10 - treating groups

Question 1

why do we need group based health care

Answer 1

limited budget and resources of the NHS
ageing population
need more preventative mechanisms

Question 2

public health cuts to NHS

Answer 2

3.9% per year reduced spending

Question 3

evidence of ageing population putting pressures on NHS

Answer 3

2/3 of hospital admissions are over 65 years old

Question 4

evidence that the NHS goal “equitable treatment for all” not function in practice

Answer 4

care homes are closing
presence of institutional bias and discrimination
cuts to funding and resources

Question 5

examples of groups to deliver health care

Answer 5

exercise/weight management classes
cardiac rehabilitation
national childbirth trust (NCT)
Alcoholics Anonymous (AA)

Question 6

why can we not assume that group based health care is cheaper

Answer 6

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)

Question 7

failure of translation of health care from 1-1 to group-based

Answer 7

some interventions were designed to be individually-focussed

Question 8

why has little evidence been gained on efficacy of group based interventions

Answer 8

groups developed independently so are hard to compare

group interventions are poorly reported so replication is impossible

Question 9

why are groups difficult to compare

Answer 9

variation in length of meeting, number of sessions, numbers of people attending, leaders of the session

Question 10

evidence suggesting group clinics are effective

Answer 10

booth et al 2016
systematic review looking at whether groups were effective and feasible

result –> consistent and promising evidence for effectiveness of group clinics

Question 11

Tarrant et al 2017 weight loss study –> looking at opinions on social groups

Answer 11

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”

Question 12

who stresses importance of group dynamics in outcome effectiveness?

Answer 12

nackers et al 2015 (obesity study)

says that groups in “conflict” are less effective

Question 13

nackers et al 2015 obesity study results

Answer 13

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

Question 14

the problem with research on existing groups rather than designing groups from bottom up

Answer 14

researchers have no impact on how the group is organised and how the intervention is delivered

Question 15

6 hypotheses to consider when designing group interventions

Answer 15

meaning
connection
norm enactment
support
influence
agency

Question 16

what do we mean by “meaning” hypothesis in a group intervention

Answer 16

when social identity develops, people focus their energies and develop a sense of purpose/worth

Question 17

connection hypothesis

Answer 17

social identities make people more likely to perceive themselves as similar and positively oriented to each other

Question 18

what do we mean by norm enactment hypothesis

Answer 18

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

Question 19

agency hypothesis

Answer 19

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

Question 20

How to create psychological connections between

people in new group settings

Answer 20

e.g. get stroke patients singing together

Tarrant et al 2016

Question 21

prevalence of stroke and associated language disorder and psychosocial problems

Answer 21

Stroke: major cause of disability
• >150,000 new cases each year
• 33% have aphasia: language disorder

Reduced social participation, social isolation,
ill-being, depression

Question 22

describe the creating of psychological connections study

Answer 22

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

Question 23

The Singing for People with Aphasia (SPA) pilot RCT

Answer 23

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)

Question 24

SPA intervention

Answer 24

combines group singing with behaviour change techniques to support psychosocial skills

Question 25

tarrant et al 2016 –> themes that came out of focus group: what underpinned the connections between the stroke patients?

Answer 25

o Developing a sense of group belonging
Member familiarity
Homogeneous nature –> same health problem
Member interactions –> facilitated by leader

Question 26

how were the conditions created for the stroke singing engagement

Answer 26

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

Question 27

groups4health (G4H) intervention

haslam et al 2016, 2018

Answer 27

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

Question 28

information-motivation-behaviour (IMB) model

Answer 28

fisher et al 2009
model outlining different aspects needed to be addressed in studies
e.g. by SPA facilitation techniques

Question 29

how was the IMB model adapted for SPA group-based delivery

Answer 29

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

Question 30

who says that “Group-based healthcare may not be suitable for everyone or every health condition”

Answer 30

Greaves & Campbell, 2007