Enhancing motivation to change in eating disorders with an online self‐help program

Ambivalence to change is a major obstacle to treating people with eating disorders. Enhancing motivation to change can contribute to recovery from the disorders. This study used an Internet‐based self‐help program developed in the Asia–Pacific region to identify the motivational stages of change in people with eating disorders. It explored their perceptions of the benefits and costs of taking action against their eating disorders, and assessed their involvement in motivational enhancement exercises and their improvement in eating disorder psychopathology. A total of 185 participants, aged 16–50 years (mean age, 26.5) were involved in the open‐trial program with a motivational enhancement component and completed the Motivational Stages of Change Questionnaire (MSCARED), the Eating Disorder Examination Questionnaire version 5 (EDE‐Q5) and the Eating Disorder Inventory version 3 (EDI‐3). The results show that more participants perceived the benefits of taking action against their eating disorders than the costs. Completer analysis shows that they experienced significant improvement in motivational stages of change and eating disorder psychopathology, from a baseline assessment to 1‐month and 3‐month follow ups. The self‐help program has potential benefit for people with eating disorders and its use could be encouraged by health‐care professionals to enhance the motivation to change and facilitate recovery.     

Evaluation of a bibliotherapy manual for reducing psychological distress in people with depression: a randomized controlled trial

Aim. This article reports a study to evaluate the efficacy of a self‐help manual in reducing psychological distress in individuals with moderate depression. Background. The prevalence of depression in Thailand is increasing markedly (e.g. from 56–197 per 100,000 population between 1997–2007). Design. We conducted a randomized controlled trial with 54 outpatients with depression in Chiang Mai Province in Thailand. Method. Participants were assigned randomly to an intervention or control group. The intervention group participants were given a self‐help manual in addition to standard care and treatment while the control group received standard care and treatment. Psychological distress was measured with the Kessler Psychological Distress Scale. Data were collected between October 2007–April 2008. Results. The findings showed statistically significant differences between both groups in their levels of psychological distress (e.g. tiredness, hopelessness, restlessness). At post‐test, the distress scores of the intervention group were lower than those in the control group. Between post‐test and 1‐month follow‐up, distress scores continued to decrease steadily in the intervention group but only decreased slightly in the control group. Conclusion. The findings affirm the benefits of bibliotherapy or self‐help therapy in book form in helping to reduce psychological distress in people with moderate depression. The approach is easy to use and can be incorporated as an adjunct to standard care and treatment. Bibliotherapy can be used by community mental health nurses and other clinicians to reduce psychological distress and promote recovery in people with moderate depression.     

The role of intrinsic motivation in a group of low vision patients participating in a self‐management programme to enhance self‐efficacy and quality of life

Self‐management programmes have previously been found to decrease health problems, enhance quality of life and increase independence. However, there is no literature that examines the influence of the participants' intrinsic motivation on the outcomes of such programmes. This study examined the role of intrinsic motivation in a pilot low vision self‐management programme to enhance self‐efficacy and quality of life of the programme participants. A positive association was observed between the female participants' perceived choice and perceived competence, two underlying dimensions of the Intrinsic Motivation Inventory. In addition, a positive correlation was observed between the younger participants' perceived competence and the change in their quality of life. The findings provide some support for consideration of participants' intrinsic motivation in the development of effective self‐management programmes.     

Using bibliotherapy to assist people to recover from depression in Thailand: Relationship between resilience,depression and psychological distress

Thailand is experiencing a marked increase in the prevalence of depression. Self‐help has an important role in helping people with depression. The aim of this study was to assess if a favourable relationship existed between resilience, depression and psychological distress in participants with depression who receive bibliotherapy in comparison with a control group. A randomized controlled trial was conducted with 56 participants with moderate depression. The intervention group received the self‐help manual, whereas the control group received standard care. The findings showed a positive relationship between higher levels of resilience and lower levels of depression and psychological distress in the intervention group only, between baseline and posttest. The findings provide preliminary evidence supporting the use of bibliotherapy for individuals with depression in Thailand. Bibliotherapy can be incorporated easily into mental health nurses and other clinicians' work in promoting recovery in people with depression in the community.     

Online self-help tools for the relatives of persons with depression -- a feasibility study

Scand J Caring Sci; 2012; 26; 70–80 Online self‐help tools for the relatives of persons with depression – a feasibility study Background: The Internet’s potential as health care tool should be explored. Aim: One objective was to determine the feasibility of constructing a digitally based tool through an iterative design process in cooperation with potential users. The tool’s purpose is to alleviate hardships in daily life of relatives of persons with depression. An additional aim was to explore motivation and hindrances to using the tool as a basis for design decisions. Method: An iterative design approach, including data collection through focus groups and with paper and web‐based prototypes, was used. Results: Cooperation with potential users, using an iterative design process, was valuable in developing the digitally based tool. Motivations (i.e. to create understanding and rehabilitate oneself) and hindrances (i.e. lack of time or energy) to using the tool were illuminated. Design decisions were based on consideration towards participants’ privacy concerns, needs of support and the depression’s influence on the relatives’ daily life. Conclusion: Prototypes and cooperation with potential users were essential and valuable for the iterative development of the website.     

Breaking the silence of eating disorders with the hope of an online self-help programme

Eating disorders are a serious debilitating health problem, causing impairments in physical and psychosocial functioning and significantly affecting sufferers' quality of life. New technologies are being developed to meet the diverse treatment needs of people with eating disorders. This qualitative study examined participants' views of an Internet-based self-help programme developed in the Asia-Pacific region for people with eating disorders. The aim of the study was to explore how the self-help programme facilitated individuals' recovery and identify the factors that contribute to the success in the programme. A purposive sample of 12 people with anorexia nervosa (N = 4), bulimia nervosa (N = 2), binge eating disorder (N = 1) and eating disorder not otherwise specified (N = 5) participated in the study. The data were collected primarily by telephone interview. The programme was found to improve individuals' awareness of eating disorders, their motivation, eating disorder symptoms and health. Recovery was enhanced by individuals' determination and motivation to get better, the support available, their perseverance, sense of control, and personal confidence, and facilitating living environment.     

Self‐harm in young people: Prevalence,associated factors,and help‐seeking in school‐going adolescents

Adolescent self‐harm is recognized as a serious public health problem; however, there is little reliable comparative data on its prevalence or characteristics, or on the extent of help‐seeking for self‐harm. The aims of the present study were to determine the prevalence and associated factors of adolescent self‐harm in an urban region in Ireland, and to investigate help‐seeking behaviours for self‐harm. This was a cross‐sectional study of 856 school‐going adolescents, employing an anonymous self‐report questionnaire. A lifetime history of self‐harm was reported by 12.1% of adolescents. Factors independently associated with self‐harm included exposure to self‐harm of a friend/family member. Professional help‐seeking was uncommon prior to (9%) and after (12%) self‐harm. Furthermore, only 6.9% of adolescents presented to hospital as a result of their last self‐harm act. These findings indicate that self‐harm is common in adolescents; however, seeking professional help is not a common phenomenon, and those who present to hospital represent the ‘tip of the iceberg’ of adolescent self‐harm. Identifying the prevalence of self‐harm and associated factors, in addition to help‐seeking behaviours, in young people is important to determine the preventative programmes to target ‘at‐risk’ groups. Mental health nurses have an important and increasing role to play in such school‐based initiatives.     

Peer‐led diabetes self‐management programme for community‐dwelling older people in China: study protocol for a quasi‐experimental design

Aim. A protocol for a new peer‐led self‐management programme for community‐dwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self‐management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi‐experimental. Methods. This study is a non‐equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self‐efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self‐efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self‐efficacy, social support, self‐management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory‐based programme tailored to Chinese patients has potential for improving diabetes self‐management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.     

Efficacy of a self‐help manual in increasing resilience in carers of adults with depression in Thailand

Caring for a person with a mental illness can have adverse effects on caregivers; however, little is known about how best to help such caregivers. The aim of the present study was to examine the efficacy of a cognitive behaviour therapy‐guided self‐help manual in increasing resilience in caregivers of individuals with depression, in comparison to caregivers who receive routine support only. A randomized, controlled trial was conducted, following CONSORT guidelines, with 54 caregivers allocated to parallel intervention (self‐help manual) (n = 27) or control (standard support) (n = 27) groups. Resilience was assessed at baseline, post‐test (week 8), and follow up (week 12). Intention‐to‐treat analyses were undertaken. Repeated‐measures ANOVA indicated a significant difference in resilience scores between the three time points, showing a large effect. Pairwise comparisons between intervention and control groups indicated resilience to be significantly different between baseline and post‐test, and between baseline and follow up, but not between post‐test and follow up. Overall, the intervention group showed a slightly greater increase in resilience over time than the control group; however, the time–group interaction was not significant. Guided self‐help is helpful in improving caregivers’ resilience and could be used as an adjunct to the limited support provided to carers by mental health nurses and other clinicians.     

Using intervention mapping to design a self‐management programme for older people with chronic conditions

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.     

A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke

Aim. The aim of this study was to determine the effectiveness of a community‐based stroke prevention programme in (1) improving knowledge about stroke; (2) improving self‐health‐monitoring practice; (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. Background. People with minor stroke (or transient ischaemic attack) tend to under‐estimate the long‐term impact of this on their health. The challenge for nurses is to prevent subsequent strokes by finding ways to promote and sustain appropriate behaviours. Educational intervention is of paramount importance in equipping those at risk with relevant knowledge and self‐care strategies for secondary stroke prevention. Design. This study adopted a quasi‐experimental design. Method. One hundred and ninety subjects were recruited, of whom 147 (77 in the intervention group and 70 in the control group) completed the study. Data were obtained at three time points: baseline (T₀); one week after (T₁) and three months after (T₂) the intervention. The intervention programme consisted of eight weekly two‐hour sessions, with the aims of improving the participants’ awareness of their own health signals and of actively involving them in self‐care management of their own health for secondary stroke prevention. Results. Significant positive changes were found among participants of the intervention group in the knowledge on stroke warning signs (P < 0·001); treatment seeking response in case of a stroke (P < 0·001); medication compliance (P < 0·001); self blood pressure monitoring (P < 0·001) as well as lifestyle modification of dietary habits (reduction in salted food intake, P = 0·004). No significant improvement was found in walking exercise participation in the intervention group, yet a significant decrease was detected among the control group. Conclusion. This study found a three‐month‐sustained effect of positive changes in knowledge and skill from participants who undertook a nurse‐led community‐based stroke prevention programme. Relevance to clinical practice: Effective educational intervention by professional nurses helped clients integrate their learned knowledge into their real‐life practice. This empowering, that is, the taking of responsibility by clients for their own self‐care management on a daily basis, affirms that patient education has moved beyond teaching people facts.     

A randomized trial of a web-based intervention to improve migraine self-management and coping

Objective.— To test the clinical efficacy of a web‐based intervention designed to increase patient self‐efficacy to perform headache self‐management activities and symptom management strategies, and reduce migraine‐related psychological distress. Background.— In spite of their demonstrated efficacy, behavioral interventions are used infrequently as an adjunct in medical treatment of migraine. Little clinical attention is paid to the behavioral factors that can help manage migraine more effectively and improve the quality of care and quality of life. Access to evidenced‐based, tailored, behavioral treatment is limited for many people with migraine. Design.— The study is a parallel group design with 2 conditions: (1) an experimental group exposed to the web intervention; and (2) a no‐treatment control group that was not exposed to the intervention. Assessments for both groups were conducted at baseline (T1), 1‐month (T2), 3‐months (T3), and 6‐months (T4). Results.— Compared with controls, participants in the experimental group reported significantly: increased headache self‐efficacy, increased use of relaxation, increased use of social support, decreased pain catastrophizing, decreased depression, and decreased stress. The hypothesis that the intervention would reduce pain could not be tested. Conclusions.— Demonstrated increases in self‐efficacy to perform headache self‐management, increased use of positive symptom management strategies, and reported decreased migraine‐related depression and stress suggest that the intervention may be a useful behavioral adjunct to a comprehensive medical approach to managing migraine.     

Predictors of parenting self‐agency among mothers receiving substance abuse or mental health treatment

Mothers' mental health or substance use disorders impact the behaviours of their children both short‐term and long‐term. There is increased concern for mothers with mental health or substance use disorders to effectively handle parenting challenges. Children of these mothers are at risk for emotional and behavioural adjustment problems as well as poor academic performances. Parenting self‐agency refers to parents' perceptions of their confidence and ability to overcome barriers and manage issues in parenting. Examining the factors that predict parenting self‐agency aids in understanding how nurses can assist mothers and families. The purpose of this study was to explore predictors of parenting self‐agency among mothers who are impacted by mental health or substance use disorders. A secondary analysis was conducted using the baseline assessment data of a randomized trial that examined the efficacy of a nurse‐led family‐strengthening home‐health intervention. The data were obtained from 172 mothers who were receiving outpatient treatment for substance use or other mental health disorders and had children under 18. A multivariate linear regression analysis was conducted to find predictors of parenting self‐agency among participating mothers. The authors found that increased children's externalizing problems and intensity of hassle predicted lower parenting self‐agency, and family cohesion predicted higher parenting self‐agency. The authors conclude that treatments need to address family as a whole to increase mothers' parenting self‐agency, thus assisting these mothers in raising their children in the best possible environment.     

Learning as an empowerment process in breast cancer self-help groups

Aim. This intervention study aimed to promote and examine empowerment processes in women recovering from breast cancer and participating in self‐help groups. Background. Feelings of powerlessness may follow from being diagnosed and treated for breast cancer. In theory, self‐help groups may stimulate empowerment, which stands in contrast to powerlessness, by increasing the participants’ sense of control. Professional assistance may contribute positively, by assuring that the issue of empowerment is addressed. Design. The study had an intervention design based on the ideas of empowerment and self‐help. Three professionally led self‐help groups were established. The groups ran sequentially and met weekly for approximately four months. Methods. Eighteen women in groups of 5–7 participated in self‐help group discussions and also in focus group interviews, which provided the main study data. Each group was interviewed three times. Observation data provided a basis for comprehension of the groups’ culture, relationships and processes. Results. Learning appeared as one of three salient components in empowerment processes in the self‐help groups. This learning component consists of four elements: consciousness‐raising, acquisition of objective knowledge, learning from others’ experiences and discovery of new perspectives in life and in oneself. Conclusions. The study shows that self‐help groups focusing on empowerment issues made a valuable contribution to recovery and are strongly recommended by the participants. Relevance to clinical practice. This study suggests that best practice, for those who manage self‐help programmes of all types, may be to arrange for empowerment to be an explicit aspect of the intervention, guided by professionals with training in group facilitation and knowledgeable about the facilitation of empowerment in particular.     

Hearing the voices of young people who self‐harm: Implications for service providers

The incidence of adolescent self‐harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self‐harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self‐harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young people's experiences of help and support for self‐harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self‐harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.     

Evaluation of a self‐efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury

Aim

This study developed a self‐efficacy enhancement program and evaluated its effects on the self‐care behaviors, self‐care knowledge, and self‐efficacy regarding pressure ulcer prevention in patients with a spinal cord injury.

Methods

This was a multicenter randomized controlled trial. Six hospitals were invited to recruit patients with a spinal cord injury who were undergoing rehabilitation after receiving acute treatment. These hospitals were randomly allocated into experimental (three hospitals) or control (three hospitals) groups and 47 patients participated (24 in the experimental group and 23 in the control group). The experimental group was given an 8 week self‐efficacy enhancement program for pressure ulcer prevention. The self‐efficacy enhancement program consisted of small‐group face‐to‐face intervention (education and skills training), education with computer animation, phone counseling, face‐to‐face counseling, and self‐management records. The control group only received a pressure ulcer prevention information booklet. Self‐care knowledge, self‐efficacy, self‐care behaviors, and pressure ulcer incidence were measured at baseline and after the 8 week self‐efficacy enhancement program.

Results

The experimental group showed a significantly greater improvement in self‐care knowledge, self‐efficacy, and self‐care behaviors for pressure ulcer prevention than did the control group. One participant in the control group developed a pressure ulcer, while none of the participants in the experimental group developed a pressure ulcer; this difference was not statistically significant.

Conclusions

The self‐efficacy enhancement program enabled patients with a spinal cord injury to engage in continued self‐care behaviors and helped them to improve their knowledge and self‐efficacy concerning pressure ulcer prevention.