Defining a Brief Intervention for the Promotion of Psychological Well-being among Unemployed Individuals through Expert Consensus

Development of a comprehensive flourishing intervention to promote mental health using an e-Delphi technique

BACKGROUND

Although observational studies have already shown promising results of flourishing, a broader concept of health based on positive psychology, there is still a gap in the literature regarding studies that combine different topics of flourishing in a single intervention.

OBJECTIVES

To develop a comprehensive and integrate intervention based on positive psychology gathering different topics of flourishing to improve mental health outcomes in individuals with depressive symptoms.

METHODS

The following steps were performed: (1) a comprehensive literature review; (2) the designing of a 12-session group intervention based on the values, virtues, and topics of flourishing; (3) assessment of the rationale, coherence, and feasibility by a panel of healthcare professionals answering semi-structured questions, and (4) application of an e-Delphi technique including mental health experts to reach a consensus of at least 80% for each item of the protocol.

RESULTS

A total of 25 experts participated in the study, 8 in the panel with semi-structured questions and 17 in the e-Delphi technique. A three-round e-Delphi technique was required to reach a consensus for all items. In the first round, a consensus was reached for 86.2% of the items. The remaining items (13.8%) were either excluded or reformulated. In the second round, a consensus was not obtained on one item, which was reformulated and approved in the third round. Qualitative analyses of the open questions were performed and suggestions for the protocol were considered. The final version of the intervention was composed of 12 weekly group sessions with 90-min each. The topics included in the intervention were physical and mental health, virtues and character strengths, love, gratitude, kindness, volunteering, happiness, social support, family, friends and community, forgiveness, compassion, resilience, spirituality, purpose and meaning of life, imagining the "best possible future," and flourishing.

CONCLUSION

The flourishing intervention was successfully developed using an e-Delphi technique. The intervention is ready to be tested in an experimental study to verify its feasibility and effectiveness.

Developing an Intervention to Improve Occupational Participation for Justice-Involved People with a Personality Disorder: Defining and Describing Intervention Components

Occupational participation is undertaking personally meaningful and socially valued activities and roles. It is an important outcome for health and justice interventions, as it is integral to health and desistance. We report the third of a four-stage research project to develop an intervention to improve occupational participation for justice-involved people with a personality disorder in the community. We completed a Delphi survey to produce expert consensus on intervention components and their content, ascertain participant ratings of 28 factors for their level of influence on occupational participation, and the modifiability of the factors with this population. Thirty multi-disciplinary participants completed three survey rounds. Most factors were rated very influential, but few were considered easily modifiable. Participants agreed 121 statements describing intervention components and content. Twenty-seven statements did not reach consensus. In targeting specific factors in intervention, practitioners must balance their degree of influence with potential modifiability. The results will inform intervention manualization and modeling.

Health Literacy Needs Among Unemployed Persons: Collating Evidence Through Triangulation of Interview and Scoping Review Data

Background

Unemployed persons are at high risk for low health literacy. Most studies addressing health literacy of unemployed persons focus on risk factors for low health literacy or correlates of health literacy, but studies on needs of unemployed persons regarding health literacy are scarce. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews.

Methods

Scoping review: We searched six databases up to January 2021 as well as gray literature for relevant studies following PRISMA-ScR guidelines. Titles, abstracts, and full texts were screened independently by two researchers. Qualitative study: Ten participants of a job-reintegration program in Germany were interviewed following a guideline covering topics including health issues of interest to the participants, their sources of health-related information and the barriers/facilitators they experience when accessing health services.

Results

Scoping review: After screening 2,966 titles and abstracts, 36 full texts were considered, and five articles fulfilled the inclusion criteria. Four focused on mental health literacy and outcomes, while the fifth assessed information-seeking practices. One additional report on health literacy was identified via the gray literature search. Awareness of one's condition was identified as a facilitator for mental health help-seeking, while fear of harmful effects of medication prevented help-seeking. Qualitative study: Participants were interested in and were generally well-informed about health topics such as nutrition and physical activity. The main challenge perceived was translating the knowledge into practice in daily life. GPs and the social services providers played an important role as a source of health information and advice. Regarding mental health, similar barriers, facilitators and needs were identified through triangulation of findings of the scoping review with those of the interviews.

Conclusions

There is need to address health literacy needs of long-term unemployed persons that go beyond mental health literacy. Public health interventions should not only aim at improving health literacy scores, but also focus on how to help participants translate health literacy into practice. Population groups of interest should also be involved in all processes of designing interventions.

Reducing Sexual and Reproductive Health Inequities Between Natives and Migrants: A Delphi Consensus for Sustainable Cross-Cultural Healthcare Pathways

The increasing number of international migrants (ranging from 153 million in 1990 to ~272 million in 2019) brought to attention the wide variation of national contexts concerning the policy measures to protect migrants' rights and ensuring their equal access to basic and essential services, namely in health. Sexual and Reproductive Health (SRH) is a key component to the overall health and quality of life and is impacted by power inequities inherent to society's institutions, environment, economics, and culture. In Portugal, guidelines for intervention in SRH are insufficient, a gap that is more pronounced with migrant populations due to the absence of culturally sensitive indicators to assess and monitor SRH. The aim of this work was 2-fold: to identify good practices in the SRH field, with a particular focus, whenever possible, on migrant populations, and to identify relevant and inclusive indicators to monitor SRH in Portugal. A Delphi panel (via online survey) with 66 experts (researchers, teachers, and health professionals) and 16 stakeholders (non-governmental organizations, civil society, and governmental organizations) was implemented in two rounds. Panelists were asked to state their level of agreement (5-point Likert-type scale) regarding four different SRH areas: Sexual Health, Reproductive Health, Social-Structural Factors, and Good Practices. Items were based on literature review and a World Café with 15 experts and stakeholders. Participation rate was 68% and response rate was 97% on the first round. From the initial list of 142 items, a total of 118 (83%) items were approved by consensus. Findings may provide extended opportunities for the healthcare system to engage in better informed decisions and more inclusive and integrative strategies regarding SRH, contributing to build political measures toward sexual and reproductive justice.

Experiences of involuntary job loss and health during the economic crisis in Portugal

Background:

The economic recession that started in 2008 left many unemployed across several European countries. Many studies have analyzed the relationship between job loss, health, and well-being in other contexts. This study aimed to explore experiences of involuntary unemployment during the economic recession and their relationship with health, conceptualized as a state of physical, mental, and social well-being among unemployed individuals.

Methods:

Semistructured qualitative interviews were carried out among a convenience sample of participants who became unemployed during the economic recession. The analysis was conducted to identify patterns and themes.

Results:

Participants (n = 22; 8 men and 14 women; 23–51 years) experienced feelings of loss of identity, stress, and a sense of powerlessness due to unemployment, as well as a lack of purpose and structure in their daily lives. Six themes were identified: work as the basis for life structure and personal fulfillment; response to unemployment and the importance of its duration; unemployment leading to isolation and loss of a role in society; impact of a change in financial situation on social life and consumption patterns; the physical and psychological health consequences of unemployment; and searching for ways to cope with unemployment and to feel well.

Conclusions:

Losing a job is an adverse experience that impairs an individual's perception of overall health and well-being. From a public health perspective, the results of this study highlight the need for policymakers’ awareness to help mitigate the potential consequences of involuntary job loss in the short- and long-term.

Efficacy of a peer-led group program for unemployed people with mental health problems: Pilot randomized controlled trial

BACKGROUND

People with long-term unemployment and mental health problems often find it difficult to take active steps toward help-seeking and job search and to navigate the complex system of available services. Likewise, job center staff would welcome interventions to improve the reintegration of long-term unemployed individuals with mental health problems into the labor market.

AIM

To examine the efficacy of a peer-led group program that supports unemployed people with mental health problems in terms of help-seeking, job search and recovery.

METHODS

Based on participatory research, a four-session group program was designed and evaluated in a pilot randomized controlled trial (RCT) with 42 participants, randomized to the program ( n = 23) or treatment as usual ( n = 19). Outcomes were assessed at baseline (T0), 3 weeks (T1), 6 weeks (T2) and 6 months later (T3).

RESULTS

There were no significant intervention effects on primary outcomes (job search self-efficacy and help-seeking). But compared to the control group, intervention participants showed significant improvements in depressive symptoms ( p = .02) and recovery ( p = .04) at T2 with medium effect sizes. There were trend-level positive program effects on self-stigma, hopelessness and secrecy.

CONCLUSION

This pilot RCT provides initial evidence for the efficacy of a peer-led group program to improve symptoms and recovery among unemployed participants with mental health problems.