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Ulibarri-Ochoa A, Sánchez-Gómez S, Gamboa-Moreno E, Duo-Trecet I, Garate-Echenique L, Belarra-Tellechea B, de Retana-García LO. Impact of the "Looking after my health after cancer" peer-led active patient education program on cancer survivors and their caregivers: A qualitative study. PLoS One 2023; 18:e0282018. [PMID: 36827237 PMCID: PMC9955581 DOI: 10.1371/journal.pone.0282018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Cancer survival has doubled and is likely to continue increasing in the near future. Cancer survivors experience long-term adverse effects, with associated psychological changes, and often they have needs that are yet to be met. Recognizing the lack of continuity-of-care initiatives for cancer survivors and caregivers, Osakidetza Basque Health Service has started to implement through primary care a peer-led active patient education program called "Looking after my health after cancer". This study explores how cancer survivors and their caregivers rate the experience of participating in the program, to what extent the program helps them understand and address their unmet felt needs, and helps them improve their activation for self-care and self-management. METHODS A qualitative exploratory phenomenological study was conducted using five focus groups: four with cancer survivors (n = 29) and caregivers (n = 2), and one with peer leaders (n = 7). Narrative content analysis was performed using the constant comparison method, facilitated by Atlas-ti software. Descriptive analysis of sociodemographic and clinical data was performed. The study was developed according to the Consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS Five main themes emerged from the content analysis: 1) satisfaction with the program as a positive learning experience; 2) peer sharing and learning ("if they can, so can I"); 3) fears prior to attending the program; 4) becoming more aware of unmet felt needs and feeling understood in the "new normal"; and 5) a more positive view of their experience, helping them become active in self-care and empowered in the self-management of their condition. CONCLUSIONS The peer education program has shown to have a positive impact on cancer survivors and caregivers. It is necessary to design, implement and evaluate interventions of this type to address unmet felt needs during cancer survivorship and improve their quality of life.
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Affiliation(s)
- Ainhoa Ulibarri-Ochoa
- Bioaraba Health Research Institute, Clinical Nursing and Community Health Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Vitoria-Gasteiz, Spain
- Vitoria-Gasteiz School of Nursing, University of the Basque Country, Vitoria-Gasteiz, Spain
- * E-mail:
| | - Sheila Sánchez-Gómez
- Bioaraba Health Research Institute, Healthcare Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Directorate for Healthcare Integration, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, General Directorate, Nursing Subcommittee, Araba Multidisciplinary Teaching Unit for Family and Community Healthcare, Vitoria-Gasteiz, Spain
| | - Estíbaliz Gamboa-Moreno
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastián-Donostia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Irene Duo-Trecet
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
| | - Lucia Garate-Echenique
- Osakidetza Basque Health Service, Coordination of Strategic Plans, Subdirectorate for Nursing, Vitoria-Gasteiz, Spain
| | - Begoña Belarra-Tellechea
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Osakidetza Basque Health Service, School of Health (Osasun Eskola), Subdirectorate for Primary Care Coordination, Vitoria-Gasteiz, Spain
| | - Lourdes Ochoa de Retana-García
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
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Tierney S, Mahtani KR, Wong G, Todd J, Roberts N, Akinyemi O, Howes S, Turk A. The role of volunteering in supporting well-being - What might this mean for social prescribing? A best-fit framework synthesis of qualitative research. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e325-e346. [PMID: 34337817 DOI: 10.1111/hsc.13516] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/27/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
Volunteering for an organisation, charity or group enables people to make connections with others and to be involved in interesting, worthwhile and/or enjoyable pursuits. Engaging in volunteering can form part of a social prescribing action plan developed between a patient and link worker. Greater understanding of the processes through which volunteering can improve people's well-being as part of social prescribing will help to support link workers in their role. We conducted a best-fit framework synthesis of qualitative literature on volunteering and well-being. Our search of eight electronic databases, complemented by a Google search, conducted in June 2020, resulted in the location of 2210 potentially relevant references. After screening, 335 papers were read in full and 54 drawn upon within the review. They were published between 1993 and 2020. We used the New Economics Foundation's Five Ways to Well-Being model to guide data extraction and synthesis. From this, we developed a conceptual framework that highlights how volunteering can contribute to identity validation and modification leading to the establishment of an acceptable sense of self. Our findings have implications for: (a) the use of volunteering as part of a link worker's toolkit as they seek to support people with varying psychosocial needs and (b) requirements of organisations accepting referrals to volunteering as part of social prescribing.
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Affiliation(s)
- Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joy Todd
- Gardens, Libraries and Museums (GLAM), University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seth Howes
- Worcester College, University of Oxford, Oxford, UK
| | - Amadea Turk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Åkerman S, Nyqvist F, Coll-Planas L, Wentjärvi A. The Expert Caregiver Intervention Targeting Former Caregivers in Finland: A Co-Design and Feasibility Study Using Mixed Methods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910133. [PMID: 34639437 PMCID: PMC8508176 DOI: 10.3390/ijerph181910133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
Informal caregivers face risks of social isolation. Given the high prevalence of informal caregivers in Europe, a considerable proportion of the population are also former caregivers. The Finnish Expert Caregiver intervention sought to train former caregivers to become volunteers aiming to support current caregivers through mainly peer support. The aims of this mixed method non-controlled exploratory intervention study were to assess the feasibility of the Finnish Expert Caregiver intervention by co-designing and implementing the intervention, and by assessing demand and practicality with special attention to the impact of COVID-19. The findings imply that the intervention was feasible as it resulted in a co-designed training course consisting of 30 h with 25 participants enrolling and 19 of them trying volunteering activities. The participants reported high scores on well-being at all timepoints of study, however, without statistically significant differences. The analysis of the focus group interviews revealed that the Expert Caregivers experienced the intervention as meaningful and offered them a sense of belonging with the other participants. Apart from using their caregiving past as an asset, the participants also took advantage of other personal skills and resources. Risks of adverse effects were related to the participants’ expectations on their own contribution, demanding peer support recipients, poorly functioning peer support groups, and insufficient distance to one’s caregiving past. The participants stressed the need for continuing support from intervention facilitators. Future studies with larger samples should investigate whether the effects differ between subgroups of participants and explore the perspective of the peer support recipients.
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Affiliation(s)
- Sarah Åkerman
- Faculty of Education and Welfare Studies, Åbo Akademi University, 65100 Vaasa, Finland;
- Correspondence:
| | - Fredrica Nyqvist
- Faculty of Education and Welfare Studies, Åbo Akademi University, 65100 Vaasa, Finland;
| | - Laura Coll-Planas
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Centre for Health and Social Care Research (CESS), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, 08500 Barcelona, Spain;
- Fundació Salut i Envelliment UAB (Foundation on Health and Ageing), Universitat Autonòma de Barcelona, 08041 Barcelona, Spain
| | - Annika Wentjärvi
- Faculty of Health and Welfare, Novia University of Applied Sciences, 65200 Vaasa, Finland;
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Stathi A, Withall J, Agyapong-Badu S, Barrett E, Kritz M, Wills D, Thogersen-Ntoumani C, Fox KR. Mobilising people as assets for active ageing promotion: a multi-stakeholder perspective on peer volunteering initiatives. BMC Public Health 2021; 21:150. [PMID: 33461519 PMCID: PMC7812118 DOI: 10.1186/s12889-020-10136-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Successful peer volunteering is central to many community-based, active ageing initiatives. This study synthesises the perspectives of a range of stakeholders involved in peer volunteering initiatives and provides recommendations as to how peer volunteers can be effectively mobilised as community assets. METHODS An evidence synthesis of qualitative data from (a) the evaluation of ACE (Active, Connected, Engaged), a feasibility trial of a peer volunteering active ageing intervention, and (b) interviews with volunteers and managers of third sector organisations providing peer volunteering programmes. Data were analysed using directed content analysis. RESULTS Ten managers, 22 volunteers and 20 ACE participants were interviewed. The analysis identified six main themes, 33 higher and 22 sub themes. Main themes were: (i) Motives, (ii) Benefits, (iii) Skills and Characteristics, (iv) Challenges, (v) Training Needs, (vi) Recruitment and Retention. Altruism, changes in life circumstances, opportunities to reconnect with the community and personal fulfilment were the main reasons for volunteering. Volunteering was described as being personally rewarding, an avenue to acquire new skills and knowledge, and an opportunity for increased social connections and physical activity. Good peer volunteers are committed, reliable, have a good sense of humour, good interpersonal skills and are able to relate to participants. When pairing volunteers with participants, shared interests and geographical proximity are important to consider. Clarity of role, level of time commitment, regular feedback, recognition of effort and strong networks for on-going support are important strategies to facilitate volunteer retention. CONCLUSIONS The findings of this study support the value of peer volunteering as a strategy for mobilising community assets in promoting active ageing. To ensure success and longevity, these schemes require appropriate funding and efficient administrative support.
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Affiliation(s)
- Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department for Health, University of Bath, Bath, UK
| | | | - Sandra Agyapong-Badu
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eva Barrett
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Marlene Kritz
- School of Psychology, Curtin University, Perth, Australia
| | | | | | - Kenneth R. Fox
- School of Policy Studies, University of Bristol, Bristol, UK
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Halvorsrud L, Bye A, Brekke LA, Bergland A. Being a trained volunteer Peer Supporter for carers of people living with dementia in Norway: Reciprocal benefits and challenges. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2150-2159. [PMID: 32490553 DOI: 10.1111/hsc.13026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/16/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
This qualitative, exploratory study aimed to investigate the perception of benefits and the challenges of Peer Support services to carers of people with dementia. Four focus group interviews were conducted with volunteer Peer Supporters (n = 40)-all former carers-on their experience of supporting such carers. One overriding theme was of making the carers' path smoother by giving the possibility for free time and reflection, and three themes summarised their experience: 'filling the gap between health care and everyday life challenges', 'importance of mutual and unique experience based on skills and knowledge' and 'the importance of setting limits'. The findings showed that voluntary work is valuable to both carers and Peer Supporters. Peer Supporters' experiences as former carers are valuable. They offer the opportunity to engage in mutually supportive relationships with carers based on shared experience and similar interests by contributing to a better management of everyday life. Being able to see positive changes in carers' lives, guarding their privacy and providing them with free time were important for volunteers in gaining enjoyment and satisfaction over time. Enabling recovery and reflection might be crucial for carers to avoid burnout. How to recruit, support Peer Supporters and incorporate them in the formal healthcare system will be of great interest in the future.
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Affiliation(s)
- Liv Halvorsrud
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Astra Bye
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Astrid Bergland
- Department Physiotherapy Norway, Oslo Metropolitan University, Oslo, Norway
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Skirbekk H, Korsvold L, Finset A. To support and to be supported. A qualitative study of peer support centres in cancer care in Norway. PATIENT EDUCATION AND COUNSELING 2018; 101:711-716. [PMID: 29191626 DOI: 10.1016/j.pec.2017.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore what peer supporters, patients and their relatives want and gain from peer support in cancer care. METHODS Focus group interviews with peer supporters, and in-depth interviews with peer supporters, patients and relatives (N=38) and observations of daily activities in a Vardesenter ("Cairn Centre"). RESULTS Peer supporters helped cancer patients and relatives with coping in and outside the hospital in several ways: (1) conveying hope and providing ways to cope in situations where despair would often be prevalent, thus protecting against unhealthy stress; (2) being someone who had the same experiences of disease and treatment, and thus providing a framework for positive social comparisons; and (3) to be an important supplement to family and health care providers. To be working as a peer supporter was also found to be positive and important for the peer supporters themselves. CONCLUSION The peer support program represented a valuable supplement to informal support from family and friends and healthcare providers, and gave the peer supporters a new role as "professionally unprofessional". PRACTICE IMPLICATIONS Organised peer support represents a feasible intervention to promote coping for cancer survivors.
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Affiliation(s)
- Helge Skirbekk
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway; Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Norway; Faculty of Business Administration, Inland Norway University of Applied Sciences, Norway; Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Live Korsvold
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Arnstein Finset
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Charlesworth G, Sinclair JB, Brooks A, Sullivan T, Ahmad S, Poland F. The impact of volunteering on the volunteer: findings from a peer support programme for family carers of people with dementia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:548-558. [PMID: 26970311 DOI: 10.1111/hsc.12341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
With an ageing population, there are increasing numbers of experienced family carers (FCs) who could provide peer support to newer carers in a similar care situation. The aims of this paper are to: (i) use a cross-sectional study design to compare characteristics of volunteers and recipients of a peer support programme for FCs of people with dementia, in terms of demographic background, social networks and psychological well-being; and (ii) use a longitudinal study design to explore the overall impact of the programme on the volunteers in terms of psychological well-being. Data were collected from programmes run in Norfolk, Northamptonshire, Berkshire and four London boroughs between October 2009 and March 2013. The volunteer role entailed empathic listening and encouragement over a 10-month period. Both carer support volunteers (N = 87) and recipient FCs (N = 109) provided baseline demographic information. Data on social networks, personal growth, self-efficacy, service use and well-being (SF-12; EuroQol Visual Analogue Scale; Hospital Anxiety and Depression Scale; Control, Autonomy, Self-Realisation, Pleasure-19) were collected prior to the start of the intervention (N = 43) and at either 3- to 5 month or 10 month follow-up (N = 21). Volunteers were more likely than recipients of support to be female and to have cared for a parent/grandparent rather than spouse. Volunteers were also more psychologically well than support recipients in terms of personal growth, depression and perceived well-being. The longitudinal analysis identified small but significant declines in personal growth and autonomy and a positive correlation between the volunteers' duration of involvement and perceived well-being. These findings suggest that carers who volunteer for emotional support roles are resilient and are at little psychological risk from volunteering.
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Affiliation(s)
- Georgina Charlesworth
- Research and Development Department, North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - James B Sinclair
- Research and Development Department, North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Alice Brooks
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Theresa Sullivan
- Research and Development Department, North East London NHS Foundation Trust, London, UK
| | - Shaheen Ahmad
- Dementia Advisory Service, Age Concern Havering, Romford, UK
| | - Fiona Poland
- School of Allied Health Professions, University of East Anglia, Norwich, UK
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‘I just want to get on with my life’: a mixed-methods study of active management of quality of life in living with dementia. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16001069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTThe active management of the experience of living with dementia appears to improve quality of life despite the lack of disease modification. However, research to date has been largely of modest scale and explanatory factors for improvements have been under-conceptualised. Thus, although promulgated through national strategies, the evidence base is relatively weak. This paper reports on a nation-wide study of the influence of the National Dementia Strategy for England in relation to Dementia Adviser and Peer Support Network services in 40 demonstration sites. The research aimed to identify ways in which the services contribute to the wellbeing and resilience of people with dementia and care partners. A mixed-methods research design collected data through: activity and outcome monitoring; organisational surveys; in-depth case studies, including qualitative interviews with people with dementia (N = 47) and care partners (N = 54), wellbeing and quality of life measures, and interviews with staff and other stakeholders (N = 82). Three themes are explored: addressing individual and community needs; promoting independence, control and choice; and getting a life back. Services promoted independence, control and choice, and consequently enabled people to re-narrate their lives as purposeful within their communities. Ways in which these are achieved resemble the public health model of lay health advisor and this research adds to the imperative to approach dementia as a key public health concern.
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Charlesworth G, Burnell K, Crellin N, Hoare Z, Hoe J, Knapp M, Russell I, Wenborn J, Woods B, Orrell M. Peer support and reminiscence therapy for people with dementia and their family carers: a factorial pragmatic randomised trial. J Neurol Neurosurg Psychiatry 2016; 87:1218-1228. [PMID: 27521377 PMCID: PMC5099314 DOI: 10.1136/jnnp-2016-313736] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/13/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate peer support and reminiscence therapy, separately and together, in comparison with usual care for people with dementia and their family carers. DESIGN Factorial pragmatic randomised trial, analysed by treatment allocated, was used for this study. SETTING The trial ran in Community settings in England. PARTICIPANTS People with dementia and their family carers were the participants. INTERVENTIONS Treatment as usual (TAU) plus one of the following: one-to-one peer support to family carers from experienced carers (Carer Supporter Programme; CSP), group reminiscence therapy (Remembering Yesterday, Caring Today; RYCT) for people with dementia and carers, both or neither. MAIN OUTCOME MEASURES Primary outcomes included health-related quality of life (SF-12) for carers and quality of life (QoL-AD) for people with dementia; secondary outcomes included quality of relationship for carers and people with dementia; both were collected by blinded assessors at baseline, 5 and 12 months (primary end point). RESULTS Of 291 pairs recruited, we randomised 145 (50%) to CSP (71% uptake) and 194 (67%) to RYCT (61% uptake). CSP and RYCT, separately or together, were not effective in improving primary outcomes or most secondary outcomes. For CSP versus 'no CSP', adjusted difference in means was 0.52 points on the SF-12 (95% CI -1.28 to 2.32) and -0.08 points on the QoL-AD (95% CI -1.70 to 1.56). For RYCT versus 'no RYCT', the difference was 0.10 points on the SF-12 (95% CI -1.72 to 1.93) and 0.51 points on the QoL-AD (95% CI -1.17 to 2.08). However, carers reported better relationships with the people with dementia (difference 1.11, 95% CI 0.00 to 2.21, p=0.05). Comparison of combined intervention with TAU, and of intervention received, suggested differential impacts for carers and persons with dementia. CONCLUSIONS There is no evidence from the trial that either peer support or reminiscence is effective in improving the quality of life. TRIAL REGISTRATION NUMBER ISRCTN37956201; Results.
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Affiliation(s)
| | - Karen Burnell
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
| | | | - Zoe Hoare
- NWORTH Clinical Trials Unit, Bangor University, Bangor, UK
| | - Juanita Hoe
- Division of Psychiatry, University College London, London, UK
| | | | - Ian Russell
- Swansea University Medical School, Swansea, UK
| | | | - Bob Woods
- DSDC Wales, Bangor University, Bangor, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
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