ABSTRACT
Mental health is inextricably linked to both poverty and future life chances such as education, skills, labour market attachment and social function. Poverty can lead to poorer mental health, which reduces opportunities and increases the risk of lifetime poverty. Cash transfer programmes are one of the most common strategies to reduce poverty and now reach substantial proportions of populations living in low- and middle-income countries. Because of their rapid expansion in response to the COVID-19 pandemic, they have recently gained even more importance. Recently, there have been suggestions that these cash transfers might improve youth mental health, disrupting the cycle of disadvantage at a critical period of life. Here, we present a conceptual framework describing potential mechanisms by which cash transfer programmes could improve the mental health and life chances of young people. Furthermore, we explore how theories from behavioural economics and cognitive psychology could be used to more specifically target these mechanisms and optimise the impact of cash transfers on youth mental health and life chances. Based on this, we identify several lines of enquiry and action for future research and policy.Copyright © The Author(s), 2023. Published by Cambridge University Press.
ABSTRACT
Introduction: Cognitive difficulties experienced in MS impact areas such as work, socialising, self-care and many activities of daily living. There is a high prevalence of cognitive difficulties in MS, but despite this there are few programmes targeting cognition that focus on the ability to function well in everyday life. The COB-MS programme, an occupation-focused cognitive intervention, was developed to address this. It focuses on both the functional difficulties and the wide-ranging symptoms that present in MS, including the ability to maintain employment, social activities, home management and self-care. Objective(s): Here we report on the results of feasibility and initial efficacy of the COB-MS as a cognitive intervention for people with MS. Method(s): Although initially designed for in-person delivery, the COB-MS was adapted for online delivery due to the COVID-19 pandemic. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in cognition, quality of life, and mood. Result(s): One hundred and twenty-five people with MS and cognitive difficulties were randomised to either usual care or COB-MS intervention. Ninety-four participants were retained at 6-month follow-up. Fidelity data was collected and analysed for occupational therapist conducting the intervention. A qualitative evaluation of the COB-MS from the perspective of participants also took place. All feasibility results will be presented- preliminary efficacy, participant experiences, intervention fidelity, and overall outcomes from the trial. Conclusion(s):The results provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy.
ABSTRACT
Approximately 43-70% of people living with multiple sclerosis (MS) experience cognitive impairment. This study-within-a-trial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS), a holistic therapy on the management of cognitive symptoms in MS. Reliable remote cognitive testing could provide safer and more convenient care for MS patients, during the COVID-19 pandemic and thereafter. The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people to 68 people with MS experiencing cognitive difficulties. Group 1 (N=34) were tested in-person pre-pandemic. Group 2 were tested remotely. No significant differences between virtual and in-person administrations of the CVLT-II and SDMT were detected. BVMT-R scores were significantly higher for virtual administrations, possibly indicating inter-rater differences. Strong positive correlations were found for in-person and virtual scores within Group 1 on the CVLT-II. The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS. Future research with larger samples could investigate performance on BVMT-R with regards to screen size of device used.
ABSTRACT
Introduction: The COVID-19 pandemic has had a significant impact on research and health care in MS. This study-within-atrial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS) that was originally designed to be delivered in-person but was amended to an online environment. As such, reliable remote cognitive testing could provide safer and more convenient care for MS patients. Aims: The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people with MS. Objectives: Performance on BICAMS measures and the TMT administered remotely are compared with performance on tests administered in-person. BICAMS measures include the California Verbal Learning Test, Second Edition (CVLT-II), the Symbol Digit Modality Test (SDMT) and the Brief Visuospatial Memory Test-Revised (BVMT-R). Method: Independent samples t-tests were conducted on a sample of 68 participants to investigate differences in performance between Group 1 (11 males, 23 females), who were visited by a research assistant in their homes before the pandemic and Group 2 (10 males, 24 females) who received online testing only via teleconference platform Zoom. Within-group differences for Group 1 who also received virtual testing after a six-month interval were also examined. Results: The analysis revealed no significant differences in scores between virtual and in-person administrations of the CVLT-II, TMT and SDMT. Strong positive correlations were found for inperson and virtual tests within Group 1 after a six-month interval on the CVLT-II, SDMT, TMT-A and TMT-B. BVMT-R scores were significantly higher for virtual testing (M = 20.59, SD = 6.65) compared to in-person testing (M = 16.35, SD = 6.05). However, this discrepancy may be attributed to inter-rater differences, rather than enhanced performance for online testing. In-person and virtual assessments within Group 1 were also strongly correlated (r = .72). Conclusions: The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS.