Lay-led self-management programmes are becoming widespread in the attempt to promote self-care for people with chronic conditions.
To assess systematically the effectiveness of lay-led ...self-management programmes for people with chronic conditions.
We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2005, Issue 1), MEDLINE (January 1986 to May 2006), EMBASE (January 1986 to June 2006), AMED (January 1986 to June 2006), CINAHL (January 1986 to June 2006), DARE (1994 to July 2006, National Research Register (2000 to July 2006), NHS Economic Evaluations Database (1994 to July 2006), PsycINFO (January 1986 to June 2006), Science Citation Index (January 1986 to July 2006), reference lists and forward citation tracking of included studies. We contacted principal investigators and experts in the field. There were no language restrictions.
Randomised controlled trials (RCTs) comparing structured lay-led self-management education programmes for chronic conditions against no intervention or clinician-led programmes.
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Results of RCTs were pooled using a random-effects model with standardised mean differences (SMDs) or weighted mean differences (WMDs) for continuous outcomes.
We included seventeen trials involving 7442 participants. The interventions shared similar structures and components but studies showed heterogeneity in conditions studied, outcomes collected and effects. There were no studies of children and adolescents, only one study provided data on outcomes beyond six months, and only two studies reported clinical outcomes.
Health status: There was a small, statistically-significant reduction in: pain (11 studies, SMD -0.10 (95% confidence interval (CI) -0.17 to -0.04)); disability (8 studies, SMD -0.15 (95% CI -0.25 to -0.05); and fatigue (7 studies, SMD -0.16 (95% CI -0.23 to -0.09); and small, statistically-significant improvement in depression (6 studies, SMD -0.16 95% CI -0.24 to -0.07). There was a small (but not statistically- or clinically-significant) improvement in psychological well-being (5 studies; SMD -0.12 (95% CI -0.33 to 0.09)); but no difference between groups for health-related quality of life (3 studies; WMD -0.03 (95% CI -0.09 to 0.02). Six studies showed a statistically-significant improvement in self-rated general health (WMD -0.20 (95% CI -0.31 to -0.10). Health behaviours: 7 studies showed a small, statistically-significant increase in self-reported aerobic exercise (SMD -0.20 (95% CI -0.27 to -0.12)) and a moderate increase in cognitive symptom management (4 studies, WMD -0.55 ( 95% CI -0.85 to -0.26)). Healthcare use: There were no statistically-significant differences between groups in physician or general practitioner attendance (9 studies; SMD -0.03 (95% CI -0.09 to 0.04)). There were also no statistically-significant differences between groups for days/nights spent in hospital (6 studies; WMD -0.32 (95% CI -0.71 to 0.07)). Self-efficacy: (confidence to manage condition) showed a small statistically-significant improvement (10 studies): SMD -0.30, 95% CI -0.41 to -0.19. No adverse events were reported in any of the studies.
Lay-led self-management education programmes may lead to small, short-term improvements in participants' self-efficacy, self-rated health, cognitive symptom management, and frequency of aerobic exercise. There is currently no evidence to suggest that such programmes improve psychological health, symptoms or health-related quality of life, or that they significantly alter healthcare use. Future research on such interventions should explore longer term outcomes, their effect on clinical measures of disease and their potential role in children and adolescents.
Introduction
Suicide is a leading cause of death for men in the United States. Men traditionally have been hesitant to seek help, based on masculine norms of stoicism and self‐reliance, among other ...factors. Man Therapy (MT) is an online suicide prevention and mental health initiative that provides promise for facilitating male help‐seeking.
Methods
This study draws on data from a randomized controlled trial which examined effects of MT on a sample of men residing in Michigan aged 25–64. The current study utilized logistic regression to test MT's effect on nonprofessional and professional help‐seeking, controlling for marital status, education, and sexual orientation.
Results
A statistically significant positive association was found between MT and professional help‐seeking (OR = 1.55, p = 0.049). A significant inverse association was also found with marital status, with partnered men less likely to seek professional help (OR = 0.53, p = 0.007). There was no significant association between MT and nonprofessional help‐seeking.
Conclusion
Man Therapy demonstrates the promise of web‐based suicide prevention efforts to reach men who typically do not engage in help‐seeking, providing a gateway to vital professional support. As technology continues to emerge, further suicide research is needed on use of this modality with working‐age men from diverse backgrounds.
Help-seeking is important to access appropriate care and improve mental health. However, individuals often delay or avoid seeking help for mental health problems. Interventions to improve ...help-seeking have been developed, but their effectiveness is unclear. A systematic review and meta-analysis were therefore conducted to examine the effectiveness of mental health related help-seeking interventions. Nine databases in English, German and Chinese were searched for randomised and non-randomised controlled trials. Effect sizes were calculated for attitudes, intentions and behaviours to seek formal, informal and self-help. Ninety-eight studies with 69 208 participants were included. Interventions yielded significant short-term benefits in terms of formal help-seeking, self-help, as well as mental health literacy and personal stigma. There were also positive long-term effects on formal help-seeking behaviours. The most common intervention types were strategies to increase mental health literacy, destigmatisation (both had positive short-term effects on formal help-seeking behaviours) as well as motivational enhancement (with positive long-term effects on formal help-seeking behaviours). Interventions improved formal help-seeking behaviours if delivered to people with or at risk of mental health problems, but not among children, adolescents or the general public. There was no evidence that interventions increased the use of informal help. Few studies were conducted in low- and middle-income countries (LMICs). This study provides evidence for the effectiveness of help-seeking interventions in terms of improving attitudes, intentions and behaviours to seek formal help for mental health problems among adults. Future research should develop effective interventions to improve informal help-seeking, for specific target groups and in LMICs settings.
Intimate partner violence (IPV) is a pervasive and devastating social problem that is estimated to occur in one of every four opposite-sex relationships and at least one of every five same-sex ...romantic relationships. These estimates may not represent violence against those who identify as transgender or genderqueer, and very little comprehensive research has been conducted on IPV within these populations. One statewide study on IPV found rates of IPV were as high as one of every two transgender individuals. In order to cope with the effects of abuse or leave an abusive partner, many lesbian, gay, bisexual, transgender, and genderqueer (LGBTQ) IPV survivors seek support from others. However, LGBTQ IPV survivors may experience unique difficulties related to their sexual orientation and gender identity when seeking assistance. This article reviews the literature on LGBTQ IPV and suggests three major barriers to help-seeking exist for LGBTQ IPV survivors: a limited understanding of the problem of LGBTQ IPV, stigma, and systemic inequities. The significance and consequences of each barrier are discussed, and suggestions for future research, policy, and practice are provided.
Although CD4+ T cell “help” is crucial to sustain antiviral immunity, the mechanisms by which CD4+ T cells regulate CD8+ T cell differentiation during chronic infection remain elusive. Here, using ...single-cell RNA sequencing, we show that CD8+ T cells responding to chronic infection were more heterogeneous than previously appreciated. Importantly, our findings uncovered the formation of a CX3CR1-expressing CD8+ T cell subset that exhibited potent cytolytic function and was required for viral control. Notably, our data further demonstrate that formation of this cytotoxic subset was critically dependent on CD4+ T cell help via interleukin-21 (IL-21) and that exploitation of this developmental pathway could be used therapeutically to enhance the killer function of CD8+ T cells infiltrated into the tumor. These findings uncover additional molecular mechanisms of how “CD4+ T cell help” regulates CD8+ T cell differentiation during persistent infection and have implications toward optimizing the generation of protective CD8+ T cells in immunotherapy.
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•scRNA-seq unveils a unique subset of cytolytic CD8+ T cells during chronic infection•CX3CR1+ CD8+ T cells are required to control chronic viral infection•CD4+ T cell help via IL-21 production is critical for CX3CR1+ CD8+ T cell formation•IL-21-producing CD4+ T cells enhance CX3CR1+ TIL formation and tumor control
The mechanisms by which CD4+ T cell help sustains exhausted CD8+ T cells during chronic infection have remained elusive. Here, Zander and colleagues show that CD4+ T-cell-derived IL-21 is required for the formation of a distinct subset of cytolytic CX3CR1+CD8+ T cells that protect against chronic infection and cancer.
The purpose of this study was to provide in‐depth insight into men's experiences of prostate cancer, specifically: perceived stigma and self‐blame, social isolation, unmet need and help‐seeking. A ...qualitative descriptive approach was used. Semi‐structured interviews were undertaken with 20 men diagnosed with prostate cancer, and thematic analysis was undertaken. Some participants perceived a stigma associated with prostate cancer and cancer in general, which sometimes acted as a barrier to disclosure. Self‐blame and internalisation of cause was not a prominent issue. Participants’ descriptions of emotional distress, social isolation and anxiety demonstrated the impact of prostate cancer. Social isolation was most commonly reported as a physical consequence of treatment and/or side effects. Participants felt both support and ongoing care were limited at post‐treatment. Most did not seek or receive help for emotional or psychosocial problems from a formal source due to anticipated awkwardness, autonomous coping, not burdening others, unwanted sympathy and retaining privacy. Prostate cancer can cause considerable emotional and social burden for some men, and many are unlikely to seek or receive help. Men, and their support networks, require active encouragement throughout diagnosis, treatment and follow‐up to overcome barriers and access additional support, particularly for sexual, emotional and psychosocial issues.
Objective
Approaches to improve earlier diagnosis of cancer often focus on symptom awareness as a key driver of help‐seeking behaviour and other psychological influences are less well understood. ...This is the first study to explore the role of patient enablement on help‐seeking for people experiencing potential blood cancer symptoms.
Methods
A cross‐sectional, nationally representative survey was completed by 434 respondents (>18 years). Questions asked about symptom experiences, medical help‐seeking and re‐consultation. Existing patient enablement items were included in the newly developed Blood Cancer Awareness Measure. We collected data on patient socio‐demographic characteristics.
Results
Of those responding to the survey 224/434 (51.6%) reported experiencing at least one potential blood cancer symptom. Half of those experiencing symptoms (112/224) had sought medical help. Results from logistic regression analysis showed that higher scores on patient enablement were associated with being less likely to seek help (Odds Ratio OR 0.89, Confidence Interval CI 0.81–0.98) after controlling for socio‐demographics. Separate analyses showed that higher enablement was associated with being more comfortable to re‐consult if symptoms didn't go away or got worse (OR 1.31, CI 1.16–1.48); after a test result suggested there was nothing to worry about, but symptoms persisted (OR 1.23, CI 1.12–1.34) or to request further tests, scans or investigations (OR 1.31, CI 1.19–1.44).
Conclusions
Contrary to our hypotheses, patient enablement was associated with lower likelihood of help‐seeking for potential blood cancer symptoms. Yet enablement appears to play an important role in likelihood of re‐consulting when symptoms persist, get worse or need further investigation.
Objective
This report describes the feasibility, acceptability, and outcomes from a pilot randomized clinical trial (RCT) comparing an online guided self‐help program version of family‐based ...treatment (GSH‐FBT) for parents with a child with DSM‐5 anorexia nervosa (AN) to FBT delivered via videoconferencing (FBT‐V).
Method
Between August 2019 and October 2020, 40 adolescents ages 12–18 years with DSM‐5 AN and their families were recruited at two sites and randomized to either twelve 20‐min guided sessions of GSH‐FBT for parents or fifteen 60‐min sessions of FBT‐V for the entire family. Recruitment, retention, and acceptability of treatment were the primary outcomes. Secondary outcomes were changes in weight, eating disorder examination (EDE), parental self‐efficacy, weight remission, full remission, and outcome efficiency (therapist time needed to achieve treatment outcomes).
Results
Descriptive data are reported. Recruitment and retention rates are similar to RCTs using in‐person treatments. Both treatments received similar acceptability rates. Medium and large effect sizes (ES) related to improvements in weight, EDE, parental self‐efficacy, and remission were achieved in both treatments and were maintained at a 3‐month follow‐up. Clinical outcomes between groups were associated with a small ES. Differences in efficiency (outcome/therapist time) were associated with a large ES difference favoring GSH‐FBT.
Discussion
These data support the feasibility of conducting an adequately powered RCT comparing online GSH‐FBT to FBT‐V to determine which approach is more efficient in achieving improvements in clinical outcomes in adolescents with AN.
Violence disclosure and help-seeking can mitigate adverse health effects associated with childhood violence, but little is known about facilitators and barriers of disclosure and help-seeking ...behaviors in sub-Saharan Africa.
To understand factors associated with disclosure and help-seeking to inform care.
Participants aged 13–24 years old in the 2019 Namibia Violence Against Children and Youth Survey (VACS).
We assessed the prevalence of victimization, disclosure, and help-seeking and examined factors associated with violence disclosure and help-seeking, separately, by gender.
4211 girls and 980 boys participated in the Namibia VACS. The prevalence of childhood sexual violence differed significantly by gender (15.7% among girls, 9.8% among boys), but physical violence prevalence did not differ by gender. Among victims of sexual violence, 57.3% of girls disclosed and 10.4% sought help, compared with only 30.7% and 3.2% of boys. Among victims of physical violence, 61.1% of girls and 53.4% of boys disclosed, and 16.9% of girls and 17.7% of boys sought help. Older age, social support, and experiencing more types of violence were associated with sexual violence disclosure among boys, but none of these factors were associated with sexual violence disclosure among girls. Lower education, perpetrator type, and witnessing violence were associated with physical violence disclosure among girls, while peer support and perpetrator type were associated with physical violence disclosure among boys.
Factors associated with childhood violence differed by gender and violence type in Namibia, highlighting a need for gender-specific violence services to facilitate violence disclosure and help-seeking.
Aim
Comparing measures of psychological wellbeing and help‐seeking in youths before and within the first school closures due to the coronavirus disease 2019 (COVID‐19) pandemic enables a better ...understanding of the effects the pandemic has for those seeking professional help for mental health problems.
Methods
Data were obtained from the Germany‐based ProHEAD school study. Pre‐lockdown and lockdown samples (n = 648) were compared regarding pupils' psychological wellbeing, help‐seeking attitudes and help‐seeking behaviour.
Results
Participants from the lockdown sample showed greater positive attitudes towards seeking professional help, whereas psychological wellbeing and help‐seeking behaviour remained stable.
Conclusions
Possible explanations may include an increased public discourse on mental health or self‐selection bias for participation during lockdown.
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