The mutual support and psycho-education groups comprised 14 two-hour group sessions, with patients participating in at least 5 sessions. Those in standard care (and two treatment groups) received routine psychiatric care. Multiple patient and family-related psychosocial outcomes were compared at recruitment and at one week, 12 months, and 24 months following interventions.

Results

One hundred and twenty-six of 135 family dyads completed the three post-tests and 43 (95.6%) attended at least nine group sessions (60%) of the mutual support group programme. Mean ages of the family caregivers in the study ranged from 41.2 (SD = 7.0) to 42.7 (SD = 7.6) years. About two-thirds of the caregivers were male and patients’ parent or spouse. The results of multivariate analysis of variance followed by Helmert contrasts tests indicated that the participants in the mutual support group indicated significantly greater improvement in family and patient functioning [F(2, 132) = 5.40, p = 0.005 and F(2, 132) = 6.88, p = 0.001, respectively] and social support for families [F(2, 131) = 5.01, p = 0.005], and in reducing patients’ symptom severity [F(2, 132) = 4.65, p = 0.01] and length of re-hospitalisations [F(2, 132) = 4.78, p = 0.01] at 12- and 24-month follow-ups.

Conclusions

Family-led mutual support group for schizophrenia produces longer-term benefits to both the patients’ and families’ functioning and relapse prevention for patients, compared with psycho-education and standard care. This group programme can be an effective family intervention for Chinese people with schizophrenia.     

A controlled trial of a needs‐based,nurse‐led psychoeducation programme for Chinese patients with first‐onset mental disorders: 6 month follow up

The study reported herein a randomized controlled trial was conducted to test the effectiveness of a nurse‐led, needs‐based psycho‐education program for Chinese patients with first‐onset mental illness over a 6‐month follow‐up. Ninety‐six families of Chinese patients with schizophrenia newly referred to one outpatient clinic in Hong Kong were randomly assigned to a nurse‐led psycho‐education program or usual outpatient care, each comprising 48 subjects. The patients’ mental health, illness insight, self‐efficacy, services utilization, and hospitalization rates were measured at recruitment and at one week and six months post‐intervention. The patients in the psycho‐education program reported significantly greater improvements in mental health, insights into treatment and illness, and hospitalization rates over the 6‐month follow‐up, when compared with those who received usual care. The findings provide evidence that the needs‐based, nurse‐led psycho‐education program can improve the health conditions and treatment insights of Chinese out‐patients with first‐onset mental illness.