10 - treating groups Flashcards
why do we need group based health care
limited budget and resources of the NHS
ageing population
need more preventative mechanisms
public health cuts to NHS
3.9% per year reduced spending
evidence of ageing population putting pressures on NHS
2/3 of hospital admissions are over 65 years old
evidence that the NHS goal “equitable treatment for all” not function in practice
care homes are closing
presence of institutional bias and discrimination
cuts to funding and resources
examples of groups to deliver health care
exercise/weight management classes
cardiac rehabilitation
national childbirth trust (NCT)
Alcoholics Anonymous (AA)
why can we not assume that group based health care is cheaper
not a given that all care will effectively translate from 1-1 to group setting
groups may be efficient but there is a lack of evidence (Paul Ebhohimhen & Avenell, 2009)
failure of translation of health care from 1-1 to group-based
some interventions were designed to be individually-focussed
why has little evidence been gained on efficacy of group based interventions
groups developed independently so are hard to compare
group interventions are poorly reported so replication is impossible
why are groups difficult to compare
variation in length of meeting, number of sessions, numbers of people attending, leaders of the session
evidence suggesting group clinics are effective
booth et al 2016
systematic review looking at whether groups were effective and feasible
result –> consistent and promising evidence for effectiveness of group clinics
Tarrant et al 2017 weight loss study –> looking at opinions on social groups
6-12 month study for obese patients (BMI>35)
patients expected to show commitment by losing 5% body weight
20 semi-structured interviews on benefits of group participation
results –> psychological connections seen as central to programmes success “social glue”
who stresses importance of group dynamics in outcome effectiveness?
nackers et al 2015 (obesity study)
says that groups in “conflict” are less effective
nackers et al 2015 obesity study results
found that group dynamics were important to increase weight loss, attendance and adherence to diet plans
found that the first sessions were critical in welcoming the patients
the problem with research on existing groups rather than designing groups from bottom up
researchers have no impact on how the group is organised and how the intervention is delivered
6 hypotheses to consider when designing group interventions
meaning connection norm enactment support influence agency
what do we mean by “meaning” hypothesis in a group intervention
when social identity develops, people focus their energies and develop a sense of purpose/worth
connection hypothesis
social identities make people more likely to perceive themselves as similar and positively oriented to each other
what do we mean by norm enactment hypothesis
When, and to the extent that, a person defines themselves in terms of a given social identity they will
enact, or at least strive to enact, the norms and values associated with that identity
agency hypothesis
When, and to the extent that, a group of people define themselves in terms of shared social identity, they will
develop a sense of collective efficacy, agency and power
How to create psychological connections between
people in new group settings
e.g. get stroke patients singing together
Tarrant et al 2016
prevalence of stroke and associated language disorder and psychosocial problems
Stroke: major cause of disability
• >150,000 new cases each year
• 33% have aphasia: language disorder
Reduced social participation, social isolation,
ill-being, depression
describe the creating of psychological connections study
tarrant et al 2016
10 post-stroke aphasia patients took part in 90-minute singing session
music demands cooperation and coordination; connectedness
Hypothesis: singing in groups may help people with aphasia build confidence to establish new relationships within the community
The Singing for People with Aphasia (SPA) pilot RCT
tarrant et al
arm 1: SPA: 10-week singing programme and resource booklet
arm 2: Control: Resource booklet only
assessment:
Quantitative follow-ups (wellbeing, aphasia)
Qualitative interviews (patients, facilitators)
SPA intervention
combines group singing with behaviour change techniques to support psychosocial skills
tarrant et al 2016 –> themes that came out of focus group: what underpinned the connections between the stroke patients?
o Developing a sense of group belonging
Member familiarity
Homogeneous nature –> same health problem
Member interactions –> facilitated by leader
how were the conditions created for the stroke singing engagement
Fixed features :
- determined in advance (group size, breaks etc)
Flexible feature:
- different forms of participation
- session delivery –> enhanced their empowerment (no judgement)
showed ability of practitioners to shape social identities in new group settings
groups4health (G4H) intervention
haslam et al 2016, 2018
group intervention targeting social isolation and disconnection
o lack of belonging
aims to help people develop and sustain group ties
focus on social connection
symptoms of stress, anxiety and depression measured pre and post intervention
information-motivation-behaviour (IMB) model
fisher et al 2009
model outlining different aspects needed to be addressed in studies
e.g. by SPA facilitation techniques
how was the IMB model adapted for SPA group-based delivery
information –> about health/emotional consequences of the session, benefits of singing on well-being
motivation –> tasks will start easy and achievable, feedback provided
behaviour –> prompt sharing of feelings, use inclusive language
who says that “Group-based healthcare may not be suitable for everyone or every health condition”
Greaves & Campbell, 2007
