Influence of a Computer Intervention on the Psychological Status of Chronically Ill Rural Women

Interventions to Reduce Loneliness in Community-Living Older Adults: a Systematic Review and Meta-analysis

BACKGROUND

The problem of loneliness has garnered increased attention from policymakers, payors, and providers due to higher rates during the pandemic, particularly among seniors. Prior systematic reviews have in general not been able to reach conclusions about effectiveness of interventions.

METHODS

Computerized databases were searched using broad terms such as "loneliness" or "lonely" or "social isolation" or "social support" from Jan 1, 2011 to June 23, 2021. We reference mined existing systematic reviews for additional and older studies. The Social Interventions Research & Evaluation Network database and Google were searched for gray literature on Feb 4, 2022. Eligible studies were RCTs and observational studies of interventions to reduce loneliness in community-living adults that used a validated loneliness scale; studies from low- or middle-income countries were excluded, and studies were excluded if restricted to populations where all persons had the same disease (such as loneliness in persons with dementia).

RESULTS

A total of 5971 titles were reviewed and 60 studies were included in the analysis, 36 RCTs and 24 observational studies. Eleven RCTs and 5 observational studies provided moderate certainty evidence that group-based treatment was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.27, 95% CI - 0.48, - 0.08). Five RCTs and 5 observational studies provided moderate certainty evidence that internet training was associated with reduced loneliness (standardized mean difference for RCTs =  - 0.22, 95% CI - 0.30, - 0.14). Low certainty evidence suggested that group exercises may be associated with very small reductions in loneliness. Evidence was insufficient to reach conclusions about group-based activities, individual in-person interactions, internet-delivered interventions, and telephone-delivered interventions.

DISCUSSION

Low-to-moderate certainty evidence exists that group-based treatments, internet training, and possibly group exercises are associated with modest reductions in loneliness in community-living older adults. These findings can inform the design of supplemental benefits and the implementation of evidence-based interventions to address loneliness.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO ( CRD42021272305 ).

Factors affecting caregivers' participation in support groups for people living with HIV in Tanzania

Introduction

Support groups for people living with HIV (PLHIV) are essential for increasing adherence, retention, addressing their psychosocial needs and improving patient literacy. However, factors that influence participation of caregivers living with HIV (LHIV) in these groups are scarcely documented, particularly for those caring for orphans and vulnerable children (OVC).

Methods

This study used baseline data collected between 1st October 2021 and 30th September 2022 from the PEPFAR/USAID-funded Adolescents and Children HIV Incidence Reduction, Empowerment and Virus Elimination (ACHIEVE) project in Tanzania to investigate factors that affect participation of caregivers LHIV in support groups for PLHIV. A total of 74,249 HIV-positive OVC caregivers who were already receiving antiretroviral therapy (ART) and had a confirmed care and treatment centre identification number were included in the analysis. Factors affecting group participation were identified through multilevel analysis using multivariable mixed-effects logistic regression.

Results

Results showed that 84.2% of the caregivers were participants in the support groups for PLHIV. Their mean age was 36 years, and the majority (82.1%) were female. Multivariable analysis revealed that participation in the groups was more likely among caregivers living in urban areas (aOR = 1.39 [1.24, 1.55]), with primary education (aOR = 1.17 [1.07, 1.28]), and without disabilities (aOR = 0.62 [0.47, 0.82]). However, participation was less likely among widowed (aOR = 0.91 [0.84, 0.999]), single or unmarried (aOR = 0.86 [0.78, 0.95]), and those with secondary education or higher levels than never attended (aOR = 0.69 [0.60, 0.80]), moderate hunger (aOR = 0.86 [0.79, 0.93]), and those aged 30 years or older (p< 0.001).

Discussion

A sizeable proportion (15.8%) of the caregivers were not in support groups for PLHIV, ranging from 12.3% among those in households with severe hunger to 29.7% among disabled ones. The study highlights the need for tailored interventions to increase participation in support groups for PLHIV, particularly for caregivers who are disabled, live in rural areas, are older, widowed, and/or unmarried, and those in poor households.

Utility of HIV support groups in advancing implementation research in resource-limited settings: experiences from an urban-setting HIV support group in Zimbabwe

Support groups for people living with the Human Immunodeficiency Virus (HIV) have continued to evolve since their emergence over two decades ago. In addition to providing HIV education and fostering psychosocial support, recent efforts have shifted the focus to socio-economic activities and retention in care. The sense of urgency to adopt new treatment and prevention strategies in sub-Saharan Africa necessitates greater engagement of established HIV care programs, especially among researchers seeking to conduct implementation research, promote prevention strategies and optimize treatment as prevention. To maximize the utility of support groups in doing so, efforts to create an organized, collaborative framework should be considered. This paper aims to describe the process of refocusing an adult HIV peer-support group and illustrate how a structured program was strengthened to sustain implementation research in resource-limited settings, while promoting patient recruitment and retention. A multidisciplinary team of scientists supporting an HIV peer-support group spearheaded the implementation process that authored the successes, challenges and lessons documented over eight years. Psychosocial support, nutrition care and support, adherence education and income generating projects were the main interventions employed. The initiative resulted in seven peer-reviewed publications, submission of 23 scientific abstracts, scientific dissemination at 12 international conferences. Eleven research studies and 16 income generating projects were successfully conducted over eight years. More than 900 patients participated in peer-support group activities every month and 400 were engaged in income generating activities. This multidisciplinary structured program was valuable in the retention and recruitment of patients for implementation research and benefits extended to psychosocial support, microeconomic projects, and improved nutrition. The support group contributed to strengthening implementation research through providing a platform for identification of research priorities, patient recruitment and retention in studies and dissemination of research findings.

Differences in Loneliness Across the Rural-Urban Continuum Among Adults Living in Washington State

PURPOSE

Rural residents may be at higher risk for loneliness than urban residents due to factors such as social isolation, poorer health, and socioeconomic disadvantage. To date, there have been few studies examining rural-urban differences in loneliness among adults in the United States. We examined differences in loneliness across the rural-urban continuum among adult residents living in Washington State.

METHODS

Stratified random sampling was used to select 2,575 adults from small rural, large rural, suburban, and urban areas who were invited to complete a survey on factors affecting health. Data were obtained from 616 adults (278 from small rural, 100 from large rural, 98 from suburban, and 140 from urban areas) from June 2018 through October 2019. Loneliness was measured using the UCLA Loneliness Scale (3rd version). Multivariable linear and logistic regressions were used to examine geographic differences in loneliness (measured continuously and dichotomously).

FINDINGS

Mean unadjusted loneliness scores were lower in suburban compared to urban areas (35.06 vs 38.57, P = .03). The prevalence of loneliness was 50.7%, 59.0%, 40.8%, and 54.3% in small rural, large rural, suburban, and urban areas, respectively. Suburban living was associated with lower odds for being lonely compared to urban living (unadjusted OR = 0.58; 95% CI = 0.34-0.98), but this association was not statistically significant in the adjusted model (OR = 0.63; 95% CI = 0.33-1.19).

CONCLUSION

Loneliness is a prevalent health issue across the rural-urban continuum among Washington State adults.

The Effectiveness of Technology-Based Interventions for Reducing Loneliness in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: To systematically analyze the effectiveness of technology-based interventions for reducing loneliness in older adults.

Methods: We searched relevant electronic databases from inception to April 2021, which included Cochrane Library, PubMed, Web of Science, SpringerLink, EMBASE, CNKI, and Wanfang. The following criteria were used: (i) study design—randomized controlled trial (RCT) designs, (ii) people—older adults (aged ≥ 60 years), (iii) intervention—technology-based interventions in which a core component involved the use of technology to reduce loneliness in older adults; and (iv) outcome—reduction of loneliness level in terms of rating scale scores. Two reviewers independently identified eligible studies, extracted data, and assessed the risk of bias in the included studies. A third reviewer resolved any conflicts. The Cochrane Collaboration's bias assessment tool was used to evaluate the risk of bias for the included studies, and Review Manager 5.4 software was used for the meta-analysis. A random effects model was adopted to measure estimates of loneliness reduction, and standard mean differences (SMD) with a 95% confidence interval (CI) were calculated for each intervention-control contrast, and the I² statistic was applied to examine heterogeneity.

Results: A total of 391 participants from six RCTs were included in the review. Of these, three studies were rated as low-quality, and the remaining three were rated as moderate-quality studies. The meta-analysis showed that the evidence regarding the effects on loneliness of technology-based interventions compared with control groups was uncertain, and suggested that technology-based interventions resulted in little to no difference in loneliness reduction compared to control groups (SMD = −0.08, 95% CI −0.33 to 0.17, p = 0.53). Two types of technology-based interventions were identified: smartphone-based video calls and computer-based training with Internet usage. The subgroup analysis found low-quality evidence to support the effectiveness of both intervention types (SMD = −0.01, 95% CI −0.25 to 0.24, p = 0.95, and SMD = −0.38, 95% CI −0.19, 0.64, p = 0.47, respectively).

Conclusions: We found no current evidence to support that technology-based interventions were effective compared to different control conditions in reducing loneliness in older adults. This suggests that more research is needed to investigate the effects of technology-based interventions on loneliness in older adults.

Equine-Assisted Activities and Therapies: State-of-the-Art Review

The purpose of this paper is to explore what is known about equine-assisted activities and therapies based on Roy's adaptation model. Quality of life for vulnerable populations who engage with equine-assisted activities and therapies is considered the main concept here. This state-of-the-art review was conducted from four databases ranging from January 2019 to February 2020. Limited studies examined the effect of equine-assisted activities and therapies on cancer survivors, although preliminary data were promising. The rural context was not extensively examined. Thus, equine-assisted activities and therapies may enhance the quality of life through four adaptation modes.

Potential directions for farm stress research: A systematic review of educational interventions to reduce psychosocial stress among farm and rural populations

BACKGROUND

Despite prevalence of high psychosocial stress and suicide among farm and rural populations, few studies exist that measure effectiveness of stress reduction interventions.

PURPOSE

To (1) compare studies with educational interventions on psychosocial stress as measured by reliable and valid instruments in farm and rural populations and (2) identify educational strategies utilized among effective interventions.

METHODS

This systematic review was conducted across 4 electronic databases and Google Scholar to identify research that reported outcomes of stress reduction educational interventions among farm and rural populations. Original research articles published in English between January 1980 and October 2020 were included. Literature was excluded that: (1) used cognitive behavioral therapy, (2) reported outcomes of post-traumatic distress disorders, and (3) examined clinical guidelines or policy change. Extracted data included study characteristics, outcomes, and delivery methodology.

FINDINGS

Title and abstract screening resulted in 256 manuscripts assessed for inclusion criteria. The final selection of 22 studies were categorized into 2 educational intervention delivery methods: home/community setting or virtual. Fourteen out of 22 studies reported significant stress reduction. Virtual interventions had the most promising impact on psychosocial stress with significant reduction reported in 4 of 6 studies; however, mixed results were found among all delivery methods.

CONCLUSIONS

Educational interventions may reduce psychosocial stress among farm and rural populations, though important questions remain. We recommend future research should focus on barriers to participation, development of measurement tools, and consistent outcome measurement.

Internet Use and Loneliness of Older Adults Over Time: The Mediating Effect of Social Contact

OBJECTIVES

The internet is increasingly commonly used by older adults. However, it remains controversial in the literature on whether older people are more or less lonely with internet adoption. The current paper aims to test the longitudinal association of internet use and loneliness and to theorize the relationship by examining the mediating effect of social contact.

METHOD

This study employed data from 2006, 2010, and 2014 waves of the Health and Retirement Study. Loneliness was measured with the three-item UCLA loneliness scale, social contact was operationalized as contact frequency with family and friends, and internet use was measured using a self-assessed dichotomous item. Longitudinal associations and mediation effects were tested using hierarchical linear modeling.

RESULTS

Internet use was associated with decreased loneliness over an 8-year period (b = -0.049, p < .001) and more social contact (b = 0.285, p < .001), which was related to lower perceived loneliness (b = -0.088, p < .001). On a scale ranges from 0 to 2 (0 = never lonely, 2 = often lonely), the total effect of internet use on loneliness was -0.060, and the mediated effect was -0.025.

DISCUSSION

These findings imply that internet use may be an effective tool for reducing loneliness in older people by maintaining social contact.

Users' Intention to Continue Using Online Mental Health Communities: Empowerment Theory Perspective

INTRODUCTION

Online mental health communities may provide new opportunities for rehabilitation for people with mental illness, so it is important to understand the factors that influence the continued use of online mental health communities by people with mental illness.

METHODS

From the perspective of empowerment, based on the theory of health self-efficacy and expectation confirmation, this study explored the mediating role of health self-efficacy and expectation confirmation in the empowerment process of patients in online mental health communities and users' intention to continue using online mental health communities. To verify this model, we obtained 272 valid questionnaires. The SmartPLS 3.0 software was selected for model construction and empirical analysis.

RESULTS

Health self-efficacy completely mediates the relationship between the empowerment process (i.e., emotional support, information support, helping others and sharing experiences) and users' intention to continue using an online mental health community. Expectation confirmation partially mediates the relationship between the empowerment process (i.e., information support and finding recognition) and users' intention to continue using an online mental health community.

CONCLUSION

The empowerment process is the main predictor of user health self-efficacy and expectation confirmation. This study has certain theoretical and practical significance for online mental health community research.

Rapid systematic review of systematic reviews: what befriending, social support and low intensity psychosocial interventions, delivered remotely, may reduce social isolation and loneliness among older adults and how?

Background: During the COVID-19 pandemic ‘social distancing’ has highlighted the need to minimise loneliness and isolation among older adults (aged 50+). We wanted to know what remotely delivered befriending, social support and low intensity psychosocial interventions may help to alleviate social isolation and loneliness and how they work. Methods: We followed a systematic ‘review of reviews’ approach. Searches of 11 databases from the fields of health, social care, psychology and social science were undertaken during April 2020. Reviews meeting our PICOS criteria were included if they focussed on the evaluation of remote interventions to reduce levels of social isolation or loneliness in adults aged 50+ and were critically appraised using AMSTAR2. Narrative synthesis was used at a review and study level to develop a typology of intervention types and their effectiveness. Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) were used at a study level to explore the characteristics of successful interventions. Results: We synthesised evidence from five systematic reviews and 18 primary studies. Remote befriending, social support and low intensity psychosocial interventions took the form of: (i) supported video-communication; (ii) online discussion groups and forums; (iii) telephone befriending; (iv) social networking sites; and (v) multi-tool interventions. The majority of studies utilised the first two approaches, and were generally regarded positively by older adults, although with mixed evidence around effectiveness. Focussing on processes and mechanisms, using ICA and QCA, we found that the interventions that were most successful in improving social support: (i) enabled participants to speak freely and to form close relationships; (ii) ensured participants have shared experiences/characteristics; (iii) included some form of pastoral guidance. Conclusions: The findings highlight a set of intervention processes that should be incorporated into interventions, although they do not lead us to recommend specific modes of support, due to the heterogeneity of interventions.

Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups

BACKGROUND

Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities.

OBJECTIVE

This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.

METHODS

A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis.

RESULTS

A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.

CONCLUSIONS

The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.

Instagram: its influence to psychologically empower women

Purpose

The purpose of this paper is to investigate whether posting on Instagram contributes to empowerment and through what mechanisms.

Design/methodology/approach

A sample of 372 women instagrammers from Kuwait participated in the survey. LISREL 8.2 was used to perform confirmatory factor analysis and structural equation modeling, employing the maximum likelihood estimation method.

Findings

Instagram posts have direct and indirect effects on psychological empowerment. The indirect effect appears through two perceptual mechanisms: sense of self-efficacy and sense of community (SOC). The former provides women with a sense of mastery and control and the latter gives them the perception of belonging to a community that equips individual participants with a collective efficacy. Of the two mechanisms, the SOC plays a more significant role in creating psychological empowerment. Having a sense of virtual community, as opposed to participating in real ones, can act as catalyst in creating empowerment.

Originality/value

This study investigates the impact of a recent new technology, namely, Instagram, in regions where women are marginalized for generations. Instagram is important, because images, photo captions, short texts and hashtags are vital elements of communication in the present day. Furthermore, women are twice as likely to think highly of a brand that makes an empowering ad and are more likely to share, comment and like the ads.

The effectiveness on sociality and social relationship by therapeutic recreation based on partner and group activity in the institutionalized elderly

This research examined the effects on sociality and social relationship of therapeutic recreation program (TRP) based on partner and group activity in the institutionalized elderly as the level of psycho-social rehabilitations. TRP sessions were designed to encourage interaction and social relationship between two people or groups performing different types of tasks applied on Mosey’s 5-step interaction skills. TRP was conducted for a total of 8 sessions, once a week, for 8 weeks. Using a pre-post experimental design, eight volunteer’s data were analyzed to examine changes in sociality and social relationship. As the result, the degree of sociality was significantly changed from 3.14 to 3.73 (P= 0.002), as well as notable improvements of social relationships were found to have statistically increased from 3.27 to 4.10 (P=0.001). Therefore, this study suggests that partner and group-based recreation programs while considering how and when facilitate interaction between participants should be applied as a way to solve the social problems and isolation of the elderly in the future.

Effectiveness of Social Support Group Interventions for Psychosocial Outcomes: A Meta-analytic Review

This study investigated the effectiveness of support groups for people living with chronic ill-health conditions. Searches of the published literature were undertaken for the period 1993–2013. Papers were included if participants were between 18 and 65 years old, and study designs were either pre-test post-test one group descriptive, non-randomised group comparison, or randomised controlled trial, with reported data appropriate for meta-analysis and sufficient for estimating effect size(s). Total 19 studies were eligible in the meta-analysis, and 2,986 participants were examined. Six general outcome categories emerged from the data: (1) psychosocial functioning, (2) self-efficacy, (3) quality of life, (4) health status, (5) health behaviours and (6) health care use. In total, 155 effect sizes were calculated from the outcome measures with 15.5% resulting in a large effect size, 6% moderate effects, 39% small effects, and 39.5% producing trivial effects. The majority of the effect sizes (92%) were in the hypothesised direction. Overall, results demonstrate that self-help and support group interventions can positively influence management of chronic ill-health conditions and contribute to the desired outcome of successful adaptation.

Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review

BACKGROUND

Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated.

OBJECTIVE

Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness.

METHODS

We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings.

RESULTS

Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included "active ingredients" such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning.

CONCLUSIONS

Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma.

Meta-analysis of the effects of peer-administered psychosocial interventions on symptoms of depression

Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost-efficient adjunct providers. The effectiveness of these and other peer-administered interventions (PAIs) for treating depression symptoms has not been well-established. The current study is a meta-analysis of PAIs' effects on depression symptoms. Twenty-three eligible studies were identified. Study characteristics were coded by multiple raters, random-effects models were used to compare mean effect sizes, and mixed-effects models were used to test for moderation. PAIs produced significant pre-post reductions in depression symptoms (d = .5043 [95 % CI .3675-.6412]). In direct comparisons, PAIs performed as well as non-peer-administered interventions (.0848 [-.1455-.3151]), and significantly better than no-treatment conditions (.2011 [.0104-.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer-administered, and educational/skills-based PAIs produced better outcomes than those that were mainly supportive. Follow-up data, when available, indicated that PAIs' benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs' benefits, and whether they are better suited as stand-alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.

The effectiveness of electronic approaches to substance abuse prevention for adolescents

Systematic reviews of computer- and Web-based treatment approaches indicate that these interventions are effective in addressing abuse of alcohol, tobacco, and other substances. However, there are few studies evaluating the effectiveness of electronic approaches to substance abuse prevention. This review of the literature synthesizes the current research on interventions that use electronic media, including CD-ROM, video, and Internet modalities, for substance abuse prevention. Overall, the studies indicate that electronic-based and enhanced interventions are effective in preventing or reducing risk for substance use. We discuss trends in the current literature, research limitations, and implications for practice.

Health Information Technology: An Expanded Care Coordination in Rural Tennessee

The Expanded Care Coordination through the Use of Health Information Technology in Rural Tennessee was a 3-year initiative implemented by The University of Tennessee Children's Mental Health Services Research Center and the Helen Ross McNabb Center Regional Mental Health System. The program targeted rural adults in the East Tennessee area. This intervention utilized the Alcohol Use Disorder Identification Test (AUDIT), Drug Abuse Screening Test (DAST), and AC-COD screening tools. After the initial screening, the appropriate level of intervention was assessed. Clients completed modules on the program's website and met with a clinician for a minimum for four face-to-face meetings. Alcohol use and drug use declined significantly over the course of the program. Alcohol use and outpatient treatment for alcohol and substance abuse declined significantly over the course of the program. There were also significant decreases in days of probations, depression, physical complaints, and violent behaviors. Health information technology is becoming more common in mental health treatment facilities. However, more testing needs to be done with larger samples to assess the efficacy of the program.

The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review

BACKGROUND

In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions.

OBJECTIVE

The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction.

METHODS

A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction.

RESULTS

Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes.

CONCLUSIONS

The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.

An evaluation of an online peer support forum for university students with depressive symptoms

BACKGROUND

Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms.

METHODS

A depression support Web site (www.losetheblues.ie) was designed specifically for 18-24 year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts.

RESULTS

The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support.

CONCLUSION

Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

Recruitment and retention of older adolescent and young adult female survivors of childhood cancer in longitudinal research

PURPOSE/OBJECTIVES

To describe the challenges encountered in the recruitment and retention of a sample of older adolescent and young adult female survivors of childhood cancer for a longitudinal study testing a targeted psychosocial intervention aimed at enhancing hope.

DATA SOURCES

Published literature on constructing longitudinal intervention studies and strategies in the recruitment and retention of childhood cancer survivors in research was used to develop the protocol of this study.

DATA SYNTHESIS

Using empirical literature to construct the study's design resulted in achieving certain goals for the design, but not in the recruitment and retention of study participants. Using online technology to deliver the intervention and collect data was efficient and effective. Traditional approaches to recruitment and retention of those survivors, however, were not effective. Use of more novel approaches to enroll study participants demonstrated only modest success.

CONCLUSIONS

Additional research is needed on strategies to successfully recruit and retain older adolescents and young adult female survivors of childhood cancer in longitudinal intervention studies.

IMPLICATIONS FOR NURSING

The improvement in the psychological well-being of female survivors of childhood cancer remains an important outcome in ongoing care. The need to continue to identify creative and effective ways to recruit and retain those survivors is warranted.

Decreasing social isolation in older adults: effects of an empowerment intervention offered through the CARELINK program

Older adults reporting social isolation are at increased risk for numerous negative health outcomes, including depressive symptoms, decreased quality of life, and cardiovascular disease. The purpose of this study was to test the effects of a university student model of care intervention offered through the CARELINK program on social isolation in a sample of community-dwelling older adults (N = 56). Older adults in the comparison group, who had not yet received the CARELINK program, were nearly 12 times more likely to be socially isolated. Results indicate the empowerment intervention offered through the CARELINK program had positive effects on reducing social isolation in older adults. The CARELINK program has important implications for nursing as it provides an uncomplicated and inexpensive intervention to decrease social isolation for older adults in the community. Given the sample selection limitation in this study, a randomized controlled trial is warranted. Future research should examine specific aspects of the CARELINK program and the amount each aspect affects social isolation.

A pilot study using electronic communication in home healthcare: implications on parental well-being and satisfaction caring for medically fragile children

The aim of this study was to explore the impact of a nurse-established and nurse-managed electronic communication in the form of e-mail on the self-reported well-being and satisfaction of parent's caring for medically fragile and technologically dependent children. This study was conducted in a pediatric home care agency located in the southeastern region of the United States. Nineteen parents and caregivers participated in a 3-month intervention. A quasiexperimental pre- and posttest design was used. There were no significant differences in pre- and postintervention parental self-reported well-being (p < .227) or satisfaction (p < .528). Parental qualitative comments suggest positive outcomes related to well-being and satisfaction. Further investigation into the utility of e-mail communication with parents of medically fragile and technologically dependent children cared for at home is warranted.

A meta-analysis of interventions to reduce loneliness

Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.

Physical activity, social support, and depression: possible independent and indirect associations in persons with multiple sclerosis

The present study examined the pattern of associations among physical activity, social support, mobility disability, perceived stress, and depressive symptoms in relapsing-remitting MS (RRMS). Persons (N = 218) with RRMS completed a battery of questionnaires that was sent and returned through the United States Postal Service (USPS). Bivariate correlation analysis indicated that physical activity and social support were both inversely associated with depressive symptoms (r's = -0.288 and -0.386, p ≤ 0.05, respectively). Multiple linear regression analysis indicated that physical activity (β = -0.21, p = 0.002) and social support (β = -0.37, p = 0.0001) were independently associated with depressive symptoms. Path analysis confirmed that the associations between physical activity and social support with depressive symptoms were indirect via mobility disability and perceived stress. Collectively, the evidence indicates that physical activity and social support are independently and indirectly associated with depression via mobility disability and perceived stress in relapsing-remitting MS. This supports the design of interventions and programs that target physical activity and social support for reducing depressive symptoms among persons with MS.

Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence

BACKGROUND

Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life.

OBJECTIVE

The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions.

METHODS

The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics.

RESULTS

Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly.

CONCLUSIONS

Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.

Computer intervention impact on psychosocial adaptation of rural women with chronic conditions

BACKGROUND

Adapting to living with chronic conditions is a life-long psychosocial challenge.

OBJECTIVE

The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions.

METHODS

A two-group study design was used with 309 middle-aged, rural women who had chronic conditions, randomized into either a computer-based intervention or a control group. Data were collected at baseline, at the end of the intervention, and 6 months later on the psychosocial indicators of social support, self-esteem, acceptance of illness, stress, depression, and loneliness.

RESULTS

The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured, with a modest impact on social support. The largest benefits were seen in depression, stress, and acceptance.

DISCUSSION

The women-to-women intervention resulted in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation. Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli, psychosocial response, and illness management.

Informed citizen and empowered citizen in health: results from an European survey

Background

The knowledge about the relationship between health-related activities on the Internet (i.e. informed citizens) and individuals' control over their own experiences of health or illness (i.e. empowered citizens) is valuable but scarce. In this paper, we investigate the correlation between four ways of using the Internet for information on health or illness and citizens attitudes and behaviours toward health professionals and health systems and establish the profile of empowered eHealth citizens in Europe.

Methods

Data was collected during April and May 2007 (N = 7022), through computer-assisted telephone interviews (CATI). Respondents from Denmark, Germany, Greece, Latvia, Norway, Poland and Portugal participated in the survey. The profiles were generated using logistic regressions and are based on: a) socio-demographic and health information, b) the level of use of health-related online services, c) the level of use of the Internet to get health information to decide whether to consult a health professional, prepare for a medical appointment and assess its outcome, and d) the impact of online health information on citizens' attitudes and behavior towards health professionals and health systems.

Results

Citizens using the Internet to decide whether to consult a health professional or to get a second opinion are likely to be frequent visitors of health sites, active participants of online health forums and recurrent buyers of medicines and other health related products online, while only infrequent epatients, visiting doctors they have never met face-to-face. Participation in online health communities seems to be related with more inquisitive and autonomous patients.

Conclusions

The profiles of empowered eHealth citizens in Europe are situational and country dependent. The number of Europeans using the Internet to get health information to help them deal with a consultation is raising and having access to online health information seems to be associated with growing number of inquisitive and self-reliant patients. Doctors are increasingly likely to experience consultations with knowledgeable and empowered patients, who will challenge them in various ways.

Phase 1 pilot study of e-mail support for people with long term conditions using the Internet

BACKGROUND

Use of the Internet for people with Long Term Conditions (LTCs) can have a positive effect on knowledge, social support, behavioural and clinical outcomes, yet there is concern that a 'digital divide' prevents some patients from benefitting. While some patients do not have access to the Internet, others that do may still lack expertise or the confidence to make full use of it. The aim of this pilot study was to develop an intervention and test methods for a definitive randomised controlled trial (RCT) of anonymous personal online email support for patients in this latter group.

METHODS

Recruitment success was evaluated by the number and appropriateness of participants recruited. A personalised e-health support intervention was developed. The provisional primary outcome was the extent to which the Internet affected the participants' confidence in dealing with their LTC. Primary outcome, seven process measures and two secondary outcomes measures were evaluated for completeness of data and sensitivity to detect changes.

RESULTS

Thirty nine participants were recruited, 29 after personally receiving a leaflet, seven via email advertising, and three via leaflets left in waiting areas. Most participants (61%) were aged over 60. The majority (21/38) rated themselves as experienced Internet users although only 5/38 had used discussion forums for their LTC. Piloting the intervention identified support needed as: (i) technical help with some websites, (ii) advice about issues such as anonymity, (iii) help in judging information quality, (iv) identification of relevant information (via 'Information Prescriptions'), (v) motivational support to try new sites. Attrition was fairly high: 20/39 completed follow up questionnaires. Three process measures showed ceiling effects and two had too many missing values to be useable.

CONCLUSION

E-health support is a promising way of addressing the problems faced by older generation e-health seekers. Face-to-face leaflet distribution recruited sufficient numbers but additional locations other than hospital should be tried to recruit Internet novices with LTCs. An RCT is feasible and necessary to evaluate the potential benefits of anonymous email support. Our methods could be used by other researchers studying Internet use by people with LTCs.

Social Support Through the Use of ICT for Caregivers of the Chronically Ill: State of the Art

El uso de tecnologías de información y comunicación (TIC) en la nueva era es una necesidad para dar soporte social en salud. Objetivo: caracterizar la producción académica y científica e identificar las estrategias y su evolución acerca del soporte social con el uso de TIC para cuidadores familiares de personas con enfermedad crónica en América en el periodo comprendido entre 1996-2009. Materiales y métodos: revisión documental, descriptiva, con diseño trasversal, desarrollada mediante una búsqueda en bases de datos. Se elaboró una matriz de análisis utilizando la metodología de elaboración de fichas de Hoyos. Resultados: para la elaboración de este estado del arte se seleccionaron 31 artículos publicados entre 1996 y 2009. La totalidad de la literatura existente en soporte social con uso de TIC se ubicó en Norteamérica, con una predominancia del idioma inglés, siendo su mayor producción en el 2004, de los cuales 14 eran cuantitativos y 13 cualitativos que evaluaron la calidad, satisfacción, accesibilidad, información proporcionada y estrategias de seguimiento. Conclusiones: las TIC en cuidadores familiares de personas con enfermedad crónica tienen un efecto protector y generan mejoría en la salud física y mental, y en el vínculo afectivo. Las de mayor uso son la Internet y el teléfono. Se reconoce la importancia de incorporarlas en el contexto colombiano y en la práctica de enfermería a través de proyectos de investigación.

Advanced cancer: a mind-body-spirit approach to life and living

OBJECTIVES

To present the nursing theory of Modeling and Role Modeling as a holistic theoretical basis for identifying needs, planning and implementing care and services, and measuring and enhancing outcomes of programs and interventions to meet the needs of people living with advanced cancer.

DATA SOURCES

Published books and journal articles, web resources, newspapers and current events magazines, and trade publications.

CONCLUSION

The growing number of people living with advanced cancer has numerous unique, multi-dimensional, and interrelated needs that are underexplored, generally unmet, and require a holistic approach to be adequately addressed.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses in clinical practice and research settings must be informed, aware of and prepared to assess and intervene to address the needs of the rapidly emerging subpopulation of cancer survivors. Using a holistic nursing theory promotes our understanding of human responses to illness and provides a way to holistically approach health, wellness, and healing among people living with advanced cancer.

A meta-analysis on the effectiveness of computer-based education in nursing

Objectives

The purpose of this study was to conduct a comparative analysis of education effectiveness between computer-based education and traditional education methods in nursing.

Methods

Medical and nursing literature databases were searched to identify studies regarding the effectiveness of computer-based education in nursing. Overall effect sizes for three outcome variables (knowledge, attitude, and practice level) were calculated. The effects of study characteristics on the outcome variables were analyzed.

Results

Twenty-seven studies published from 1990 to February 2009, which that met the inclusion criteria, were included in the analysis. The meta-analysis showed that computer-based education generally had positive effects on knowledge, attitude, and practice, with overall effect sizes of 0.43, 0.35, and 0.34, respectively. This study also showed that the type of learner and the total education period had different effects on knowledge.

Conclusions

This metaanalysis found that computer-based education in nursing had positive effects on knowledge, attitude, and practice.

The relevance of depressive symptoms and social support to disability in women with multiple sclerosis or fibromyalgia

Multiple sclerosis and fibromyalgia syndrome may spur substantial disability for those affected. Using structural equation modeling, this secondary analysis examined predictors of disability in women with multiple sclerosis (n = 118) and fibromyalgia syndrome (n = 197) recruited for separate wellness studies. Greater functional limitations, lower economic adequacy, less social support, and higher depressive symptoms predicted greater disability in both groups. The final multigroup model showed good fit chi [(111, n = 315) = 135.92, comparative fit index = 0.99, root mean square error of approximation = 0.03] and identified similarities and differences across groups.

Response to a Relational Agent by Hospital Patients with Depressive Symptoms

Depression affects approximately 15% of the US population, and is recognized as an important risk factor for poor outcomes among patients with various illnesses. Automated health education and behavior change programs have the potential to help address many of the shortcomings in health care. However, the role of these systems in the care of patients with depression has been insufficiently examined. In the current study, we sought to evaluate how hospitalized medical patients would respond to a computer animated conversational agent that has been developed to provide information in an empathic fashion about a patient's hospital discharge plan. In particular, we sought to examine how patients who have a high level of depressive symptoms respond to this system. Therapeutic alliance-the trust and belief that a patient and provider have in working together to achieve a desired therapeutic outcome- was used as the primary outcome measure, since it has been shown to be important in predicting outcomes across a wide range of health problems, including depression. In an evaluation of 139 hospital patients who interacted with the agent at the time of discharge, all patients, regardless of depressive symptoms, rated the agent very high on measures of satisfaction and ease of use, and most preferred receiving their discharge information from the agent compared to their doctors or nurses in the hospital. In addition, we found that patients with symptoms indicative of major depression rated the agent significantly higher on therapeutic alliance compared to patients who did not have major depressive symptoms. We conclude that empathic agents represent a promising technology for patient assessment, education and counseling for those most in need of comfort and caring in the inpatient setting.

Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis

BACKGROUND

Patient empowerment is growing in popularity and application. Due to the increasing possibilities of the Internet and eHealth, many initiatives that are aimed at empowering patients are delivered online.

OBJECTIVE

Our objective was to evaluate whether Web-based interventions are effective in increasing patient empowerment compared with usual care or face-to-face interventions.

METHODS

We performed a systematic review by searching the MEDLINE, EMBASE, and PsycINFO databases from January 1985 to January 2009 for relevant citations. From the 7096 unique citations retrieved from the search strategy, we included 14 randomized controlled trials (RCTs) that met all inclusion criteria. Pairs of review authors assessed the methodological quality of the obtained studies using the Downs and Black checklist. A meta-analysis was performed on studies that measured comparable outcomes. The GRADE approach was used to determine the level of evidence for each outcome.

RESULTS

In comparison with usual care or no care, Web-based interventions had a significant positive effect on empowerment measured with the Diabetes Empowerment Scale (2 studies, standardized mean difference [SMD] = 0.61, 95% confidence interval [CI] 0.29 - 0.94]), on self-efficacy measured with disease-specific self-efficacy scales (9 studies, SMD = 0.23, 95% CI 0.12 - 0.33), and on mastery measured with the Pearlin Mastery Scale (1 study, mean difference [MD] = 2.95, 95% CI 1.66 - 4.24). No effects were found for self-efficacy measured with general self-efficacy scales (3 studies, SMD = 0.05, 95% CI -0.25 to 0.35) or for self-esteem measured with the Rosenberg Self-Esteem Scale (1 study, MD = -0.38, 95% CI -2.45 to 1.69). Furthermore, when comparing Web-based interventions with face-to-face deliveries of the same interventions, no significant (beneficial or harmful) effects were found for mastery (1 study, MD = 1.20, 95% CI -1.73 to 4.13) and self-esteem (1 study, MD = -0.10, 95% CI -0.45 to 0.25).

CONCLUSIONS

Web-based interventions showed positive effects on empowerment measured with the Diabetes Empowerment Scale, disease-specific self-efficacy scales and the Pearlin Mastery Scale. Because of the low quality of evidence we found, the results should be interpreted with caution. The clinical relevance of the findings can be questioned because the significant effects we found were, in general, small.

Development of My Health Companion to enhance self-care management of chronic health conditions in rural dwellers

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals, and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health record and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

Systematic review on Internet Support Groups (ISGs) and depression (1): Do ISGs reduce depressive symptoms?

Background

Internet support groups (ISGs) enable individuals with specific health problems to readily communicate online. Peer support has been postulated to improve mental health, including depression, through the provision of social support. Given the growing role of ISGs for both users with depression and those with a physical disorder, there is a need to evaluate the evidence concerning the efficacy of ISGs in reducing depressive symptoms.

Objective

The objective was to systematically review the available evidence concerning the effect of ISGs on depressive symptoms.

Method

Three databases (PubMed, PsycINFO, Cochrane) were searched using over 150 search terms extracted from relevant papers, abstracts, and a thesaurus. Papers were included if they (1) employed an online peer-to-peer support group, (2) incorporated a depression outcome, and (3) reported quantitative data. Studies included both stand-alone ISGs and those used in the context of a complex multi-component intervention. All trials were coded for quality.

Results

Thirty-one papers (involving 28 trials) satisfied the inclusion criteria from an initial pool of 12,692 abstracts. Sixteen trials used either a single-component intervention, a design in which non-ISG components were controlled, or a cross-sectional analysis, of which 10 (62.5%) reported a positive effect of the ISG on depressive symptoms. However, only two (20%) of these studies employed a control group. Only two studies investigated the efficacy of a depression ISG and neither employed a control group. Studies with lower design quality tended to be associated with more positive outcomes (P = .07). Overall, studies of breast cancer ISGs were more likely to report a reduction in depressive symptoms than studies of other ISG types (Fisher P = .02), but it is possible that this finding was due to confounding design factors rather than the nature of the ISG.

Conclusions

There is a paucity of high-quality evidence concerning the efficacy or effectiveness of ISGs for depression. There is an urgent need to conduct high-quality randomized controlled trials of the efficacy of depression ISGs to inform the practice of consumers, practitioners, policy makers, and other relevant users and providers of online support groups.

Computer-mediated patient education: opportunities and challenges for supporting women with ovarian cancer

A majority of women with ovarian cancer will face recurrent disease despite receiving aggressive chemotherapy at the time of diagnosis. Given the complex medical and psychosocial needs of women with ovarian cancer and the time constraints within busy clinical settings, providing women with the necessary education related to their disease and treatments can be challenging. The advent of computers and web-based technologies has created new opportunities for educating cancer patients and supporting them to better cope with their disease. This article reviews prior studies of computer-based patient education interventions to identify key intervention components and other factors associated with improved patient outcomes. Opportunities for using computer-based technologies to support women with ovarian cancer are discussed and WRITE Symptoms (a Written Representational Intervention To Ease Symptoms), a web-based, symptom management intervention for women with recurrent ovarian cancer, is introduced.

New mothers network: the provision of social support to single, low-income, African American mothers via e-mail messages

Electronic mail (e-mail) is being investigated as a health care intervention for mothers caring for their infants. The purpose of this study is to describe themes representing the content of e-mail messages written by 12 single, low-income, African American mothers to nurses participating in the New Mothers Network Study. Three themes that emerged were (a) life's logistics: day-to-day concerns; (b) relationships of support; and (c) personal reflections about being a new mother. Reported themes support the social support theory based on works by House and Revenson, Schiaffano, Majerovitz, and Gibofski used to develop the nursing intervention. Nurses are in key positions to offer social support to African American mothers adjusting to single parenting. Nurses can provide social support to single, low-income African American mothers via e-mail messages to assist them with caring for themselves and their infants.

Evolution of a conceptual model for adaptation to chronic illness

PURPOSE

To describe the evolution of "The Women to Women Conceptual Model for Adaptation to Chronic Illness."

DESIGN

A three-phase, computer-based research intervention to provide support and health information to chronically ill middle-aged women living in rural areas of the intermountain West. EVOLUTION OF A CONCEPTUAL MODEL: The path of the conceptualization of the WTW project was traced from a single concept to its present explanatory, multiconcept model consisting of three major adaptation constructs (environmental stimuli, psychosocial response, illness management) with related middle-range theoretical concepts (focal, contextual, and residual stimuli, psychosocial adaptation, chronic illness self-management, and quality of life) including empirical indicators and measures for each.

CLINICAL RELEVANCE

As the computer-based intervention is maturing, we are demonstrating its efficacy in helping rural women to better manage chronic illness. At the completion of this study, the intervention should be adequately tested so that it could be adapted for use by advanced practice nurses especially those working with people in isolated rural areas.

Participation in online patient support groups endorses patients' empowerment

OBJECTIVE

Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in online support groups, and which processes that occur in these groups are related to the empowering outcomes.

METHODS

An online questionnaire was completed by 528 individuals who were active in online groups for patients with breast cancer, fibromyalgia and arthritis.

RESULTS

The respondents felt empowered in several ways by their participation. The empowering outcomes that were experienced to the strongest degree were 'being better informed' and 'enhanced social well-being'. No significant differences in empowering outcomes between diagnostic groups were found. The empowering outcomes could only be predicted in a modest way by the processes that took place in the online support groups.

CONCLUSION

This study indicates that participation in online support groups can make a valuable contribution to the empowerment of patients.

PRACTICE IMPLICATIONS

Health care providers should acquaint their patients with the existence of online support groups and with the benefits that participation in these groups can offer.