Joining,belonging, and re-valuing: A process of meaning-making through group participation in a mental health lifestyle intervention

Background: Balancing Everyday Life (BEL), a new group-based intervention for mental health service users, was implemented in Sweden. Mental health service users often experience group interventions as meaningful, but knowledge of the process of meaning-making in a group is lacking.

Aim: To explore participants’ perceptions of the group in the Balancing Everyday Life (BEL) lifestyle intervention; specifically, personal experiences of what brings meaning when participating in a group.

Methods: This qualitative Grounded Theory study included 26 interviews with 19 BEL participants.

Results: A process of meaning-making in a group was constructed: Joining with others: from feeling alone to connected, A sense of belonging: mutual support and understanding, and Re-valuing Self: respect and self-worth. No longer feeling alone contributed to meaning. Peers and group leaders were considered important parts of the group, and participants appreciated feeling understood, respected, and helping others.

Conclusion: The proposed process of meaning-making, as well as ‘Joining’ as a unique step, seems to be new contributions which could help practitioners when organizing groups. Overcoming fear of joining could break a cycle of isolation and lead to connecting and belonging. The value of participants finding purpose through helping others should be further explored.     

Occupational Therapy Intervention: Effects on Self-Care,Performance, Satisfaction,Self-Esteem/Self-Efficacy,and Role Functioning of Older Hispanic Females with Arthritis

ABSTRACT

The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.     

Psychotherapeutic and vocational interventions among young adults with work disability due to mental disorders in Finland

Abstract

Backround: Little is known about treatment and rehabilitation received and planned among young adults with work disability due to a mental disorder.

Aims: To examine the implemented psychotherapeutic and vocational interventions and treatment plans among young adults with work disability due to a mental disorder.

Material and methods: Data were collected from medical records of young Finnish adults aged 18–34 with a long-term work disability history due to a mental disorder (N?=?1163). The participant characteristics associated with four types of interventions were analyzed using log-binomial regression analysis.

Results: In total, 34% had participated in a psychotherapeutic intervention. Of the non-students, 26% had participated in vocational intervention. For 46% of the non-students, neither type of intervention was planned. Both implemented and planned psychotherapeutic interventions were associated with female sex, high education, attachment to employment, and absence of substance abuse. Low education and childhood adversity were associated with implemented vocational interventions and absence of substance abuse with planned vocational interventions.

Conclusion and significance: There is an unmet need for psychotherapeutic interventions among men, among those with lower socio-economic status, and among those with poor attachment to labor market. In addition, there is a lack of vocational interventions for those with high education. People with substance abuse are largely excluded from both types of interventions.     

The Occupation-Based Intervention of Bathing: Cases in Home Health Care

Abstract

Although bathing skills can be an indicator of long term placement, documentation of occupational therapists doing bathing as an occupation-based intervention is limited. Five clients were referred to a hospital-based home health agency with various diagnoses and at different levels of functioning. Each client was assessed at admission and discharge using the Outcomes and Assessment Information Set and the occupational therapists used the Activities of daily living (ADL) of bathing as the intervention based on client centered expressed needs. Findings reveal a statistically significant change in individuals pre- and post-assessment of bathing (Z?=?–2.032, p?=?.042) supporting occupation-based interventions, specifically bathing, should be further researched as a means of significantly improving the functional status of clients.     

Feasibility and acceptability of a Mediterranean-style diet intervention to reduce cardiovascular risk for low income Hispanic American women

Objective: Evidence for the cardioprotective effects of a Mediterranean-style (Med-style) diet is strong, however few Med-style dietary interventions have been developed for and tested among Hispanic Americans (HAs), especially younger HAs of reproductive age whose dietary habits may strongly influence dietary intake for all family members.

Design: We adapted a previously tested and evidence-informed lifestyle intervention to reduce CVD risk and evaluated its feasibility, acceptability, and effects on self-reported lifestyle behaviors in this study enrolling low-income HA women attending a Title X family planning clinic in eastern North Carolina. The 3-month long intervention, given to all participants, promoted a Med-style dietary pattern with a focus on increasing consumption of foods commonly consumed by HA that have high quality dietary fats (polyunsaturated and monounsaturated fats primarily from plant sources and fish) and carbohydrates (fruits, vegetables, and whole grains). The intervention also recommended increasing physical activity and was given during 2 face-to-face counseling sessions and 2 telephone counseling sessions. Major outcomes were engagement with study activities and intervention acceptability; lifestyle behavior change at 3-month follow-up is also reported.

Results: Baseline characteristics (n?=?36) were: mean age 33 years, 35 (97%) without health insurance, 32 (89%) born in Mexico, and mean BMI 30?kg/m². Engagement was high among the 36 participants with 33 (92%) completing the intervention and follow-up measures. At follow-up, most participants thought the intervention was helpful (range: 85–100%) and acceptable (100% agreed ‘I would recommend the program to others’). The mean dietary fat quality score improved by 0.5 units (95% CI: 0.0–1.1) and the mean fruit-vegetable servings/day improved by 0.7/day (95% CI: 0.1–1.3).

Conclusion: Intervention engagement and acceptability were high and there was improvement in self-reported dietary behaviors. This type of Med-style dietary pattern intervention should be evaluated in randomized trials enrolling HAs at risk for CVD.     

Experiences of meaning of occupation at day centers among people with psychiatric disabilities

Abstract

Background: There is a need for intervention studies of persons with psychiatric disabilities who attend day centers (DCs).

Aim: The aim of this study was to investigate how people living with psychiatric disability experience and describe the meaning of occupation at DCs after taking part in an intervention.

Methods: An interpretative phenomenological approach was used and 11 participants in the intervention were interviewed.

Results: The superordinate theme describing the experienced meaning at the DC was As a substitute for work, and the sub-themes were; A feeling of belonging to a subculture; Flexibility and adaptation of occupation in accordance with the individual’s needs and recovery process; and Influence.

Conclusions: The results indicated that the intervention played an important role for the creation of meaning at the DC’s for the participants in their daily lives and appeared to promote their well-being. Activities that promoted structure and were experienced as work-like as well as activities that promoted social belonging and influence at the DC were experienced as meaningful. Further intervention studies are needed to gain more knowledge about how to tailor different approaches and activities at DCs in the municipalities that could be experienced as meaningful by their members.     

Impact of a person-centred group intervention on life satisfaction and engagement in activities among persons aging in the context of migration‡

Abstract

Background: There is a growing need to support the health and wellbeing of older persons aging in the context of migration.

Objectives: We evaluated whether a group-based health promotion program with person-centred approach, maintained or improved life satisfaction and engagement in activities of older immigrants in Sweden.

Methods: A randomised controlled trial with post-intervention follow-ups at 6 months and 1 year was conducted with 131 older independently living persons aged ≥70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and a follow-up home visit) and a control group (no intervention). Outcome measures were life satisfaction and engagement in activities. Chi-square and odds ratios were calculated.

Results: The odds ratios for maintenance or improvement of life satisfaction (for social contact and psychological health) were higher in the person-centred intervention group. More participants in the intervention group maintained or improved their general participation in activities compared with the control group. However, no significant between-group differences were found.

Conclusion: Person-centred interventions can support older person’s capability to maintain their health in daily life when aging in migration. Further research is needed with a larger sample and longer intervention period to determine the effectiveness of the intervention.     

Mental health and psychosocial support needs among people displaced by Boko Haram in Nigeria

ABSTRACT

Since 2013, the Boko Haram insurgency in Nigeria has left almost 2 million people displaced and 10 million in need of life-saving services. While the humanitarian response has focused on provision of food, shelter, and physical health needs, mental health needs remain largely overlooked. This mixed-methods project explored the mental health and psychosocial (MHPS) burden, existing resources and coping mechanisms, and remaining needs among internally displaced persons (IDPs) and host communities in Borno State, Nigeria. Survey findings reveal a high burden of mental health needs: 60% of participants strongly endorsed at least one mental health symptom, and 75% endorsed functional impairment associated with mental health symptoms. Unexpectedly, we found that adult men had the highest rates of symptom burden, suggesting that typical approaches focusing on women and children would miss this vulnerable population. Qualitative findings (free lists, interviews, focus group discussions) reflect MHPS needs that could be addressed through solutions-focused approaches, although tailored interventions would be needed to support stigmatised and vulnerable groups such as drug users and rape victims. Finally, participants emphasised the breakdown of community and political leadership structures, as well as of economic and livelihood activities, suggesting that MHPS interventions should focus on restoring these key resources.     

Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults

Objectives. To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults.

Design. Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina.

Intervention. The culturally adapted behavioral intervention consisted of six weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally appropriate food choices, and physical activity.

Main outcomes. Systolic blood pressure (BP), weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted.

Results. There were 64 potential participants identified via healthcare provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants ‘strongly agreed/agreed’ that the group sessions provided them with the tools they needed to achieve weight loss, BP control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic BP decreased an average of ?10.4±10.6 mmHg, weight decreased 1.5±3.2 lbs, BMI decreased 0.3±0.5, and physical activity increased 40 minutes per week.

Conclusion. Our findings suggest that lifestyle interventions for preventing and treating hypertension are feasible and potentially effective in the Hispanic/Latino population.     

Being visible: PhotoVoice as assessment for children in a school-based psychiatric setting

Background: Recovery-oriented mental health services empower all clients, including youth and their families, to be actively involved in directing their own care. In order to develop person-driven interventions, clinicians must understand what matters from their perspective. Thus, recovery-oriented assessments need self-report measures that adequately capture the domains and content that matter to a range of particular persons.

Aim: This study examined if and how PhotoVoice, a participatory research method used to empower and highlight the unique experiences of vulnerable groups, could be used as a recovery-oriented self-report measure for children with a mental health disorder.

Methods: We used PhotoVoice to engage four children with mental health related disorders at a day hospital program for severe behavioural disorders. The children, as co-researchers in this participatory approach, created life books from photographs and images of what mattered to them across nine sessions. To examine the PhotoVoice process, we used ethnographic methods, including child interviews and participant observations in their classes and at recess before, during and after the weekly sessions. Our overarching narrative-phenomenological theoretical framework focused data collection and analysis on what mattered most to the children.

Results: The PhotoVoice method engaged and empowered the children in articulating what mattered in their everyday lives from their perspective that resulted in a novel, child-generated domain of ‘mattering to others’ for future self-report measures, and facilitated changes that generalized outside of the group. We illustrate these results by drawing a particularly illustrative case example from the study.

Conclusion: The PhotoVoice method foregrounded children’s perspectives on what matters more explicitly than clinical or parent perspective on function.

Significance: The participatory philosophy and methods of PhotoVoice provides a viable approach to recovery-oriented self-report measures as well as an occupation-based assessment and intervention.     

‘It helps me make sense of the world’: the role of an art intervention for promoting health and wellbeing in primary care—perspectives of patients, health professionals and artists

Background

Art interventions are increasingly used in public health for the enhancement of patients’ health and wellbeing. The present study investigated perceived outcomes and role of an art intervention from the collective perspectives of participants (patients who took part), deliverers (artists) and referrers (general practitioners and practice nurses).

Methods

A qualitative methodology, using interviews and focus groups, allowed investigation of participants (n?=?18) perceived outcomes and role of the intervention. Participants included patients (n?=?10), artists (n?=?5), and referring health professionals (n?=?3).

Results

Themes that emerged from the analysis included perceived benefits, role and value of the intervention, and setting and referral process. Central to these themes were psychological and mental health benefits, an appreciated holistic treatment option and the merits of the intervention being situated in the surgery setting.

Conclusions

The study showed that art interventions within primary care are valuable in the promotion of public health, and in particular, patients’ mental health. Interactions between other participants and the artist were central to achieving patients’ perceived health improvement. Locating the intervention in primary care facilitated patient participation and provided health professionals with a holistic treatment alternative. There is also some evidence that participation in the intervention encourages less dependence on the health professional.     

A randomised controlled trial of postural interventions for prevention of musculoskeletal symptoms among computer users

Aims: To examine the effect of two workstation and postural interventions on the incidence of musculoskeletal symptoms among computer users.

Methods: Randomised controlled trial of two distinct workstation and postural interventions (an alternate intervention and a conventional intervention) among 376 persons using computer keyboards for more than 15 hours per week. The incidence of neck/shoulder symptoms and hand/arm symptoms during six months of follow up among individuals in the intervention groups was compared to the incidence in computer users who did not receive an intervention (comparison group). For individuals in the intervention groups, study staff adjusted workstations, where possible, and trained individuals to assume the intervention postures. Individuals reported musculoskeletal symptoms in a weekly diary. Participants who reported discomfort intensity of 6 or greater on a 0–10 visual analogue scale or who reported musculoskeletal symptoms requiring use of analgesic medication were considered symptomatic.

Results: There were no significant differences in the incidence of musculoskeletal symptoms among the three intervention groups. Twenty two (18.5%) participants in the alternate intervention group, 25 (20.2%) in the conventional intervention group, and 25 (21.7%) in the comparison group developed incident arm or hand symptoms. Thirty eight (33.3%) participants in the alternate intervention group, 36 (31.0%) in the conventional intervention group, and 33 (30.3%) in the comparison group developed incident neck or shoulder symptoms. Compliance with all components of the intervention was attained for only 25–38% of individuals, due mainly to the inflexibility of workstation configurations.

Conclusions: This study provides evidence that two specific workplace postural interventions are unlikely to reduce the risk of upper extremity musculoskeletal symptoms among computer users.

     

Enjoyable company in sharing stroke experiences; - lifestyle groups after stroke

Background: Even people with mild to moderate stroke will experience changes in their abilities to perform everyday occupations. Group interventions may be appropriate in late-stage rehabilitation. The aim of this study was to explore how the participants involved themselves in person-centered lifestyle groups after stroke in Norway.

Method: Semi-structured interviews were performed with six older adults with mild-to-moderate stroke who had participated in lifestyle groups over a period of nine months. The interviews were analyzed using qualitative content analysis.

Results: The participants involved themselves in the lifestyle groups in a variety of ways by creating enjoyable company in sharing stroke experiences, sharing knowledgeable interest, pushing and forcing each other forward and reflecting on self-worth. Through doing group activities together, they created various ways of being, belonging and becoming, addressing development of strategies for regaining self-belief and a sense of autonomy, and for adapting to everyday life post-stroke.

Conclusion: The participants were active contributors in the groups and pushed each other and themselves regarding involvement in meaningful occupations. This active participation seemed to bring the participants’ resources into focus and contrasted with the frequent negative perceptions of people post-stroke as ‘victims’.     

NEWS

Background: Psychosocial factors such as depressive symptoms should be considered when assessing cardiovascular (CV) risk. Depressive symptoms are suggested to be associated with poor perception of one’s health, i.e. self-rated health (SRH). Thus, assessing SRH could be a practical tool in CV risk prediction. However, SRH may also emphasize physical, mental or social aspects.

Objectives: To assess the relationship of SRH and depressive symptoms, classic CV risk factors and perceived physical health among persons at risk for type 2 diabetes (T2D) and cardiovascular disease (CVD).

Methods: In this cross-sectional study in a primary care population, 2555 persons (mean age 58?±?7, 56% women) at risk for T2D or CVD were evaluated. Generalized linear statistical models were used to evaluate the association of depressive symptoms (Beck’s Depression Inventory score ≥10), CV risk factors, and perception of SRH and physical health (assessed by Short Form Health Survey).

Results: Poor or fair health was reported by 40% of the participants. They had more unhealthy lifestyle habits and CV risk factors than subjects rating their health as at least good. Among those with poor or fair SRH, the prevalence of depressive symptoms was 36% and associated with perception of physical health.

Conclusion: Poor SRH is associated with depressive symptoms and impaired perceived physical health. Assessing SRH might be useful for detecting possible depressive symptoms in patients in CV risk management and diabetes care.     

Low baseline awareness of gastric cancer risk factors amongst at-risk multiracial/ethnic populations in New York City: results of a targeted,culturally sensitive pilot gastric cancer community outreach program

ABSTRACT

Background and Aims: There are limited efforts to address modifiable risk factors for gastric cancer (GC) among racial/ethnic groups at higher GC risk, which may reflect decreased public awareness of risk factors. Our primary aim was to assess baseline awareness of GC risk factors and attitudes/potential barriers for uptake of a GC screening program among high-risk individuals.

Methods: Participants attended a linguistically and culturally targeted GC educational program in East Harlem (EH)/Bronx and Chinatown communities in New York City. Demographic information and relevant behavioral/lifestyle habits were collected. Participants’ ability to identify GC risk factors and attitudes/barriers surrounding GC screening were assessed before and after the program.

Results: Of the 168 included participants, most were female with 77% above age 70. Nearly half of participants in the EH/Bronx programs identified themselves as black and 63% as Hispanic/Latino; 93% of the Chinatown participants identified as Chinese. Among EH/Bronx participants, the majority correctly identified older age, smoking, alcohol, H. pylori, family history, race/ethnicity, excess salt, and preserved foods as risk factors. Among Chinatown participants, the majority correctly identified smoking, alcohol, race/ethnicity, and excess salt, although only 53% and 57.8% correctly identified H. pylori and preserved foods, respectively; the majority incorrectly answered that older age was not a major risk factor. The majority in both groups failed to identify male gender as higher risk and incorrectly identified stress and obesity as major risk factors. Participants were more concerned about the potential findings on GC screening tests than the risks and costs or having to take time off work.

Conclusion: Among multiracial/ethnic groups of individuals presumably at higher risk for GC, we identified several gaps in baseline knowledge of both modifiable and non-modifiable GC risk factors. Culturally and linguistically appropriate educational interventions may be a worthwhile adjunctive intervention within the context of a targeted GC screening program.     

Differences among participants’ response to a wellness intervention for individuals with spinal cord injuries

BackgroundIndividuals with spinal cord injuries (SCI) often struggle with lifestyle adjustment following injury. Effective wellness interventions may aid in improving quality of life; however, treatment response heterogeneity is a concern for behavioral interventions.ObjectiveTo identify differences among adults with SCI who were responders and non-responders in a wellness intervention.MethodsThere were 29 persons with SCI who received a wellness intervention. Participants engaged in six in-person workshops over a 3-month period, led by wellness experts with peer mentors available. Individual intervention participant change was compared to the mean among control group participants target outcomes variables (i.e., satisfaction with life, self-efficacy for health practices, secondary conditions, health promoting behaviors, and perceived stress) to classify responders versus non-responders.ResultsOf the 29 participants, 18 who completed the intervention were classified as responders and 11 were non-responders. The mean age was 43.2 ± 11.2 years, and years post-injury were 12.0 ± 9.8. Decision tree regression analysis for demographic variables and injury characteristics showed that single/divorced participants were more likely to not respond to the intervention (52%), compared to married participants (17%). Further, participants who were single/divorced and ≤50 years old were more likely to not respond to the intervention (62%) than those who were older (25%).ConclusionsSingle/divorced individuals with SCI may respond differently to behavioral wellness interventions than married individuals. Additionally, the effects of age on treatment response in behavioral interventions should be further examined. Identifying non-modifiable factors related to response heterogeneity may help guide the creation of tailored interventions specific to patient characteristics.