scholarly journals Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Åsa Kadowaki ◽  
Anna-Karin Alvunger ◽  
Hanna Israelsson Larsen ◽  
Anna Persdotter ◽  
Marta Stelmach Zak ◽  
...  

Abstract Background The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jönköping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jönköping, letting sick leave in the year 2017 to be the reference period for both areas. Results The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 ± 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 ± 9.1ongoing sick leaves/month in 2017 to 22.6 ± 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 ± 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 ± 39 sick leaves/month in 2017 to 118 ± 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 ± 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values ≥ 0.24). Conclusions Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jönköping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality. Trial registration Pre-registration November 9, 2018 on ClinicalTrials.gov with number NCT03737019.

1998 ◽  
Vol 9 (7) ◽  
pp. 418-423 ◽  
Author(s):  
C M Baksi ◽  
I Harper ◽  
Margaret Raj

Samraksha, a non governmental organization NGO in Bangalore, South India, was established in 1993 to take steps to control the spread of HIV infection. As a result of their interactions the Samraksha team recognized the urgent need for management of sexually transmitted diseases STDs as a crucial component of their work. Samraksha approached Action Health, a UK based charity, for assistance. This paper outlines the needs assessment and the process of setting up a Well Woman Clinic for commercial sex workers CSWs and other vulnerable groups in Bangalore. The pilot project has been running for over a year and has gained credibility both with vulnerable women and with professionals. Furthermore it has officially become a government resource centre for the training of doctors and health care staff in the management of STDs, and provides formal training sessions for the staff at each of the primary health care centres in Bangalore. Thus STD management is being integrated with the current primary health care provision for women throughout Bangalore. Factors influencing the successful development of such a service are considered.


10.2196/22507 ◽  
2020 ◽  
Vol 4 (11) ◽  
pp. e22507
Author(s):  
Menna Brown ◽  
Nic Hooper ◽  
Parisa Eslambolchilar ◽  
Ann John

Background Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease. Objective This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective. Methods A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype. Results Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included. Conclusions The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage.


1991 ◽  
Vol 25 (3) ◽  
pp. 243-250 ◽  
Author(s):  
B. SIBBALD ◽  
P. FREELING ◽  
H. COLES ◽  
J. WILKINS

Author(s):  
Kirsti Kasila ◽  
Suvi Vainio ◽  
Mari Punna ◽  
Päivi Lappalainen ◽  
Raimo Lappalainen ◽  
...  

Abstract Aim: To explore what thoughts, feelings, and learning processes were involved in obese participants’ lifestyle change during an acceptance and commitment therapy (ACT) lifestyle intervention delivered in primary health care. Background: Previous studies have revealed that lifestyle interventions are effective at promoting initial weight loss, but reduced weight is often difficult to sustain because of the failure to maintain healthy lifestyle changes. Achieving and maintaining lifestyle changes requires to learn self-regulation skills. ACT-based lifestyle interventions combine many self-regulatory skill factors, and the results from previous studies are promising. Research on the individual learning processes of lifestyle change is still needed. Methods: This study investigated a subset of data from a larger web-based lifestyle intervention. This subset consisted of online logbooks written by 17 obese participants (n = 17, body mass index mean 41.26 kg/m2) during the six-week online module. The logbooks were analyzed via data-driven content analysis. Findings: Four groups were identified based on the participants being at different phases in their lifestyle changes: stuck with barriers, slowly forward, reflective and hardworking, and convincingly forward with the help of concrete goals. Differences between the groups were manifested in personal barriers, goal setting, training of mindfulness and acceptance, and achieving healthy actions. The ACT-based lifestyle intervention offered participants an opportunity to reflect on how their thoughts and feelings may hinder healthy lifestyle changes and provided tools for learning psychological flexibility.


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