Achieving Whole Health: A Preliminary Study of TCMLH, a Group-Based Program Promoting Self-Care and Empowerment Among Veterans

Objective An emerging literature suggests patients with chronic illnesses can benefit from integrated, person-centric approaches to health care, including group-based programs. However, much of the research in this area is disease specific. The objective of this study was to collect preliminary evidence on the efficacy of Taking Charge of My Life and Health (TCMLH), a Whole Health group-based program that emphasizes self-care and empowerment on the overall health and well-being of veterans, a population burdened with high rates of multiple chronic conditions. Method Self-reported outcomes, including standardized survey measures, were collected at pretest, posttest, and 2-month follow-up from 77 participants across 15 groups at four VA sites. Random intercept mixed-model regressions were used to analyze data. Results Results from this initial study showed high satisfaction with the program and facilitators, and high attendance. There were significant pre–post gains in self-care attitudes and behaviors, patient motivation, meaning and purpose, mental health, perceived stress, goal progress, and goal-specific hope. Outcomes were maintained at 2-month follow-up for patient motivation, perceived stress, goal-specific hope, and goal progress. Significant gains were observed in health care empowerment and physical health from pretest to follow-up. Conclusions Preliminary findings support the efficacy of TCMLH, a Whole Health group-based program that emphasizes patient empowerment, self-care practices, and peer support. Future research priorities include a rigorous evaluation with a larger sample size and control group to assess effectiveness.

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Mindfulness-Based IARA Model® Proves Effective to Reduce Stress and Anxiety in Health Care Professionals. A Six-Month Follow-Up Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224421 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4421 ◽

Cited By ~ 7

Author(s):

Massimiliano Barattucci ◽

Anna Maria Padovan ◽

Ermanno Vitale ◽

Venerando Rapisarda ◽

Tiziana Ramaci ◽

...

Keyword(s):

Health Care ◽

Perceived Stress ◽

Health Care Professionals ◽

Emotional Regulation ◽

Well Being ◽

Point Of View ◽

Clinical Samples ◽

Control Group ◽

Specific Work ◽

Health Care Environment

Changes in the health care environment, together with specific work-related stressors and the consequences on workers’ health and performance, have led to the implementation of prevention strategies. Among the different approaches, those which are mindfulness-based have been institutionally recommended with an indication provided as to their effectiveness in the management of stress. The aim of the present study was to analyze the efficacy of the mindfulness-based IARA Model® (an Italian acronym translatable into meeting, compliance, responsibility, autonomy) in order to ameliorate perceived stress, anxiety and enhance emotional regulation among health care professionals (HCPs; i.e., doctors, nurses, and healthcare assistants). Four hundred and ninety-seven HCPs, 215 (57.2%) of which were women, were randomly assigned to a mindfulness-based training or control group and agreed to complete questionnaires on emotion regulation difficulties (DERS), anxiety, and perceived stress. Results showed that HCPs who attended the IARA training, compared to the control group, had better emotional regulation, anxiety and stress indices after 6 months from the end of the intervention. Furthermore, the results confirmed the positive relationship between emotional regulation, perceived stress and anxiety. The present study contributes to literature by extending the effectiveness of IARA in improving emotional regulation and well-being in non-clinical samples. Moreover, the study provides support for the idea that some specific emotional regulation processes can be implicated in perceived stress and anxiety. From the application point of view, companies should invest more in stress management intervention, monitoring and training, in order to develop worker skills, emotional self-awareness, and relational resources.

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Efficacy of a mindfulness-based intervention programme with and without virtual reality support to reduce stress in university students: protocol for a randomized controlled pragmatic trial

10.21203/rs.2.12892/v2 ◽

2021 ◽

Author(s):

Marta Modrego-Alarcón ◽

María Teresa Navarro-Gil ◽

María Beltrán-Ruiz ◽

Alicia Monreal-Bartolomé ◽

Santiago Gascón ◽

...

Keyword(s):

Virtual Reality ◽

University Students ◽

Perceived Stress ◽

Well Being ◽

Self Report ◽

Control Group ◽

Large Sample Size ◽

Randomized Controlled ◽

The Impact

Abstract Background: There is growing concern about mental health problems in university students. For this reason, mindfulness training is becoming increasingly popular in university settings. However, mindfulness-based interventions (MBIs) usually present high attrition rates. This trial aims to evaluate the efficacy of a MBI to reduce perceived stress and to improve the psychological well-being of university students, as well as to explore the capacity of virtual reality (VR) to enhance adherence to the intervention. Methods: This study protocol presents a randomized controlled trial (RCT) involving assessment time points of baseline, posttreatment and 6-month follow-up. A total of 280 students from the Spanish National Distance Education University (UNED) or the University of Zaragoza will be randomly assigned to a mindfulness condition, a mindfulness condition complemented by VR, and a relaxation condition to serve as a control group. Stress will be the main outcome and will be measured using the 10-item self-report Perceived Stress Scale (PSS). Other well-being and academic functioning outcomes will be assessed, as well as variables that explore the impact of VR. Multilevel mixed-effects models will be calculated to estimate the efficacy of the programme, and effect size estimations will be carried out. Effects of VR in adherence to programme will be evaluated. Discussion: Some strengths of this study are the RCT design, which includes a suitable active control group and a 6-month follow-up assessment; a large sample size of university students at different stages of their courses and a variety of degrees; and the incorporation of the VR support to facilitate completion of the MBI programme. Potential limitations are the voluntary participation of the students and the utilization of self-report measures.Trial registration number: ClinicalTrials.gov NCT03771300.

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A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249227 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9227

Author(s):

Marita Stier-Jarmer ◽

Cornelia Oberhauser ◽

Dieter Frisch ◽

Götz Berberich ◽

Thomas Loew ◽

...

Keyword(s):

Perceived Stress ◽

Prevention Program ◽

Primary Outcome ◽

Controlled Trial ◽

Well Being ◽

Control Group ◽

Management Intervention ◽

Stress Prevention ◽

Telephone Coaching

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: −13.38 (±14.98); 95%-CI: (−17.68; −9.07); noTC: −11.09 (±14.15); 95%-CI: (−15.11; −7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: −1.58; 95%-CI: (−7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants’ resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.

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The Effectiveness of Mindfulness-based Group Therapy on Perceived Stress, Emotional Cognitive Regulation, and Self-care Behaviors in Patients With Hypertension

Quarterly of Horizon of Medical Sciences ◽

10.32598/hms.27.2.3502.1 ◽

2021 ◽

Vol 27 (2) ◽

pp. 246-263

Author(s):

Nima Sabetfar ◽

◽

Farahnaz Meschi ◽

Marjan Hosseinzade Taghvaei ◽

◽

...

Keyword(s):

Group Therapy ◽

Perceived Stress ◽

Negative Emotion ◽

Self Care ◽

Control Group ◽

Cognitive Regulation ◽

Significant Difference ◽

Post Test ◽

And Control

Aims: Patients with high blood pressure usually experience high levels of stress that affect their emotion regulation and self-care behaviors. The current study aimed to examine the cognitive-minded group therapy on perceived stress, emotional, cognitive regulation, and self-care behaviors in patients with hypertension. Methods & Materials: The study has a quasi-experimental design with a pre-test, post-test, follow-up, and a control group. The study population was all people with hypertension referred to medical centers in Kish Island, Iran, in 2010 (March to June). The research sample consisted of 32 qualified candidates who were selected using the purposive sampling method. Then they were randomly assigned to the experimental and control groups. Perceived stress, emotional and cognitive regulation, and self-care questionnaires of patients with hypertension were used to collect information in the pre-test, post-test, and follow-up stages. The experimental group underwent mindfulness-based group therapy, but the control group did not receive any intervention. The obtained data were analyzed with repeated measures analysis of variance in SPSS v. 22. The significance level of the tests was considered 0.05. Findings: The results showed a significant difference between the experimental and control groups in the mean scores of positive stress (P=0.001), negative stress (P=0.001), positive emotion (P=0.001), negative emotion (P=0.001), medication regimen (P=0.003), diet (P=0.011), and disease management (P=0.026) in the post-test and follow-up. But there was no significant difference between the mean scores of food labels (P=0.195). Conclusion: The effectiveness of mindfulness-based group therapy on reducing stress and negative emotion and improving self-care of patients with hypertension suggests that in addition to the physical components of chronic diseases, the psychological components of patients be considered to prevent recurrence diseases and increase adherence to treatment in them.

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Efficacy of a mindfulness-based intervention programme with and without virtual reality support to reduce stress in university students: protocol for a randomized controlled pragmatic trial

10.21203/rs.2.12892/v1 ◽

2019 ◽

Author(s):

Marta Modrego-Alarcón ◽

María Teresa Navarro-Gil ◽

María Beltrán-Ruiz ◽

Alicia Monreal-Bartolomé ◽

Santiago Gascón ◽

...

Keyword(s):

Virtual Reality ◽

University Students ◽

Perceived Stress ◽

Well Being ◽

Self Report ◽

Control Group ◽

Large Sample Size ◽

Randomized Controlled ◽

The Impact

Abstract Background There is growing concern about mental health problems in university students. For this reason, mindfulness training is becoming increasingly popular in university settings. However, mindfulness-based interventions (MBIs) usually present high attrition rates. This trial aims to evaluate the efficacy of a MBI to reduce perceived stress and to improve the psychological well-being of university students, as well as to explore the capacity of virtual reality (VR) to enhance adherence to the intervention. Methods This study protocol presents a randomized controlled trial (RCT) involving assessment time points of baseline, posttreatment and 6-month follow-up. A total of 280 students from the Spanish National Distance Education University (UNED) or the University of Zaragoza will be randomly assigned to a mindfulness condition, a mindfulness condition complemented by VR, and a relaxation condition to serve as a control group. Stress will be the main outcome and will be measured using the 10-item self-report Perceived Stress Scale (PSS). Other well-being and academic functioning outcomes will be assessed, as well as variables that explore the impact of VR. Multilevel mixed-effects models will be calculated to estimate the efficacy of the programme, and effect size estimations will be carried out. Effects of VR in adherence to programme will be evaluated. Discussion Some strengths of this study are the RCT design, which includes a suitable active control group and a 6-month follow-up assessment; a large sample size of university students at different stages of their courses and a variety of degrees; and the incorporation of the VR support to facilitate completion of the MBI programme. Potential limitations are the voluntary participation of the students and the utilization of self-report measures. Trial registration number ClinicalTrials.gov NCT03771300.

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Family Physicians’ Standpoint and Mental Health Assessment in the Light of COVID-19 Pandemic—A Nationwide Survey Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042093 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2093

Author(s):

Tina Vilovic ◽

Josko Bozic ◽

Marino Vilovic ◽

Doris Rusic ◽

Sanja Zuzic Furlan ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Perceived Stress ◽

Depression Scale ◽

Family Physicians ◽

Knowledge Score ◽

Well Being ◽

Anxiety And Depression ◽

Event Scale ◽

The Impact

During the coronavirus disease 2019 (COVID-19) outbreak, family physicians (FPs) are the backbone of the healthcare system with considerable impact on the general population, and their well-being is of great importance. The aim of this investigation was to assess FPs mental health, as well as knowledge, attitudes and practices (KAPs) regarding the pandemic, and opinions on non-communicable disease (NCD) health care provided to patients. A cross-sectional study was carried out with a sample of 613 FPs. Anxiety and depression levels were estimated with the Hospital Anxiety and Depression Scale, subjective perceived stress with the Perceived Stress Scale, while trauma-related symptoms were assessed using the Impact on Event Scale-COVID19. KAPs toward the pandemic and opinions regarding NCD patients were evaluated with questionnaires accordingly. Results have shown that age (β = −0.02, p = 0.013) and personal risk of COVID‑19 (β = 1.05, p < 0.001) were significant independent correlates of the knowledge score. A total of 87.7% FPs expressed moderate/high perceived stress, 45.2% moderate/severe trauma-related symptoms, 60.4% borderline/abnormal anxiety levels, and 52.4% borderline/abnormal depression levels. Knowledge score was an independent predictor of perceived stress (β = −0.33, p = 0.023) and anxiety (β = −0.31, p = 0.006) levels. Limited accessibility to healthcare services and decreased number of newly-diagnosed NCD cases were mostly agreed on. The pandemic puts a considerable strain on FPs mental health, as well as on public health measures, due to the decreased overall quality of NCD patient health care. Educational programs may bridge the gaps between FPs’ knowledge. Thus lowering anxiety and improving patient care.

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Validity and reliability of the Self-Care Activities Screening Scale (SASS-14) during COVID-19 lockdown

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01607-6 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Martín Martínez ◽

Elkin O. Luis ◽

Edwin Yair Oliveros ◽

Pablo Fernández-Berrocal ◽

Ainize Sarrionandia ◽

...

Keyword(s):

General Population ◽

Perceived Stress ◽

Convergent Validity ◽

Self Care ◽

Internal Validity ◽

Well Being ◽

Validity And Reliability ◽

Good Reliability ◽

Confirmatory Factor Analyses ◽

Health Consciousness

Abstract Background In a context where there is no treatment for the current COVID-19 virus, the combination of self-care behaviours together with confinement, are strategies to decrease the risk of contagion and remain healthy. However, there are no self-care measures to screen self-care activities in general population and which, could be briefly in a lockdown situation. This research aims to build and validate a psychometric tool to screen self-care activities in general population. Methods Firstly, an exploratory factor analysis was performed in a sample of 226 participants to discover the underlying factorial structure and to reduce the number of items in the original tool into a significant pool of items related to self-care. Later a confirmatory factor analyses were performed in a new sample of 261 participants to test for the fit and goodness of factor solutions. Internal validity, reliability, and convergent validity between its score with perceived stress and psychological well-being measures were examined on this sample. Results The exploratory analyses suggested a four-factor solution, corresponding to health consciousness, nutrition and physical activity, sleep, and intra-personal and inter-personal coping skills (14 items). Then, the four-factor structure was confirmed as the best model fit for self-care activities. The tool demonstrated good reliability, predictive validity of individuals’ perception of coping with COVID-19 lockdown, and convergent validity with well-being and perceived stress. Conclusions This screening tool could be helpful to address future evaluations and interventions to promote healthy behaviours. Likewise, this tool can be targeted to specific population self-care’s needs during a scalable situation.

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Efficacy of ‘Foundations’, a Digital Mental Health App to Improve Mental Well-Being, during COVID-19: A Proof-of-Principle Randomised Controlled Trial (Preprint)

10.2196/preprints.30976 ◽

2021 ◽

Author(s):

Silvina Catuara-Solarz ◽

Bartlomiej Skorulski ◽

Inaki Estella ◽

Claudia Avella-Garcia ◽

Sarah Shepherd ◽

...

Keyword(s):

Mental Health ◽

Perceived Stress ◽

Intervention Group ◽

Well Being ◽

Self Report ◽

World Health ◽

Randomised Control Trial ◽

Control Group ◽

Mental Well Being ◽

Proof Of Principle

BACKGROUND Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. OBJECTIVE The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomised control trial that took place during the first wave of the COVID-19 pandemic in the UK. METHODS Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomised to either the intervention or control arm. Participants in the intervention arm were given access to the app, Foundations, for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10]; 7-item Generalised Anxiety Disorder scale [GAD-7]; Office of National Statistics Four Subjective Well-being Questions [ONS-4]; World Health Organisation-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and weeks 2 and 4; and, in addition, on perceived stress weekly (10-item Perceived Stress Score [PSS]). RESULTS 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety (GAD-7 score, delta from baseline to week 2 in the intervention group: -1.35 [SD 4.43]; control group: -0.23 [SD 3.24]; t134= 1.71 , P=.04), resilience (CD-RISC score, delta from baseline to week 2 in the intervention group: 1.79 [± SD 4.08]; control group: -0.31 [± SD 3.16]; t134 -3.37, P<.001), sleep (MISS score, delta from baseline to week 2 in the intervention group: -1.16 [± SD 2.67]; control group: -0.26 [± SD 2.29]; t134= 2.13, P=.01), and mental well-being (WHO-5 score, delta from baseline to week 2 in the intervention group: 1.53 [5.30]; control group: -0.23 [± SD 4.20]; t134= -2.16, P=.02) within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the results did not reach statistical significance relative to the control group (PSS score, delta from baseline to week 2 in the intervention group: -2.94 [± SD 6.84]; control group: -2.05 [± SD 5.34]; t134= 0.84, P=.20). CONCLUSIONS This study provides proof-of-principle that the digital mental health app, Foundations, can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. It therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic.

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Impact of pulmonary rehabilitation on patients’ health care needs and asthma control: a quasi-experimental study

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01301-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Julia Salandi ◽

Andrea Icks ◽

Jalal Gholami ◽

Stefan Hummel ◽

Konrad Schultz ◽

...

Keyword(s):

Health Care ◽

Asthma Control ◽

Pulmonary Rehabilitation ◽

Preliminary Evidence ◽

Control Group ◽

Health Care Needs ◽

Care Needs ◽

Asthma Control Test ◽

Quasi Experimental

Abstract Background Pulmonary rehabilitation offers potential benefits to people with asthma. It is however unknown if rehabilitation favourably affects patients’ health care needs. We therefore examined if rehabilitation reduced needs and, in addition, if it improved asthma control. Methods One hundred fifty patients with asthma were surveyed in three rehabilitation clinics at admission and at discharge. Additionally, we surveyed 78 participants with asthma twice 4 weeks apart. The latter sample (i.e. the control group) was recruited through other pathways than rehabilitation clinics. The Patient Needs in Asthma Treatment (NEAT) questionnaire and the Asthma Control Test (ACT) were completed at baseline and follow-up. Differences between baseline and follow-up and between rehabilitation and control group were examined by t-tests and chi-squared-tests. Univariate ANCOVAS were used to examine if NEAT and ACT follow-up scores differed significantly between groups. Within the rehabilitation group, linear regressions were used to examine if self-reported utilization of more interventions that addressed needs were associated with NEAT scores at follow-up. Results At baseline, there were no differences between the rehabilitation and the control group regarding needs and asthma control. At follow-up, the rehabilitation group showed reduced needs (t(149) = 10.33, p < 0.01) and increased asthma control (t(130) = -6.67, p < 0.01), whereas members of the control group exhibited no changes. Univariate ANCOVAS showed that unmet follow-up needs (F(1, 212) = 36.46, p < 0.001) and follow-up asthma control (F(1, 195) = 6.97, p = 0.009) differed significantly between groups. In the rehabilitation group, self-reported utilization of more interventions was associated with reduced needs (β = 0.21; p = 0.03). Conclusions This study provides preliminary evidence suggestion that pulmonary rehabilitation in adults with asthma may reduce asthma-related needs and confirms previous findings that rehabilitation may improve asthma control.

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Effect of implementation intention on walking in people with diabetes

Revista de Saúde Pública ◽

10.11606/s1518-8787.2020054002024 ◽

2020 ◽

Vol 54 ◽

pp. 103

Author(s):

Marco Antonio Vieira da Silva ◽

Thaís Moreira São-João ◽

Marilia Estevam Cornelio ◽

Fábio Luiz Mialhe

Keyword(s):

Health Care ◽

Primary Health Care ◽

Leisure Time Physical Activity ◽

Intervention Strategy ◽

Intervention Group ◽

Implementation Intention ◽

Control Group ◽

Primary Health ◽

Significant Difference

OBJECTIVE: To evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM). METHODS: We conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments. RESULTS: After twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups. CONCLUSIONS: Implementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.

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