Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study

BACKGROUND

Patients undergoing spinal surgery report high levels of insecurity, pain, stress, and anxiety before and after surgery. Unfortunately, there is no guarantee that surgery will resolve all issues; postsurgical recovery often entails moderate to severe postoperative pain, and some patients undergoing spinal surgery do not experience (long-term) pain relief after surgery. Therefore, focusing on sustainable coping skills and resilience is crucial for these patients. A digital health intervention based on acceptance and commitment therapy (ACT) and positive psychology (PP) was developed to enhance psychological flexibility and well-being and reduce postsurgical pain.

OBJECTIVE

The objective of this study was 3-fold: to explore the potential benefits for patients undergoing spinal surgery of the digital ACT and PP intervention Strength Back (research question [RQ] 1), explore the feasibility of a future randomized controlled trial in terms of recruitment and dropout (RQ 2), and assess the acceptability of Strength Back by patients undergoing spinal surgery (RQ 3).

METHODS

We used a nonrandomized experimental design with an intervention group (n=17) and a control group (n=20). To explore the potential benefits of the intervention, participants in both groups filled out questionnaires before and after surgery. These questionnaires included measurements of pain intensity (Numeric Pain Rating Scale), pain interference (Multidimensional Pain Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), valued living (Engaged Living Scale), psychological flexibility (Psychological Inflexibility in Pain Scale), and mental well-being (Mental Health Continuum-Short Form). Semistructured interviews combined with log data and scores on the Twente Engagement With eHealth Technologies Scale were used to assess the acceptability of the intervention.

RESULTS

A significant improvement over time in emotional (V=99; P=.03) and overall (V=55; P=.004) well-being (Mental Health Continuum-Short Form) was observed only in the intervention group. In addition, the intervention group showed a significantly larger decline in pain intensity (Numeric Pain Rating Scale) than did the control group (U=75; P=.003). Of the available weekly modules on average 80% (12/15) was completed by patients undergoing spinal fusion and 67% (6/9) was completed by patients undergoing decompression surgery. A total of 68% (17/25) of the participants used the intervention until the final interview. Most participants (15/17, 88%) in the intervention group would recommend the intervention to future patients.

CONCLUSIONS

This pilot feasibility study showed that combining ACT and PP in a digital health intervention is promising for patients undergoing spinal surgery as the content was accepted by most of the participants and (larger) improvements in pain intensity and well-being were observed in the intervention group. A digital intervention for patients undergoing (spinal) surgery can use teachable moments, when patients are open to learning more about the surgery and rehabilitation afterward. A larger randomized controlled trial is now warranted.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands

BACKGROUND

Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality.

METHODS

Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.

RESULTS

Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.

CONCLUSIONS

Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

Older adults' active involvement in an undergraduate program in gerontology: Motives and meaning

Two Dutch undergraduate programs in applied gerontology have teamed up with older volunteers to educate students in collaborating with older adults in the field of age-friendly service development. The research question of this study was: What are the motives and meanings of the older volunteers concerning their participation in an undergraduate program?An explorative descriptive qualitative design was used to study the motives and meanings of the older volunteers through semi-structured interviews (n = 11) and a focus group interview (n = 4). Two themes and nine categories emerged: (1) Personal norms and values (categories: responsible life attitude, contribution, self-determination), (2) Personal gain (categories: intergenerational education, personal development, staying healthy, pleasure, feeling appreciated, feeling connected). Personal norms and values and personal gains are meaningful to older volunteers in applied gerontology education. Universities should respect these when designing measures for improving participation methods.

Knowledge and attitude of nursing students regarding older adults' sexuality: A cross-sectional study

BACKGROUND

Although older adults are sexual, sexuality is infrequently discussed with them by health care professionals. Nursing students, as future professionals, can make an important contribution by developing competences in discussing intimacy and sexuality with older adults to increase quality of life and to prevent sexual problems. In order to improve these competences, current levels of knowledge and attitude need to be explored.

OBJECTIVES

To investigate i) knowledge and attitudes of nursing students regarding intimacy and sexuality of older adults, ii) the difference in knowledge and attitudes of nursing students in different years of study and iii) frequency of discussing intimacy and sexuality with older adults.

DESIGN

Cross-sectional.

SETTINGS

A University of Applied Sciences in the Netherlands.

PARTICIPANTS

Nursing students, ≥16 years who were able to read and write in Dutch.

METHODS

The Ageing Sexual Knowledge and Attitudes Scale was used among nursing students. Furthermore, demographic information and frequencies were collected. Data was analyzed using SPSS.

RESULTS

In total, 732 students participated. The mean knowledge-score was 43.9 (SD = 8.9), the mean attitude-score 64.3 (SD = 16.0). Unlike attitude, the level of knowledge differed significantly per year of study: first year students had the lowest and third year students the highest knowledge. Most students stated they 'never' (54.1%) or 'once' (13.2%) discussed intimacy and sexuality with older adults. Reasons to avoid talking about intimacy and sexuality were feelings of 'not being the right person' (17.3%) and 'incompetence' (14.0%).

CONCLUSIONS

Nursing students had moderate knowledge and positive attitudes toward older adults' intimacy and sexuality. The knowledge-level differed per year of study, the attitude level did not. Only a minority discussed intimacy and sexuality with older adults. Moderate knowledge and positive attitudes do not mean that intimacy and sexuality is discussed. To ensure students feel responsible and competent, interventions should focus on continuous knowledge dissemination, role clarification and role modelling.

CARE DEPENDENCY: EXPERIENCES AND EXPECTATIONS OF COMMUNITY-DWELLING OLDER ADULTS

“Not to be a burden” is a common phrase used by community-dwelling older adults in discussing their dependency on others in care for their daily life. This attitude may lead to conflicts with relatives, neighbors, or professionals when in their opinion, care is necessary and, ultimately, may result in unmet care needs. The goal of this study is to gain a better understanding of how older adults experience their increased dependency on others and to contribute to the development of an ethic of care. Thirty-two participants of a larger research sample (n=64) from a descriptive qualitative research were purposefully selected, resulting in an equal distribution of the following variables: gender, living situation, living with or without partner, and having children or not. From a multiphase qualitative analysis with five researchers, including two senior citizens four themes emerged: (1) relationships in the context of care; (2) experiences with giving, receiving and asking for care; (3) future perspectives towards receiving and asking for care; and (4) actual practices of caregiving and receiving. Our study clarifies how community-dwelling older adults deal with the changes in their dependency on others. The study results highlight particular dynamics which appear, at least, partly in contrast with current policy regarding care at home. Moreover, it contributes to an empirical refinement of the concepts of dependency and interdependency in an ethic of care. Further studies are needed to clarify the influential factors on asking for care in diverse groups of older adults and the response from their network.

Gerontology competencies: Construction, consensus and contribution

The Academy for Gerontology in Higher Education (AGHE) in 2014 approved the first integrative "Gerontology Competencies for Undergraduate and Graduate Education"©. This article describes the background, thought development, guiding framework and consensus process for its construction. A modified Delphi method utilizing seven review rounds within three developmental cycles, with gerontology educators from 30 institutions, achieved input and consensus. The comprehensive framework has ten major domains, employs three categories each including multiple selective competencies. Six Category I competencies are essential orientations to gerontology. Four Category II competencies are "interactional" processes of knowing and doing across the field. Category III provides eight selective competencies for sectors where gerontologists may work. From educators' feedback, gerontology characteristics emerged: multi-system approaches; interdisciplinary; communication of older adults' "voices" and strengths; research utilization. The discussion includes the contribution of competency-based gerontology to students and aging workforce development as well as next steps, outcome measurement, levelling and accreditation.

Nurturing gerontology students' intrinsic motivation to cocreate: The design of a powerful learning environment

Professionals such as gerontologists play an important role in the design, development and implementation of age-friendly services. and products, by using working methods and principles of co-creation. A Dutch undergraduate applied gerontology programme aims to train students in the why, how and what of co-creation. The degree to which students are intrinsically motivated to develop competencies depends on how their psychological needs are met. These needs are autonomy, an awareness of competence and a sense of relatedness, as described in the self-determination theory. To nurture the intrinsic motivation of the applied gerontology students, a realistic, powerful learning environment called the Living Lab Applied Gerontology was designed and implemented. The aim of this paper is to present the design of this powerful learning environment and to discuss its value for nurturing the students' intrinsic motivation for co-creation. Based on a focus group with eight students, we identify directions for further research and development of living labs.

[Evaluation by case managers dementia : An explorative practice based study on types and content]

BACKGROUND

This practice based explorative study aims to provide insight into the ways in which case managers shape and fill up the evaluation phase of their support of the informal care network of persons with dementia.

METHOD

A combination of quantitative and qualitative research methods were used. A group of 57 case managers of persons with dementia in three different organisational networks took part in this study.

RESULTS

Results from the quantitative and qualitative data are organized into four themes: (1) attitude towards evaluation, (2) forms of evaluation, (3) implementation of evaluation and (4) content of evaluation. There are different ways in shaping evaluation and the content of it. The importance of interim and final evaluation is recognized, but is difficult to realize in a methodical way. Barriers experienced by the case managers include various factors associated both with clients as professionals.

CONCLUSION

Case managers evaluate continuously and in an informal way to assess whether the extent of their assistance is meeting the needs of the client and informal network. Case managers do not use systematic evaluation to measure the quality of care they offer to persons with dementia and their caregivers. The findings demand a discussion on the level of clients, as well as on the professional and societal level about the way case managers should evaluate their support.

Competencies in European gerontological higher education. An explorative study on core elements

This study explores whether there is a common core of competencies in European gerontology education programs by doing a cross-comparison of five undergraduate-level programs. Content analysis of competency profile documents at the five European educational programs were studied using thematic analysis. Study results document that there indeed is a common core of elements in gerontological educational programs. Three clusters which included a total of 15 categories were identified. The clusters were labeled professional attitude, communication skills, and service provision. Clusters and categories varied across the five programs. One program in particular included fewer clusters and categories. This may reflect a difference in focus in the program but could also reflect a less elaborately formulated competency profile document. The results of this study show that, at least at the level of formulating competencies, there is a strong agreement on the major components that are important for a gerontologist at the undergraduate level.

Person-centred care and job satisfaction of caregivers in nursing homes: a systematic review of the impact of different forms of person-centred care on various dimensions of job satisfaction

OBJECTIVE

The positive effects of person-centred care on older clients have been demonstrated. However, relatively little is known about the effect that giving person-centred care has on caregivers. This literature review examines the job satisfaction of caregivers who deliver person-centred care in nursing homes.

DESIGN

The research questions are: Do the various forms of person-centred care affect job satisfaction differently? Which particular dimensions of job satisfaction have been evaluated in studies on person-centred care, and does their sensitivity to person-centred care differ? Using the search engines Pubmed, Cinahl, Psychinfo and Embase up to August 2010, 46 efficacy studies were found, seven of which satisfied our criteria.

RESULTS

Emotion-oriented care, snoezelen, and small-scale care most often show positive effects on job satisfaction. Person-centred care has been shown to have positive effects on general job satisfaction, job demands at psychogeriatric wards, emotional exhaustion and personal accomplishment.

CONCLUSIONS

Taking into account the fair-to-moderate quality of the studies included, it is concluded that there are limited indications that person-centred care has a positive effect on a number of dimensions of caregivers' job satisfaction. Further study is required to expand and to support these tentative conclusions.