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Cheung WC, Miles LM, Hawkes RE, French DP. Experiences of online group support for engaging and supporting participants in the National Health Service Digital Diabetes Prevention Programme: A qualitative interview study. J Health Serv Res Policy 2024; 29:100-110. [PMID: 38096783 PMCID: PMC10910750 DOI: 10.1177/13558196231212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVES The National Health Service Digital Diabetes Prevention Programme is a nine-month behavioural intervention for adults in England at risk of type 2 diabetes. This qualitative study aimed to explore how service users engaged with the group support available within the programme. METHODS The majority of participants (n = 33), all service users, were interviewed twice via telephone, at 2-4 months into the programme, and at the end of the programme at 8-10 months. Semi-structured interviews covered participants' experiences of online group support functions and how such groups served as a route of support to aid participants' behavioural changes. Data were analysed using manifest thematic analysis. RESULTS The majority of participants valued the format of closed group chats, which provided an interactive platform to offer and receive support during their behaviour change journey. However, engagement with group chats reduced over time, and some participants did not find them useful when there was a lack of common interests within the group. Health coaches helped to promote engagement and build rapport among participants within the group chats. Participants reported mixed experiences of discussion forums. CONCLUSIONS Programme developers should consider how to optimise online group support to help service users make behavioural changes, in terms of format, participant composition and use of health coach moderators. Further research is required to better understand who might benefit most from 'group chat' or 'discussion forum' support. Health coach moderation of online support groups is likely to facilitate engagement.
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Affiliation(s)
- Wang Chun Cheung
- Research Assistant, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa M Miles
- Research Associate, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rhiannon E Hawkes
- Research Associate, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P French
- Professor of Health Psychology, Manchester Centre for Health Psychology, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Taylor TA, Beban G, Yi E, Veukiso M, Sang-Yum G, Dewes O, Wrapson W, Taufa N, Campbell ART, Siegert RJ, Shepherd P. Empowering Pacific Patients on the Weight Loss Surgery Pathway: A Co-designed Evaluation Study. Obes Surg 2024; 34:959-966. [PMID: 38345730 PMCID: PMC10899268 DOI: 10.1007/s11695-024-07084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. MATERIALS AND METHODS This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. RESULTS Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. CONCLUSION This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.
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Affiliation(s)
- Tamasin Ariana Taylor
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand.
| | - Grant Beban
- General Surgery Department, Auckland City Hospital, Te Whatu Ora, Te Toka Tumai, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Elaine Yi
- General Surgery Department, Auckland City Hospital, Te Whatu Ora, Te Toka Tumai, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Michael Veukiso
- School of Social Work, College of Health, Massey University, Albany, North Shore, Auckland, 0745, New Zealand
| | - Genevieve Sang-Yum
- School of Social Work, College of Health, Massey University, Albany, North Shore, Auckland, 0745, New Zealand
| | - Ofa Dewes
- Centre of Methods and Policy Application in the Social Sciences, The Faculty of Arts, University of Auckland, 12 Grafton Road, Auckland, 1010, New Zealand
- Langimalie Research Centre, Tongan Health Society, M20 Business Park, 86F Plunket Avenue, Manukau, Auckland, 2104, New Zealand
| | - Wendy Wrapson
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand
| | - Nalei Taufa
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Andrew R T Campbell
- Department of Anthropology, The Faculty of Arts, The University of Auckland, 22 Symonds Street, Auckland, 1010, New Zealand
| | - Richard J Siegert
- Faculty of Health and Environmental Sciences, School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand
| | - Peter Shepherd
- Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Building 507, Room 1090, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
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Pinkney J, Tarrant M. Time for a new agenda for behavioural treatment of overweight and obesity. Clin Obes 2024; 14:e12628. [PMID: 37968241 DOI: 10.1111/cob.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Jonathan Pinkney
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mark Tarrant
- School of Psychology, University of Plymouth, Plymouth, UK
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Smit AK, Vos RC, Bijl RW, Busch KJG, Verkleij SM, Kiefte-de Jong JC, Numans ME, Bonten TN. Implementation of a group-based lifestyle intervention programme (Healthy Heart) in general practices in The Netherlands: a mixed-methods study. BJGP Open 2023; 7:BJGPO.2023.0064. [PMID: 37402548 PMCID: PMC11176702 DOI: 10.3399/bjgpo.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Lifestyle intervention programmes target behavioural risk factors that contribute to cardiovascular diseases (CVDs). Unfortunately, sustainable implementation of these programmes can be challenging. Gaining insights into the barriers and facilitators for successful implementation is important for maximising public health impact of these interventions. The Healthy Heart (HH) programme is an example of a combined lifestyle intervention programme. AIM To analyse the reach, adoption, and implementation of the HH programme. DESIGN & SETTING A mixed-methods study conducted in a general practice setting in The Netherlands. METHOD Quantitative data were collected from the Healthy Heart study (HH study), a non-randomised cluster stepped-wedge trial to assess the effect of the HH programme on patients at high risk of developing CVDs at practice level. Qualitative data were obtained through focus groups. RESULTS Out of 73 approached general practices, 55 implemented the HH programme. A total of 1082 patients agreed to participate in the HH study, of whom 64 patients were referred to the HH programme and 41 patients participated. Several barriers for participation were identified such as time investment, lack of risk perception, and being confident in changing lifestyle on their own. Important barriers for healthcare providers (HCPs) to refer a patient were time investment, lack of information to sufficiently inform patients, and preconceived notions regarding which patients the programme was suitable for. CONCLUSION This study has offered insights from a patient and HCP perspective regarding barriers and facilitators for implementation of the group-based lifestyle intervention programme. The identified barriers and facilitators, and the suggested improvements, can be used by others who wish to implement a similar programme.
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Affiliation(s)
- Anne K Smit
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Rimke C Vos
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Rozemarijn W Bijl
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Karin J G Busch
- Primary Care Group The Hague (Hadoks), Hague, The Netherlands
| | - Sanne M Verkleij
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care (V-0-P), Leiden University Medical Center, Leiden, The Netherlands
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Everitt JD, Battista-Dowds EM, Heggs D, Hewlett P, Squire ALM. Determinants of completion and early dropout in an adult weight management service: a prospective observational study. J Hum Nutr Diet 2023; 36:1931-1941. [PMID: 37357716 DOI: 10.1111/jhn.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND High attrition rates in weight management interventions (WMIs) undermine their effectiveness but are poorly understood. This study aimed to identify determinants of completion and early dropout in National Health Service (NHS) WMIs. METHODS In this prospective observational study, 329 patients recruited at initial consultation appointments satisfied the eligibility criteria: age ≥18 years and body mass index (BMI) ≥30 kg/m2 . Multivariate logistic regression analyses were performed to identify the odds ratios (OR, given with 95% confidence interval) of completion and early dropout. RESULTS Intervention completion rate was 39.8% (131 of 329). Variables that increased the likelihood of completion included engagement in support sessions, OR10.6 (4.7-23.6, p < 0.001); male sex, OR2.5 (1.4-4.5, p = 0.002); osteoarthritis, OR1.9 (1.1-3.3, p = 0.014); and one or more missed intervention appointments marked as 'could not attend' (notified nonattendance), OR1.8 (1.1-2.9, p = 0.032). Odds of early dropout were higher for participants with anxiety and depression OR2.0 (1.0-4.0, p = 0.039). Dietetic 1:1 participants were less likely to drop out early compared with group programme participants, OR0.3 (0.2-0.7, p = 0.002), but were less likely to complete the full intervention, OR0.5 (0.3-0.9, p = 0.02). Age, BMI, social deprivation and travel distance were among the variables not associated with completion or early dropout. CONCLUSIONS This study provides further evidence of the importance of support for participants of WMIs and the need for services to consider how support networks can be incorporated. Patients with poorer mental health may be more likely to drop out early and consequently benefit less from WMIs. Future research should qualitatively explore why these factors contribute to attrition to improve WMI effectiveness.
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Affiliation(s)
| | - Enzo M Battista-Dowds
- Weight Management Service, Nutrition and Dietetics Department, Cwm Taff Morgannwg University Health Board, Merthyr Tydfil, Wales, UK
| | - Daniel Heggs
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Paul Hewlett
- Department of Applied Psychology, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| | - Amanda L M Squire
- Department of Healthcare and Food, School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
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Haslam C, Bertschy K, Cruwys T, Griffin J, Johnson D. The group mechanism in treatment: group identification and cohesion contributes to reducing chronic lower back pain by increasing personal control. Disabil Rehabil 2023; 45:1332-1342. [PMID: 35403527 DOI: 10.1080/09638288.2022.2057602] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE There is increasing recognition of the contribution that group processes, particularly identification and cohesion, make to outcomes of group delivered health treatments. This study examined the role that these particular group processes play in the treatment of lower back pain, and a theorised mechanism of personal control through which group treatment might enhance outcomes. METHODS Participants (N = 85) elected to either receive NeuroHAB®, a defined functional movement therapy of 8 weeks duration, or continue with treatment-as-usual (TAU). Pain intensity and disability were assessed at baseline (T1) and post-intervention or 8 weeks later (T2), as well as at a 1-month follow-up (T3). Only the NeuroHAB® participants additionally completed weekly questionnaires that measured treatment group identification, cohesion, and personal control. RESULTS NeuroHAB® was significantly more effective than TAU in reducing pain intensity and disability at T2 and T3. Furthermore, among NeuroHAB® recipients, stronger treatment group identification and cohesion early in the program predicted better pain outcomes over time, and this relationship was fully mediated by perceptions of personal control. CONCLUSION These data provide further support for the role of group identification and cohesion as a contributing mechanism of change in group-based treatments and extend this to the domain of pain management.Implications for RehabilitationA focus on defined functional movement therapy, as offered by the NeuroHAB® group program, was found to improve pain outcomes in patients with lower back pain.A key ingredient in the NeuroHAB® rehabilitation program was its group delivery.Group delivery supported treatment group identification and cohesion which, through enhancing the perception of personal control, reduced pain intensity and disability.
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Affiliation(s)
- Catherine Haslam
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Kristen Bertschy
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Joanne Griffin
- Functional Movement Training Centre, St Andrews Memorial Hospital, Brisbane, Australia
| | - David Johnson
- Functional Movement Training Centre, St Andrews Memorial Hospital, Brisbane, Australia
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Imhagen A, Karlsson J, Jansson S, Anderzén-Carlsson A. A lifelong struggle for a lighter tomorrow: A qualitative study on experiences of obesity in primary healthcare patients. J Clin Nurs 2023; 32:834-846. [PMID: 35655375 PMCID: PMC10084391 DOI: 10.1111/jocn.16379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
AIM To describe experiences of living with obesity before the start of a group-based lifestyle intervention. BACKGROUND Obesity is a chronic disease that affects a person's physical and psychological health. Increased knowledge of experiences of living with obesity is required. DESIGN A qualitative study with a descriptive design. METHODS Semi-structured individual interviews with 17 participants living with obesity (Body Mass Index 32-49) were conducted between October and November 2019. The interviews were analysed using qualitative content analysis. The COREQ checklist was followed. RESULTS The analysis resulted in one main theme: Struggling for a lighter tomorrow and three subthemes: Suffering, Resilience and Need for support in making changes. For the majority of the participants, living with obesity was a lifelong struggle involving suffering on different levels. Yet despite this, the participants had not given up and hoped for a better life. They showed a degree of resilience and motivation, and a perceived ability to achieve lifestyle changes. However, there was a pronounced need for support to help them achieve this. CONCLUSION Living with obesity is complex and carries a risk of medical complications as well as psychosocial suffering. Healthy lifestyle habits to achieve better health and to lose weight should be encouraged, taking patient resources into account. Patients also need help in handling weight stigmatisation, and both healthcare professionals and society must engage with this. RELEVANCE TO CLINICAL PRACTICE Obesity is a chronic disease, and patients need ongoing support. Therefore, care for patients with obesity in primary health care must be further developed. Patient resources and strengths have to be acknowledged and encouraged in the process of helping them adopt healthy lifestyle habits. The findings of this study can contribute to ending weight stigmatisation by increasing the knowledge of living with obesity.
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Affiliation(s)
- Annika Imhagen
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Jan Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Stefan Jansson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Agneta Anderzén-Carlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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Swancutt D, Tarrant M, Ingram W, Baldrey S, Burns L, Byng R, Calitri R, Creanor S, Dean S, Evans L, Gill L, Goodwin E, Hawkins L, Hayward C, Hind S, Hollands L, Hosking J, Lloyd J, Moghadam S, Neilens H, O’Kane M, Perry S, Sheaff R, Spencer A, Taylor A, Ward T, Watkins R, Wilding J, Pinkney J. A group-based behavioural intervention for weight management (PROGROUP) versus usual care in adults with severe obesity: a feasibility randomised controlled trial protocol. Pilot Feasibility Stud 2022; 8:206. [PMID: 36088457 PMCID: PMC9463813 DOI: 10.1186/s40814-022-01167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Approximately 15 million people in the UK live with obesity, around 5 million of whom have severe obesity (body mass index (BMI) ≥35kg/m2). Having severe obesity markedly compromises health, well-being and quality of life, and substantially reduces life expectancy. These adverse outcomes are prevented or ameliorated by weight loss, for which sustained behavioural change is the cornerstone of treatment. Although NHS specialist ‘Tier 3’ Weight Management Services (T3WMS) support people with severe obesity, using individual and group-based treatment, the current evidence on optimal intervention design and outcomes is limited. Due to heterogeneity of severe obesity, there is a need to tailor treatment to address individual needs. Despite this heterogeneity, there are good reasons to suspect that a structured group-based behavioural intervention may be more effective and cost-effective for the treatment of severe obesity compared to usual care. The aims of this study are to test the feasibility of establishing and delivering a multi-centre randomised controlled clinical trial to compare a group-based behavioural intervention versus usual care in people with severe obesity. Methods This feasibility randomised controlled study is a partially clustered multi-centre trial of PROGROUP (a novel group-based behavioural intervention) versus usual care. Adults ≥18 years of age who have been newly referred to and accepted by NHS T3WMS will be eligible if they have a BMI ≥40, or ≥35 kg/m2 with comorbidity, are suitable for group-based care and are willing to be randomised. Exclusion criteria are participation in another weight management study, planned bariatric surgery during the trial, and unwillingness or inability to attend group sessions. Outcome assessors will be blinded to treatment allocation and success of blinding will be evaluated. Clinical measures will be collected at baseline, 6 and 12 months post-randomisation. Secondary outcome measures will be self-reported and collected remotely. Process and economic evaluations will be conducted. Discussion This randomised feasibility study has been designed to test all the required research procedures and additionally explore three key issues; the feasibility of implementing a complex trial at participating NHS T3WMS, training the multidisciplinary healthcare teams in a standard intervention, and the acceptability of a group intervention for these particularly complex patients. Trial registration ISRCTN number 22088800. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01167-0.
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Hargreaves EA, Marsh S, Maddison R. Factors Influencing Men's Experiences and Engagement with the Rugby Fans in Training-New Zealand Pilot Trial: A Healthy Lifestyle Intervention for Men. Healthcare (Basel) 2021; 9:1737. [PMID: 34946463 PMCID: PMC8700970 DOI: 10.3390/healthcare9121737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Health promotion programs designed specifically to support men to improve their lifestyle behaviours are required to improve men's health. This study explored factors that influenced men's experiences of, and engagement with, the Rugby Fans in Training-New Zealand pilot trial, a professional sport-based healthy lifestyle intervention for overweight men. Thirty-five men (mean age = 45, SD = 10 years) who completed the 12-week intervention participated in one of eight semi-structured focus groups. Using inductive thematic analysis, five themes represented the meanings in the data. First, a group of like-minded men all in the same boat recognised the importance of being in similar life situations and having similar reasons for joining the programme. Second, the men described the importance of the support and motivation provided by the team atmosphere created through the programme. Third, the motivational coach recognised the characteristics, skills and knowledge of the coach delivering the programme which created engagement with it. Fourth, the education sessions were valued for the knowledge gained and underpinning philosophies that guided them. Finally, the involvement of the rugby franchise influenced commitment to the programme and created initial interest. These results provide evidence for the key components that should be incorporated into the future development of and improvement to healthy lifestyle interventions for men.
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Affiliation(s)
- Elaine Anne Hargreaves
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin 9016, New Zealand
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1010, New Zealand; (S.M.); (R.M.)
| | - Ralph Maddison
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland 1010, New Zealand; (S.M.); (R.M.)
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC 3125, Australia
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Social Support for People with Morbid Obesity in a Bariatric Surgery Programme: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126530. [PMID: 34204427 PMCID: PMC8297395 DOI: 10.3390/ijerph18126530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022]
Abstract
Background—Morbid obesity (MO) is a chronic metabolic disease affecting physical, psychological and social wellbeing. Bariatric surgery is a reliable method for losing weight in the long term, improving the quality of life, body image and social life of people with MO. Current literature recognises the importance of social support in controlling weight and coping with MO. The objective of this study was to describe and understand experiences related to social support for patients with MO included in a bariatric surgery programme. Methods—A qualitative descriptive study, where data collection included thirty-one interviews with people diagnosed with MO involved in a bariatric surgery programme. Results—Three main themes emerged from the analysis: (1) accepting the problem in order to ask for help, (2) the need for close support and (3) professional support: opposing feelings. Conclusions—A partner, family and friends are the key pillars of social support for those with MO included in a bariatric surgery programme. Healthcare professionals gave formal support; the bariatric surgery team provided information, trust and assurance. Nurses provided healthcare 24 h a day, making them the main formal support for people in the bariatric surgery programme.
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11
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Tarrant M, Lamont RA, Carter M, Dean SG, Spicer S, Sanders A, Calitri R. Measurement of Shared Social Identity in Singing Groups for People With Aphasia. Front Psychol 2021; 12:669899. [PMID: 34220642 PMCID: PMC8248786 DOI: 10.3389/fpsyg.2021.669899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Community groups are commonly used as a mode of delivery of interventions for promoting health and well-being. Research has demonstrated that developing a sense of shared social identity with other group members is a key mechanism through which the health benefits of group membership are realized. However, there is little understanding of how shared social identity emerges within these therapeutic settings. Understanding the emergence of shared social identity may help researchers optimize interventions and improve health outcomes. Group-based singing activities encourage coordination and a shared experience, and are a potential platform for the development of shared social identity. We use the "Singing for People with Aphasia" (SPA) group intervention to explore whether group cohesiveness, as a behavioral proxy for shared social identity, can be observed and tracked across the intervention. Video recordings of group sessions from three separate programmes were rated according to the degree of cohesiveness exhibited by the group. For all treatment groups, the final group session evidenced reliably higher levels of cohesiveness than the first session (t values ranged from 4.27 to 7.07; all p values < 0.003). As well as providing confidence in the design and fidelity of this group-based singing intervention in terms of its capacity to build shared social identity, this evaluation highlighted the value of observational methods for the analysis of shared social identity in the context of group-based singing interventions.
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Affiliation(s)
- Mark Tarrant
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Ruth A Lamont
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Mary Carter
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| | - Sarah G Dean
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sophie Spicer
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Amy Sanders
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Raff Calitri
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
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Carlén K, Kylberg E. An intervention of sustainable weight change: Influence of self-help group and expectations. Health Expect 2021; 24:1498-1503. [PMID: 34089622 PMCID: PMC8369104 DOI: 10.1111/hex.13290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obesity is one of the most challenging public health problems in Western societies. Group activities are a way to empower individuals to make sustainable lifestyle changes. Self‐help groups enable individuals to share expectations and experiences on an equal basis. Objective The aim was to find a model for sustainable weight reduction for people with obesity and to evaluate the importance of expectations before entering the weight reduction programme. Methods Persons with a BMI >30 and aged over 30 years were recruited. Weekly seminars for 6 months with discussions concerning physical activity, eating habits and how to change one's lifestyle occurred. After the seminars, a self‐help group was initiated. The participants were encouraged to express their expectations before each step in the study. Results Our findings showed that those who had joined a self‐help group had reduced their weight significantly (−6.0 kg) compared with those who had not (−1.4 kg). Further, those who expressed a more mature expectation of the coming change in behaviour towards a healthy lifestyle showed slightly larger weight reduction (−6.1 kg) than those who expressed low expectations (−3.7 kg). Patient or public contribution Participants expressed their thoughts and views, which were considered and included in the programme. Conclusions Our findings indicate that the self‐help group can be an essential part of a weight reduction programme. The self‐help group is a novel strategy to strengthen sustainability in reducing weight. The study also highlights the importance of identifying behaviour change expectations before participating in a programme.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Sweden
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A Conceptual Model of Long-Term Weight Loss Maintenance: The Importance of Cognitive, Empirical and Computational Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020635. [PMID: 33451110 PMCID: PMC7828595 DOI: 10.3390/ijerph18020635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/22/2022]
Abstract
Living with obesity is related to numerous negative health outcomes, including various cancers, type II diabetes, and cardiovascular disease. Although much is known about the factors associated with obesity, and a range of weight loss interventions have been established, changing health-related behaviours to positively affect obesity outcomes has proven difficult. In this paper, we first draw together major factors that have emerged within the literature on weight loss to describe a new conceptual framework of long-term weight loss maintenance. Key to this framework is the suggestion that increased positive social support influences a reduction in psychosocial stress, and that this has the effect of promoting better executive functioning which in turn facilitates the development of healthy habits and the breaking of unhealthy habits, leading to improved ongoing maintenance of weight loss. We then outline how the use of computational approaches are an essential next step, to more rigorously test conceptual frameworks, such as the one we propose, and the benefits that a mixture of conceptual, empirical and computational approaches offer to the field of health psychology.
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14
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Morgan C, de Wildt G, Prado RBR, Thanikachalam N, Virmond M, Riley R. Views and Experiences of Adults who are Overweight and Obese on the Barriers and Facilitators to Weight Loss in Southeast Brazil: A Qualitative Study. Int J Qual Stud Health Well-being 2020; 15:1852705. [PMID: 33250018 PMCID: PMC7717597 DOI: 10.1080/17482631.2020.1852705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Obesity in Brazil is increasing with 54% of the Brazilian population being overweight, of which 20% is obese. Obesity is a risk factor for non-communicable diseases such as cardiovascular disease: the leading cause of mortality in Brazil. This study aims to identify the barriers and facilitators to weight loss as perceived by patients with a view to reducing the burden of obesity-related diseases on patients and healthcare services. Methods: Fifteen qualitative, semi-structured, in-depth interviews were conducted in the preventive medicine department in a private health clinic in Bauru, Southeast Brazil. Inductive thematic analysis was conducted. Results: The barriers and facilitators were classified into three themes: lifestyle, motivation and education. Barriers include cost of a healthy lifestyle, time management, personal safety, mobility, junk food advertising, sustaining weight loss, mental health, lack of support and health education. Facilitators include change in eating habits, sleep quality, cooperative food networks, access to the multidisciplinary team and expert patients as health educators. Conclusion: Expert patients should be utilized as an education method, as they increase motivation, promote the facilitators and provide realistic expectations of the weight loss process. Barriers such as junk food advertising and accessibility to treatment need to be addressed. Abbreviations: BMI: Body Mass Index; NCD: Non-Communicable Disease; SUS: Sistema Único de Saúde; WHO: World Health Organization.
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Affiliation(s)
- Caroline Morgan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Nisha Thanikachalam
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marcos Virmond
- Research Institute, Instituto Lauro De Souza Lima, Bauru, Brazil
| | - Ruth Riley
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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15
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Toft BS, Galvin K, Nielsen CV, Uhrenfeldt L. Being with others during physical activity: experiences of well-being among adults with severe obesity. Physiother Theory Pract 2020; 38:1003-1015. [PMID: 32875926 DOI: 10.1080/09593985.2020.1815262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The experience of physical activity is influenced by social relations and gendered roles. Group-based lifestyle interventions are considered effective in promoting physical activity, yet the experiences of being active with others are unknown among individuals with severe obesity. PURPOSE To explore how individuals with severe obesity experience being with others during physical activity. METHODS A qualitative hermeneutic phenomenological study of repeated single-gender focus group interviews was conducted with adults living with severe obesity during group-based lifestyle intervention. RESULTS Three themes were developed: 1) 'Enjoying safety, kinship and belonging among peers'; 2) 'Feeling like a failure is shameful: A sense of aversion'; and 3) 'Striving to feel at home in physical activity: Needing distance from others.' The themes were drawn into an overall meaning 'Achieving wellbeing may always be a challenge: not feeling at home in the group or in body.' CONCLUSION Intersubjective and spatial dimensions of experiences are central and influence how individuals with severe obesity can feel wellbeing and 'at home' in physical activity. Physiotherapists should be aware of the individuals' vulnerability regarding feelings of failure, aversion, and shame as well as awareness of gendered norms and roles.
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Affiliation(s)
- Bente Skovsby Toft
- Department of Lifestyle Rehabilitation, Horsens Regional Hospital, Brædstrup, Denmark
| | - Kathleen Galvin
- Centre for Arts and Wellbeing, School of Health Sciences, Brighton, UK
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,DEFACTUM, Aarhus, Denmark.,Regional Hospital West Jutland, Herning, Denmark
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16
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Khan SS, Tarrant M, Kos K, Daly M, Gimbuta C, Farrow CV. Making connections: Social identification with new treatment groups for lifestyle management of severe obesity. Clin Psychol Psychother 2020; 27:686-696. [PMID: 32267579 DOI: 10.1002/cpp.2454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022]
Abstract
Groups are regularly used to deliver healthcare services, including the management of obesity, and there is growing evidence that patients' experiences of such groups fundamentally shape treatment effects. This study investigated factors related to patients' shared social identity formed within the context of a treatment group for the management of severe obesity. A cross-sectional survey was administered to patients registered with a UK medical obesity service and enrolled on a group-based education and support programme. Patients (N = 78; MBMI = 48 on entry to the service) completed measures of group demographics (e.g., group membership continuity) and psychosocial variables (e.g., past experiences of weight discrimination) and reported their social identification with the treatment group. The results showed that patients identified with the treatment group to the extent that there was continuity in membership across the programme and they perceived themselves more centrally in terms of their weight status. Weight centrality was negatively associated with external social support and positively associated with experiences of weight discrimination. Group continuity was positively correlated with session attendance frequency. Patients presenting to clinical treatment services with severe obesity often do so after sustained weight loss failure and exposure to negative societal experiences. This study highlights that providing a treatment environment wherein these experiences can be shared with other patients may provide common ground for development of a new, positive social identity that can structure programme engagement and progression.
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Affiliation(s)
- Sammyh S Khan
- University of Exeter Medical School, University of Exeter, Exeter, UK.,School of Psychology, Keele University, Keele, UK
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Katarina Kos
- University of Exeter Medical School, University of Exeter, Exeter, UK.,Royal Devon and Exeter NHS Hospital Trust, Exeter, UK
| | - Mark Daly
- Royal Devon and Exeter NHS Hospital Trust, Exeter, UK
| | - Chloe Gimbuta
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Claire V Farrow
- School of Life and Health Sciences, Aston University, Birmingham, UK
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17
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Bjornstad G, Wilkinson K, Cuffe-Fuller B, Fitzpatrick K, Borek A, Ukoumunne OC, Hawton A, Tarrant M, Berry V, Lloyd J, McDonald A, Fredlund M, Rhodes S, Logan S, Morris C. Healthy Parent Carers peer-led group-based health promotion intervention for parent carers of disabled children: protocol for a feasibility study using a parallel group randomised controlled trial design. Pilot Feasibility Stud 2019; 5:137. [PMID: 31788323 PMCID: PMC6875041 DOI: 10.1186/s40814-019-0517-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme's effectiveness and cost-effectiveness. Methods We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants' and facilitators' feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups. Discussion This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme. Trial registration ISRCTN, ISRCTN151144652, registered on 25 October 2018; ClinicalTrials.gov, NCT03705221, registered on 15 October 2018.
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Affiliation(s)
- Gretchen Bjornstad
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Kath Wilkinson
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Beth Cuffe-Fuller
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Katharine Fitzpatrick
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Aleksandra Borek
- 2Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Obioha C Ukoumunne
- 3National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Annie Hawton
- 4Health Economics Group, University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Mark Tarrant
- 3National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Vashti Berry
- 3National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Jenny Lloyd
- 3National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Annabel McDonald
- 5PenCRU Family Faculty, University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Mary Fredlund
- 5PenCRU Family Faculty, University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Shelley Rhodes
- 6Exeter Clinical Trials Unit, University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Stuart Logan
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Christopher Morris
- 1Peninsula Childhood Disability Research Unit (PenCRU) and National Institute for Health Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter Medical School, University of Exeter, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
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18
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Kabu Hergül F, Özbayır T. I Am As Normal As Everyone Now. . . : Examination of Experiences of Patients Undergoing Bariatric Surgery According to Roy's Adaptation Model: A Qualitative Study. Clin Nurs Res 2019; 30:511-521. [PMID: 31609134 DOI: 10.1177/1054773819880291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study is to examine experiences of patients undergoing bariatric surgery according to Roy's adaptation model (RAM). This is a qualitative study with a phenomenological design. The sample included patients undergoing bariatric surgery (N: 32). Of all the patients 84.37% were female and 59.38% were married. According to results of the content analysis, adaptive patient behavior was described by the themes "My life has changed", Everything is beautiful" "I can cope" and "Luckily, I have them" and their nonadaptive behavior was described by the themes "What if I cannot succeed", "Bad news" and "So many people, so many views". Patients having bariatric surgery experience various difficulties in adapting to their life and bodies, but the surgery leads to improvements in their body image, social life, personal relationships, and maintenance of roles. However, some patients can be afraid of postoperative complications and experience anxiety about regaining weight.
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Affiliation(s)
- Filiz Kabu Hergül
- Faculty of Health Science, Department of Surgical Illnesses Nursing, Pamukkale University, Denizli, Turkey
| | - Türkan Özbayır
- Department of Surgical Illnesses Nursing, Ege University Faculty of Nursing, Izmir, Turkey
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19
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Abstract
PURPOSE OF REVIEW Rising demand for specialised "Tier 3" weight management services in England is exceeding capacity, leading many services to offer group-based care programmes. This review considers the organisation of current provision, exploring how group programmes may enhance services and how these could be scaled up for wider implementation. RECENT FINDINGS Existing group-based programmes mainly focus on providing patients with information and education about their condition. Evidence suggests that groups themselves offer therapeutic benefits beyond this, by underpinning patients' engagement with programme materials and contributing to wider health and well-being. To maximise these benefits, there is a need to attend to the group processes that emerge in treatment groups which, left unchecked, may limit or even adversely impact programme outcomes. Group-based interventions may be of benefit to patients in Tier 3 specialist weight management services, although their format is complex and reliant on facilitators' expertise.
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Affiliation(s)
- Dawn Swancutt
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
| | - Mark Tarrant
- College of Medicine and Health , University of Exeter, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Jonathan Pinkney
- Peninsula Schools of Medicine and Dentistry, Plymouth University, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK
- University Medicine, Level 7, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, Plymouth PL6 8DH, UK
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20
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Borek AJ, Abraham C, Greaves CJ, Tarrant M, Garner N, Pascale M. 'We're all in the same boat': A qualitative study on how groups work in a diabetes prevention and management programme. Br J Health Psychol 2019; 24:787-805. [PMID: 31273908 DOI: 10.1111/bjhp.12379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/07/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although many health interventions are delivered in groups, it is unclear how group context can be best used to promote health-related behaviour change and what change processes are most helpful to participants. This study explored participants' experiences of attending type 2 diabetes prevention and management programme, and their perceptions of how group participation influenced changes in diet and physical activity. DESIGN Qualitative. METHODS Semi-structured telephone interviews were conducted with 20 participants (twelve men) from nine groups in the Norfolk Diabetes Prevention Study. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis in NVivo. RESULTS Participants benefited from individual change processes, including information provision, structuring and prioritizing health goals, action planning, self-monitoring, and receiving feedback. They also benefited from group processes, including having a common purpose, sharing experiences, making social comparisons, monitoring and accountability, and providing and receiving social support in the groups. Participants' engagement with, and benefits from, the groups were enhanced when there was a supportive group context (i.e., group cohesion, homogeneous group composition, and a positive group atmosphere). Optimal facilitation to develop an appropriate group context and initiate effective change processes necessitated good facilitator interpersonal and professional skills, credibility and empathy, and effective group facilitation methods. Participants reported developing a sense of responsibility and making behaviour changes that resulted in improvements in health outcomes and weight loss. CONCLUSIONS This study highlights the role of individual and group processes in facilitating health-promoting behaviour change, and the importance of group context and optimal facilitation in promoting engagement with the programme. Statement of contribution What is already known on this subject? Many health interventions, including programmes to help prevent or manage diabetes and facilitate weight loss, are delivered in groups. Such group-based behaviour-change interventions are often effective in facilitating psychological and behaviour change. There is considerable research and theory on individual change processes and techniques, but less is known about which change processes and techniques facilitate behaviour change in group settings. What does this study add? This study contributes to our understanding of how participating in group-based health programmes may enhance or impede individual behaviour change. It identified individual (intrapersonal) and group (interpersonal, facilitated through group interaction) change processes that were valued by group participants. The findings also show how these change processes may be affected by the group context. A diagram summarizes the identified themes helping to understand interactions between these key processes occurring in groups. The study offers an insight into participants' views on, and experiences of, attending a group-based diabetes prevention and management programme. Thus, it helps better understand how the intervention might have helped them (or not) and what processes may have influenced intervention outcomes. Key practical recommendations for designing and delivering group-based behaviour-change interventions are presented, which may be used to improve future group-based health interventions.
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Affiliation(s)
- Aleksandra J Borek
- University of Exeter Medical School, University of Exeter, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Charles Abraham
- University of Exeter Medical School, University of Exeter, UK.,School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Colin J Greaves
- University of Exeter Medical School, University of Exeter, UK.,School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, UK
| | - Mark Tarrant
- University of Exeter Medical School, University of Exeter, UK
| | - Nikki Garner
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
| | - Melanie Pascale
- Norfolk Diabetes Prevention Study, Norfolk & Norwich University Foundation Healthcare Trust, UK
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21
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Cruwys T, Steffens NK, Haslam SA, Haslam C, Hornsey MJ, McGarty C, Skorich DP. Predictors of social identification in group therapy. Psychother Res 2019; 30:348-361. [DOI: 10.1080/10503307.2019.1587193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Tegan Cruwys
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Niklas K. Steffens
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | | | - Catherine Haslam
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | | | - Craig McGarty
- School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Daniel P. Skorich
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
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22
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Hanson P, Shuttlewood E, Halder L, Shah N, Lam FT, Menon V, Barber TM. Application of Mindfulness in a Tier 3 Obesity Service Improves Eating Behavior and Facilitates Successful Weight Loss. J Clin Endocrinol Metab 2019; 104:793-800. [PMID: 30566609 DOI: 10.1210/jc.2018-00578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/06/2018] [Indexed: 01/28/2023]
Abstract
CONTEXT Mindfulness strategies may facilitate healthier eating behavior but have not previously been studied in a United Kingdom-based tier 3 obesity service. OBJECTIVE To demonstrate the clinical effectiveness of mindfulness as part of newly created group sessions within a tier 3 obesity service. METHODS Recruitment of participants (n = 53, including n = 33 completers) from patients attending a tier 3-based obesity service at University Hospitals Coventry and Warwickshire. Each participant attended four group sessions, at which mindfulness-based eating behavior strategies were taught. Self-reported eating behavior and body weight were assessed at baseline and following completion of attendance at the group sessions. Paired-sample t tests were performed. P < 0.05 was considered significant. Data are reported for the 33 completers. Weight difference was assessed in a retrospective control group of 33 patients who did not attend the group sessions but received the standard multidisciplinary input. RESULTS There were statistically significant improvements (P = 0.009) in self-reported eating behavior [driven by improvements in "fast-foodism" (P = 0.031)] and reduction in body weight [3.06 kg (SD 5.2 kg), P = 0.002] at 6 months following completion of the group sessions. This was statistically more (P = 0.036) than 6-month weight loss in the control group (0.21 kg). Participants reported improved self-esteem and confidence in self-management of body weight. CONCLUSION Application of mindfulness-based eating behavior strategies, taught at group sessions within a tier 3 obesity service, resulted in significant improvement in eating behavior, and facilitated subsequent weight loss over 6 months. Such a strategy has potential for scalability to the wider obese population.
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Affiliation(s)
- Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Emma Shuttlewood
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Louise Halder
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Neha Shah
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - F T Lam
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Vinod Menon
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
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23
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Tarrant M, Carter M, Dean SG, Taylor RS, Warren FC, Spencer A, Adamson J, Landa P, Code C, Calitri R. Singing for people with aphasia (SPA): a protocol for a pilot randomised controlled trial of a group singing intervention to improve well-being. BMJ Open 2018; 8:e025167. [PMID: 30206095 PMCID: PMC6144319 DOI: 10.1136/bmjopen-2018-025167] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The singing for people with aphasia (SPA) intervention aims to improve quality of life and well-being for people with poststroke aphasia. A definitive randomised controlled trial (RCT) is required to assess the clinical and cost effectiveness of SPA. The purpose of this pilot study is to assess the feasibility of such a definitive trial and inform its design. METHODS AND ANALYSIS A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation. Forty-eight participants discharged from clinical speech and language therapy will be individually randomised 1:1 to SPA (10 group sessions plus a resource booklet) or control (resource booklet only). Outcome assessment at baseline, 3 and 6 months postrandomisation include: ICEpop CAPability measure for adults, Stroke and Aphasia Quality of Life, EQ-5D-5L, modified Reintegration into Normal Living Index, Communication Outcome After Stroke, Very Short Version of the Minnesota Aphasia Test, Service Receipt Inventory and Care Related Quality of Life. Feasibility, acceptability and process outcomes include recruitment and retention rates, with measurement burden and trial experiences being explored in qualitative interviews (15 participants, 2 music facilitators and 2 music champions). Analyses include: descriptive statistics, with 95% CIs where appropriate; qualitative themes; intervention fidelity from videos and session checklists; rehearsal of health economic analysis. ETHICS AND DISSEMINATION NHS National Research Ethics Service and the Health Research Authority confirmed approval in April 2017; recruitment commenced in June 2017. Outputs will include: pilot data to inform whether to proceed to a definitive RCT and support a funding application; finalised intervention manual for multicentre replication of SPA; presentations at conferences, public involvement events; internationally recognised peer reviewed journal publications, open access sources and media releases. TRIAL REGISTRATION NUMBER NCT03076736.
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Affiliation(s)
- Mark Tarrant
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Mary Carter
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Sarah Gerard Dean
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Rod S Taylor
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Fiona C Warren
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Anne Spencer
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Jane Adamson
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Paolo Landa
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
| | - Chris Code
- Department of Psychology, University of Exeter, Exeter, UK
| | - Raff Calitri
- Institute for Health Research, University of Exeter Medical School & PenCLAHRC, Exeter, UK
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24
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Sandlund C, Kane K, Ekstedt M, Westman J. Patients' experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study. BMC FAMILY PRACTICE 2018; 19:111. [PMID: 29986651 PMCID: PMC6038282 DOI: 10.1186/s12875-018-0798-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
Abstract
Background The majority of patients who seek help for insomnia do so in primary health care. Nurse-led group treatment in primary care based on cognitive behavioral therapy for insomnia (CBT-I) can lead to improvements in both day- and nighttime symptoms. This study aimed to explore patients’ experiences of nurse-led group treatment for insomnia in primary health care. Methods Seventeen patients who had participated in the group treatment program were interviewed in five focus groups. Interview transcriptions were analyzed with qualitative content analysis. Results Four themes emerged that described patients’ experiences of the group treatment program. Involvement and trust open the door for change: Motivation to engage in treatment arose from patients’ own desire for change, from being together with others who shared or understood their struggles, and from feeling emotionally affirmed and trustful. Competence arising from deeper understanding: Patients obtained knowledge and made it their own, which enabled them to develop functional sleep habits and let go of sleep performance and worry. The ability to impact their insomnia increased patients’ trust in their own efficacy and helped them persist in behavioral change. Struggling with vulnerability and failure: Treatment was tough, and patients could feel challenged by external circumstances. Moreover, they could distrust their own efficacy. Tailoring treatment to individual needs: Patients experienced different life circumstances and adapted the techniques to their needs and abilities by focusing on what felt right for them. Conclusions Patients went through a process of motivation, change, and challenges. They experienced certain aspects of treatment as essential to changing behavior and achieving improvements. Examples included being in a group with others who shared similar experiences, gaining knowledge about sleep, keeping a sleep diary, and practicing the sleep restriction technique. The study provides insights into patients’ struggles during treatment, both those related to external circumstances and those related to feelings of vulnerability and failure. It also highlights the importance of adapting treatment to patients’ differing needs, underscoring the value of person-centered care.
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Affiliation(s)
- Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. .,Academic Primary Health Care Centre, Stockholm County Council, Solnavägen 1 E, Box 45436, 104 31, Stockholm, Sweden.
| | - Kimberly Kane
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Solnavägen 1 E, Box 45436, 104 31, Stockholm, Sweden.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan 14, SE-392 34, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Jeanette Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Stockholm County Council, Solnavägen 1 E, Box 45436, 104 31, Stockholm, Sweden
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Pouwels S, Alebeek MKV, Smelt HJM, Smulders JF. The Patients' Perspective Is the Missing Link in Current Bariatric Surgical Practice. Obes Surg 2017; 27:2467-2468. [PMID: 28667511 DOI: 10.1007/s11695-017-2787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sjaak Pouwels
- Department of Surgery Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
| | - Miranda Kruizinga-van Alebeek
- Department of Surgery Catharina Hospital, Eindhoven, Netherlands.,Obesity Center, Catharina Hospital, Eindhoven, Netherlands
| | - Hendrika J M Smelt
- Department of Surgery Catharina Hospital, Eindhoven, Netherlands.,Obesity Center, Catharina Hospital, Eindhoven, Netherlands
| | - Johannes F Smulders
- Department of Surgery Catharina Hospital, Eindhoven, Netherlands.,Obesity Center, Catharina Hospital, Eindhoven, Netherlands
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Pontiroli AE, Ceriani V, Folli F. Patients' Expectations are Important for Success in Bariatric Surgery. Obes Surg 2017; 27:2469-2470. [PMID: 28669070 DOI: 10.1007/s11695-017-2788-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Antonio E Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy.
| | | | - Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, Milan, Italy
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