Treating groups Flashcards
Why is the NHS squeezed?
Population growth and the aging population.
What proportion of hospital admissions are over 65?
2/3
How many unplanned admissions are there of over 65s a year?
2million
Older people are more likely to be _______ and stay in ___________.
readmitted and longer.
Health spending on over 75s is _______ greater than the rest of the population.
13x
How many adults are obese worldwide?
500 million
Which health problems are associated wth obesity?
Heart disease, T2DM, stroke, cancer depression.
What percentage of men and women in the UK were obese in 2009?
22% / 24%
What is the predicted percent of men and women in the UK who will be obese by 2025? (ref?)
47% / 36% (Foresight, 2007)
What is the cost to the NHS from obesity related sick leave?
£16bn
Despite the increasing pressure on the NHS, what is the projected spending cut to Public Health funding in the NHS?
6% (£200million)
What is Public Health funding used for? Cuts in this area are potentially an example of _________.
Reducing obesity, smoking, alcohol and drug use. Inequitable treatment (institutional bias).
There is an assumption that ______ are a more efficient way of delivering the same service.
groups
Physical activity groups are routinely used in __________ and __________.
Bariatric care and cardiac rehab.
“Group clinics” are used to deliver __________ to patients with the same condition.
specialist care
The national childbirth trust provides ________.
Parent groups (social support)
What is the translation gap in relation to treating groups?
Current use of groups in health care is generally no informed by literature on group effects (e.g. social cure literature). Groups are generally driven by the assumption of cost effectiveness.
There is a paucity of group research published in __________.
Journals read by health care professionals.
We know that groups can be good for health (social cure) but we need _________.
More joined up thinking.
There is some research looking at why some groups are effective, looking to unpack the ________ of this form of delivery.
‘group element’
American study of group clinics - ‘What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions, a systematic review’ - Give ref and PICO
Booth et al. (2016) N = 13SRs, 22RCTs, 12 qualitative studies (mostly focused on diabetes)
P - adults/children receiving HC for 1 or more chronic condition
I - Groups delivered by HCPs
C - Any other method of organisations
O - patient outcomes, health service outcomes, patient/carer satisfaction, resource use
What were the results of Booth et al’s (2016) systematic review on the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions?
- Positive effects on patient outcomes (improved glycated haemoglobin, systolic blood pressure, quality of life)
- Effectively elicited patient values of socialisation, normalisation and information sharing
- Cost effectiveness: Mixed evidence due to increased costs of training.
This study has limited generalisability - particularly to the NHS. There are also issues with ‘dose’ of treatment.
Systematic review of group based weight loss interventions - Give ref and PICO
Borek et al. (2016)
P - Overweight/obese adults
I - Lifestyle interventions focused on physical activity/diet
C - no intervention/WLC?TAU/minimal intervention
O - BMI (weight)
41 RCTs included
What were the results of Borek et al’s (2016) systematic review of group based weight loss interventions?
Evidence for effectiveness in weight loss at 6, 12 and 24 months. This was moderated by the focus of the intervention (explicit focus on weightless was more effective), men only groups did better and providing feedback on progress throughout led to better outcomes.
Because the driver for groups is often cost effectiveness ____________ is hugely variable (ref?)
the way group elements are reported in papers (Borek et al., 2015)
Who developed a checklist of things to report when studying group interventions?
Borek et al. (2015)
According to NICE guidelines (2014) bariatric patients should receive __________, for ______________
“intensive management” from a secondary care multidisciplinary team, led by a bariatric physician/pre-surgery assessment and education and early psychological support.
Despite NICE guidelines (2014) bariatric patients are routinely _________________ to prepare them for surgery.
a group lifestyle intervention of 6-12months.
There is an assumption that group interventions are cost effective (ref?).
Greaves & Campbell (2007)
There is little data on whether group interventions are actually more cost effective than 1:1 (Ref?)
Paul-Ebrahim & Avenell. (2009)
On what grounds is there good reason to expect that group programmes would be beneficial of bariatric care?
Forming social connections with others has health benefits.
Why is group identity important for group success?
Social identity promotes wellbeing in rehabilitation and mental health (Gliebs et al., 2011; Wakefield, 2013)
Group norms influence behaviour and impact on motivation (Oysterman et al., 2007; Tarrant et al., 2012)
Social support is good for health (Haslam et al., 2012)
______ decided to explore how the dynamics of a group can influence its success in bariatric care.
Tarrant et al. (2012)
Give details of the group whose dynamics were studied by Tarrant et al (2012)
- participants participated for 6-12 months
- BMI = more than or = to 40kg per m sq. OR more than or = to 35kg per m sq. with comorbidities (morbidly obese)
- participants attended 6 sessions 8-12 participants per group
- facilitated by dieticians and clinical psychologists
- focus on info. and dietary behaviour
Give details of Tarrant et al’s (2012) design and findings
conducted 20 semi-structured interviews with group participants focused on pos&neg of group participation. Overarching theme was group acted as a resource underpinning lifestyle change.
Describe diagram on card 2 showing the main factors identified by Tarrant et al as being key to the ‘group factor’
see card 2
Psychological connection is central to ________.
group success
bariatric groups seem to be able to provide the _________ that helps participants to engage and use the material.
social glue
There are gaps in knowledge about how we _________ and ________ group interventions.
design
deliver
lack of _______ in group design may undermine group potential
systematisation
we should be drawing on the ________ when designing groups
group dynamic literature
much of what we know about clinical groups is based on analysis of _______ rather than ________.
existing groups
those that have been designed from bottom up
why does social identities matter in health?
- glue that holds people together
- enable cohesive collective access to shared education
- likely to be important in reducing drop out rates.
describe the importance of social identities as resources.
They frame understanding of health, self and change.
They provide normative context for behaviour.
They are resource to be drawn upon when e.g. ill.
Describe the importance of social identity networks
belong to multiple groups and identities can overlap and compete for attention. When people have access to rich networks, with multiple identities this can buffer against illness. (Jetten et al 2012)
Being able to choose the identity we draw upon seems importance for well being because …
This empowers us to feel in control.
describe the importance of social identity trajectories
When we activate a group membership, past experiences aswell as future possibilities are important. We might have access to incompatible identities and this may lead to inconsistencies in behaviour (Tarrant 2016)
Describe Haslam et al’s 2012 model of designing interventions to assess social identity risk. See Card 3
See card 3
What factors should be taken into consideration when creating a new group?
structural factors (funding, resources, training) patient factors (expectations, values) group factors (size, dose) facilitator factors (empathy, entrepreneurship)
Who developed a focus group evaluation of a group singing session for people with aphasia
Tarrant et al (2016)
Stroke victims often lose but want to regain __________
social connections
There are ______ new cases of stroke per yr in the UK. and ________ of sufferers experience the language disorder aphasia.
150,000
33%
What was Tarrant et al’s (2016) rationale for creating a singing group for aphasic stoke victims?
participating in musical activity demands coordination and is therefore social by definition. It was also something which stroke sufferers said they would enjoy
What was Tarrant et al’s (2016) hypothesis
singing in groups may help stroke suffers with aphasia build confidence to establish new relationships within the community.
Describe the intervention developed by Tarrant et al (2016)
90 min session, N = 10, developed by psychologists music facilitators, patients, speech & language therapists and health researchers.
Focused on building new social identities and group commitment.
How did Tarrant et al (2016) maximise engagement?
Participants sang familiar songs
How did Tarrant et al (2016) take into account structural factors?
They seated participants in a semi-circle to inc. non verbal interaction.
How did Tarrant et al (2016) use feedback to promote commitment?
Progress acknowledged and rewarded interaction.
Key features reflecting participant experience of an introductory session of a new group singing for people with aphasia
See card 4
How did Tarrant et al (2016) identify the Key features reflecting participant experience of an introductory session of a new group singing for people with aphasia?
They formed a focus group with participants and facilitators
What do the findings of Tarrant et al’s (2016) study show?
shows that social identity promotes engagement with new groups via reduced anxiety about the new setting, and is the foundation of effective delivery of intervention content.
up to 50% of patients do not want to be in a group (ref)
Wingham et al (2006)
Group based healthcare may not be suitable for all (ref)
Greaves & Campbell (2007)
Groups may be best for …
- Simple messages
- Peer support
- When they are as effective as but lower cost than 1:1
Many of the problems with groups can be overcome by design (ref)
Tarrant et al (2016)
Describe ‘Groups 4 Health’ and give reference.
A manualised 5 module psychological intervention that targets the development and maintenance of social group relationships to treat distress arising from social isolation (Haslam, 2016)
Describe Haslam’s (2016) study of ‘Groups 4 Health’
A non-randomised control design.
P = Young adults with SI and affective disturbance
Measures = Metal health wellbeing, social connectedness and whether mechanisms of social identification are responsible for changes in outcomes.
Results = Improved scores on all measures, maintained at 6 months. Improvements in depression, anxiety, stress, loneliness and life satisfaction were underpinned by increased identification with G4H group and other groups. (however his is only a pilot study)
Who conducted a meta-analysis on the effectiveness of group versus 1:1 interventions to promote physical activity?
Burke et al. (2006)
PICO Burke et al’s (2006) study
Meta analysis of the effectiveness of group versus 1:1 interventions to promote physical activity.
P = 44 studies, N:4578 - 214 effect sizes
I = 1. Home based programmes (no contact from HP)
2. Standard exercise class
3. Exercise class where group dynamic principles were
used to increase cohesiveness (true groups)
4. Home based programmes involving some contact
C = Usually baseline condition
O = 5 categories of outcome: Adherence, social interactivity, quality of life, physiological effectiveness and functional effectivenessWhat were the results of Burke et al’s (2006) study?
True groups > standard group = home with contact > home with no contact (across all DVs)
The lack of data about the ____________ of group therapy with in ___________ countries is striking, given that __________ is a key justification for giving treatment in groups. (ref?)
Cost effectiveness/high-income/increased cost-effectiveness (Huntley et al., 2012)
The benefits of forming social connections in groups: Gliebs et al (2011) - Describe their study
Water groups in care homes are used to increase hydration and enhance health and wellbeing. This study found that enhanced focus on drinking more water did not, on its own improve health and wellbeing. However, residents who took part in water clubs showed improved levels of perceived social support, and those who participated in water and control clubs showed beneficial oHutcomes in terms of the number of General Practitioner calls they required. Improved social support and shared social identity mediated the relationship between club membership and positive effects.
