Reassures Me There Are People Around Who Care about Me: Analyzing Meanings of Support for People with Epilepsy

Aims The study aimed to examine the nature and outcomes of social support for the well-being and quality of life (QoL) of adults with epilepsy. Methods The Australian Epilepsy Longitudinal Survey's 5 th Wave included the Medical Outcomes Study Modified Social Support Survey on four dimensions of social support and the QOLIE-31. Both numerical data and open-ended responses were analyzed quantitatively and qualitatively. A mixed method was used where quantitative analysis used t -tests, analysis of variance and block recursive regression, and qualitative analysis identified themes. Results Three-hundred thirty-two people with epilepsy (PWE) participated. The quantitative component showed that for emotional/informational support being older and living alone were key factors. These as well as household income were important in tangible support. For affectionate support living alone and household income were factors, but only income was a factor for positive social interaction. In addition, only positive social interaction predicted increased QoL. In the qualitative component of the study both positive and negative supports were identified for the emotional/informational supports. Many reported the benefits of having information, although some reported failure to have their needs taken seriously by health professionals or epilepsy associations. Inability to drive was an important feature of negative tangible support as was finding some assistive services unaffordable. Reports of positive social interaction identified being accepted as a person with epilepsy that is the primary concern. Peer support plays a role here. Discussion The findings of factors affecting the four dimensions of support in this study have supported a number of studies. This includes the effects of positive social interaction on QoL. The qualitative analysis supports these results, but it also contributes to deeper understanding of support in the lives of PWE. Conclusion Social support is a particularly important issue for PWE. The results of this study demonstrate the complexities and benefits of obtaining the appropriate forms of support. This survey took place before the coronavirus disease 2019 pandemic and it may well be that this phenomenon affects PWE's support needs. Copyright © 2023. Indian Epilepsy Society. All rights reserved.

Inequalities in Access to Mental Health Treatment by Australian Youths During the COVID-19 Pandemic.

OBJECTIVE: The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas. METHODS: Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates. RESULTS: Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status. CONCLUSIONS: During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

Psycholinguistic changes in the communication of adolescent users in a suicidal ideation online community during the COVID-19 pandemic.

Since the outbreak of the COVID-19 pandemic, increases in suicidal ideation and suicide attempts in adolescents have been registered. Many adolescents experiencing suicidal ideation turn to online communities for social support. In this retrospective observational study, we investigated the communication-language style, contents and user activity-in 7975 unique posts and 51,119 comments by N = 2862 active adolescent users in a large suicidal ideation support community (SISC) on the social media website reddit.com in the onset period of the COVID-19 pandemic. We found significant relative changes in language style markers for hopelessness such as negative emotion words (+ 10.00%) and positive emotion words (- 3.45%) as well as for social disengagement such as social references (- 8.63%) and 2nd person pronouns (- 33.97%) since the outbreak of the pandemic. Using topic modeling with Latent Dirichlet Allocation (LDA), we identified significant changes in content for the topics Hopelessness (+ 23.98%), Suicide Methods (+ 17.11%), Social Support (- 14.91%), and Reaching Out to users (- 28.97%). Changes in user activity point to an increased expression of mental health issues and decreased engagement with other users. The results indicate a potential shift in communication patterns with more adolescent users expressing their suicidal ideation rather than relating with or supporting other users during the COVID-19 pandemic.

Impact of Covid-19 among Small Scale Industry Fishermen - A Mixed Methods Study from Coastal Area of Karnataka

Background: The ongoing COVID-19 pandemic has grave implications worldwide. Workers in small scale industries like fisheries forms a vulnerable group without social security/recognised labour rights Objectives: To assess the physical, mental and socio- economic impact of COVID-19 among fishermen community from coastal area of Karnataka 2. To understand the challenges faced and coping mechanism adopted to mitigate the impact Methodology: This community based mixed methods study was conducted among 138 participants from a fishermen community in coastal Karnataka. Quantitative data included sociodemographics, COVID-19 diagnosis, treatment, related expenses and DASS -21 questionnaire. Qualitative data was collected through 3 Focus Group Discussions and 7 Key informant Interviews till data saturation. Result(s): A total of 138 participants (quantitative 107 and qualitative 31) were included. Majority of the participants were males (70.1%), belonged to age category of 46-60 years (37.4%), nuclear family (71%) and were from low socioeconomic status (79.4%). COVID-19 appropriate behaviour was found to be poor among participants with only 36% using masks, 24.3% washing hands and 10.3% maintaining social distancing. Among 107, 51 (47.7%) participants had probable COVID-19 symptoms. However only 7 (10.9%) had tested for COVID-19 with test positivity rate of 57.1%. Two participants were admitted in hospital with mean hospital stay of 7 days. According to DASS-21, 20.6%, 15.9% and 9.3% screened positive for depression, anxiety and stress respectively. Nealy 90% lost jobs and more than 75% reported to have financial difficulties. Major challenges included loss of livelihood, inaccessibility to health care, repayment of loans, stigma related to Covid-19 and meeting educational expenses of children with one drop out from college. Strategies to cope up with financial difficulty included borrowings, pawning and selling assets at individual level. Activities of local self-help groups in the community and grass root level marketing strategies were highly successful in mitigating the impact as a community. Conclusion(s): COVID-19 has affected fishermen community to a large extent. This understanding will enable to implement need-based intervention strategies and help in disaster preparedness among this population.

Micro Finance in India - Emerging Challenges

For promoting financial inclusion in India, both banks and Non-Banking Finance Companies - Micro Finance Institutions (NBFC-MFIs) play a pivotal role by providing microfinance to individuals and tiny enterprises. There are 187 lending institutions in India engaged in providing microfinance of more than Rs.2.27 lakh crore. Today, microfinance activity is more technology driven to ensure adequate, timely and hassle free financial services. During the Covid-19 pandemic, the sector suffered significantly due to lack of demand for credit and increasing loan defaults. Hence, RBI announced certain measures including debt restructuring to provide relief for stressed micro loan customers and creating more liquidity in the market. Post the pandemic, there are enough business opportunities for the microfinance sector to prosper. However, the age old issues such as lack of due diligence in lending, over-indebtedness and multiple borrowing by customers and unethical recovery practices need to be addressed. Therefore, there is a need to make microfinance activity more digital, promote financial literacy, strengthen risk management systems, upgrade skills of the field level staff and formulate an effective grievance redressal system. Towards this end, the article attempts to review the performance of the microfinance sector at a time when India is currently celebrating the 75th year of Independence and offer suggestions to strengthen the microfinance sector in the country.

A Guide to Mental Health in Family Under the COVID-19 Epidemic

This book tells us from a professional perspective how to deal with stress response in the family, effectively address family problems in the epidemic, and handle the infectious emotions. This book is a profound explanation of the new stress, conflicts, and problems arising at home amid the epidemic. It provides people with a psychological self-help scale to effectively distinguish the normal and abnormal states of psychological response. Besides, it also provides professional psychological assistance and suggestions for special groups, including children, the elderly, the quarantined, and the bereaved, in order to help all families actively respond to the epidemic with the power of psychology. © Beijing Normal University Press 2022.

CANreduce-SP-adding psychological support to web-based adherence-focused guided self-help for cannabis users: study protocol for a three-arm randomized control trial.

BACKGROUND: Cannabis is the most-frequently used illicit drug in Europe. Over the last few years in Spain, treatment demand has increased, yet most cannabis users do not seek treatment despite the related problems. A web-based self-help tool, like CANreduce 2.0, could help these users to control their consumption. METHODS: This study protocol describes a three-arm randomized controlled trial (RCT) comparing the effectiveness of three approaches, in terms of reducing cannabis use among problematic cannabis users, the first two treatment arms including the Spanish version of CANreduce 2.0 (an adherence-focused, guidance-enhanced, web-based self-help tool) (1) with and (2) without psychological support; and the third group (3) treatment as usual (TAU). Study hypotheses will be tested concerning the primary outcome: change in the number of days of cannabis use over the previous week, comparing assessments at 6 weeks and 3 and 6 months follow-up between groups and against baseline. Secondary outcomes related to cannabis use will be tested similarly. Mental disorders will be explored as predictors of adherence and outcomes. Analyses will be performed on an intention-to-treat basis, then verified by complete case analyses. DISCUSSION: This study will test how effective the Spanish version of CANreduce 2.0 (CANreduce-SP) is at reducing both the frequency and quantity of cannabis use in problematic users and whether adding psychological support increases its effectiveness. TRIAL REGISTRATION: This trial is registered with the Clinical Trials Protocol Registration and Results System (PRS) number: NCT04517474 . Registered 18 August 2020, (Archived by archive.is https://archive.is/N1Y64 ). The project commenced in November 2020 and recruitment is anticipated to end by November 2022.

#How Can We Help You?: An Instagram-Based Online Self-Help for Eating Disorders

In recent years, there has been a noticeable increase in online self-help treatments and peer-support programs for eating disorders. The possibility of easily accessing them anytime makes these programs an important support tool and an influencing source for increasing motivation to change. The aim of this work is to describe the #How can we help you? project, its initial feedback received from users, and its future directions. Researchers and clinicians developed an Instagram profile (Dicci Come Aiutarti) based on psychoeducation, aimed at orienting those suffering from a self-reported eating disorder towards clinical care, providing information about eating concerns and related constructs, and increasing motivation for treatment and illness awareness. The contents shared are based on narratives about people who had recovered from an eating disorder, importance and ability to change, and nutrition management. We have provided an overview of the needs of the Instagram profile users, a description of the main interactions recorded since the profile was opened, and examples of the unmet needs shared by users in direct messages. Future directions of the project concern the definition and formalization of the type of support provided by developing a psychoeducational and integrated program and also, the formulation of a research protocol able to assess the usability, effectiveness, and satisfaction of the Instagram profile.

Psychological Aid to Victims of War and the Covid Pandemic 19 in Ukraine

The article reflects theoretical, methodological and methodical bases of psychological aid to victims of unexpected crisis-military situations on the background of coronovirus pandemics spreading. The essence of psychological self-help as a factor of stress-resistance and internal psychological potential of resisting psychological traumas in the conditions of war and viral pandemics with the propositions of effective methodological means of its conducting is revealed. In providing psychological aid, the cognitive-behavioral approach was deemed effective as the basic one, and it was suggested that integrative psychotherapeutic and comprehensive psychological approaches to crisis counseling in conditions of military conflict be applied, depending on the specifics of survivors' experience of acute emotional reactions and the complexity of the course of posttraumatic stress disorders of resistance to the action of a psychotraumatic factor. Neuropsychological correction deserves special attention in providing psychological aid in conditions of military conflict and pandemics, which allows a combination of an integrated bodyoriented psychological approach with neuro-psycho-correctional techniques and psychotherapeutic methods for effective restoration of the tone of the nervous system and stabilization of the psycho-emotional state. The main provisions of practical psychology that in conditions of war and pandemic COVID-19 the adaptive potential of psychological health of each person and psychological self-help is love, faith and hope. Psychological recommendations of educational character for the formation of basic skills to ensure psychological health in conditions of war and pandemic COVID-19 have been developed.

COVID-19 lockdown and collective activities: Evidence from the world's largest self-help group program

We study the impact of the COVID-19 lockdown in 2020 on the monthly savings of self-help groups (SHGs) in India, and the role of SHGs in mitigating the economic effects of the lockdown. Administrative data suggest that monthly savings of SHGs declined by 66% between March and July of 2020, with larger declines in areas with more stringent lockdowns. Survey data revealed that SHG and non-SHG households had similar consumption and income losses during the lockdown. Households with SHG members and those that received assistance from SHGs in procuring ration or accessing community kitchens reported significantly higher food security, however. © 2023 Agricultural & Applied Economics Association.

Adapting the Queen Square Guided Self Help (Qgsh) for Functional Neurological Disorders as a Stand-Alone Intervention: An Exonian Pilot Study

Aim Functional neurological disorders (FND) are one of the most common presentation in neurology clinics, causing a significant disability and economic burden. Cognitive behavioural therapy (CBT) has one of the best available evidence in managing FND, although access remains limited. Queen Square, London neuropsychiatry experts have established an excellent model for a CBT based, Guided Self Help (GSH) programme, which is preparatory to a multidisciplinary inpatient treatment. It has been shown to have good outcomes. This study was designed to ascertain the feasibility and acceptance of this QGSH model, in an Exonian cohort of FND patients, whilst piloting its stand-alone version, without the inpatient component. Additionally, the study explores the need and types of modifications required for the stand-alone adaptation of QGSH. Method Consecutive patients referred to Exeter FND Service, between February to June 2020, who had internet access, were offered the QGSH pilot. Patients with a primary mental disorder concurrent drug/alcohol misuse or risk of self-harm or suicide were excluded. Ethics approval was not required. The QGSH intervention constitutes of 11 modules focussing on specific elements crucial to FND management along with homework tasks, delivered by the author, under supervision by QGSH experts. Patients completed Pre and Post-intervention questionnaires as well as structured feedback. Results Three successive patients with varied FND symptoms were recruited to the pilot between February and June 2020. The baseline health status of these patients was worse as compared to EQ-5D-5L population norms with significant baseline psychiatric comorbidity. Outcome measures used before and after QGSH intervention included PHQ 9, GAD 7, EQ-5D-5L and a locally devised symptom severity questionnaire. Necessary modifications were made to the program based on the patients informal feedback and structured formal feedback was sought in the end. Conclusion All patients derived some benefit from QGSH and certain modifications were suggested in patient feedback to improve engagement. Despite study limitations, especially small size and the impact of Covid 19 pandemic during the intervention;QGSH model appears acceptable and feasible in an Exonian cohort, however, some modifications are recommended for the stand-alone version to succeed. The recommendations will be presented.

Efficacy of Self-supportive Intervention Program on Post-traumatic Stress Disorder and Quality of life among Battered Wives in Madhya Pradesh, India

Recently post-traumatic stress symptoms are highly noticed among women with intimate partner violence or experiencing battering and their quality of life became a question. In Indian society, the rate of suicide is increasing among battered wives and the need for psychological intervention is highly suggested. Based on previous findings and needs current study developed a Self-Supportive Intervention program combining the Mindfulness-based cognitive theory and emotional processing theory to reduce PTSD symptoms among battered women in Madhya Pradesh, India by scrutinizing its efficacy. The study used three phases of the Conklin program development model (1997), including planning, design and implementation, and evaluation. The planning and pilot testing of the SSI program included the first two phases and the third phase tested its efficacy using a "randomized controlled trial" of two groups comprising 40 Battered wives. Twenty participants were included in experimental and control groups respectively. Participants' socio-demographic profiles, the posttraumatic Symptoms Scale Interview version for DSM-5 (PSS-I-5), the World Health Organization Quality of Life-Bref Scale, and the Interview Protocol were used for collecting data. The newly developed self-supportive intervention program had an inter-reliability score of .845 after its evaluation by experts. To determine the extent of the program's impact, data analyses included MANOVA and Paired t-tests. According to the MANOVA results, the SSI program significantly affected participants' quality of life and PTSD symptoms (F [5,34] = 275.67, p<0.05). Paired t-test results were also significant at the 0.05 level. The Partial Esta-square of .976 indicated that the SSI program was effective in alleviating PTSD symptoms and increasing the quality of life.

Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis.

BACKGROUND: Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access. METHODS: A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery. RESULTS: Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity psychological interventions were equivalent on reducing eating disorder psychopathology (g = - 0.13), more effective at improving DSM severity specifier-related outcomes (g = - 0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes. CONCLUSION: Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder.

Feeding and eating disorders can significantly impair health and psychosocial functioning. However, demand for eating disorder services is greater than services' ability to deliver effective treatment. Low intensity psychological interventions, which are brief in nature and require less therapist input than standard treatments, have the potential to bridge this demand-capacity gap. The current review examined the effectiveness of low intensity psychological interventions for the treatment of feeding and eating disorders. Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms, particularly binge eating-related symptoms. Given their relatively low costs and ease of accessibility, such interventions can help people to access treatment at a time when this is so desperately needed. More research is needed to determine the value of low intensity psychological interventions for children and adolescents, and people with feeding and eating disorders that are not characterised by recurrent binge eating, such as anorexia nervosa, ARFID, pica and rumination disorder.

Dificultades en mujeres madres de niños y niñas en edad escolar durante el confinamiento por COVID-19

La pandemia por COVID-19 ha tenido un impacto social, económico y de salud física y emocional en la población, siendo las mujeres uno de los grupos mayormente afectados. El objetivo del presente trabajo fue identificar las dificultades y estrategias de solución de madres de niños y niñas en edad escolar, participantes de un grupo de autoayuda virtual durante el confinamiento por COVID-19. La recolección de datos se realizó mediante un análisis documental y una serie de preguntas detonadoras en el grupo de autoayuda. El trabajo de campo virtual se realizó durante los meses de mayo y junio de 2020. Durante la pandemia, las principales dificultades de las madres de familia con hijos e hijas pequeños, en edad entre 3 a 12 años, fueron sobrecarga de actividades, estrés y agotamiento, que les provocaron sentimientos de preocupación, incertidumbre, irritabilidad, cansancio y emociones de culpa y miedo. Los resultados permitieron evidenciar la vulnerabilidad de las mujeres, en función de la socialización de género, que ha promovido una distribución desigual de roles y actividades entre ambos sexos, asignando mayor carga de responsabilidades a ellas. Se destaca la importancia de fortalecer el autocuidado, la red de apoyo social y la corresponsabilidad con la pareja para hacer frente a las situaciones adversas.Alternate abstract: The COVID-19 pandemic has had a social, economic, physical, and emotional health negative impact on the population, with women being one of the most affected groups. The objective of this work was to identify the difficulties and solution strategies of mothers of school-aged boys and girls, who were participants in a virtual self-help group during the COVID-19 confinement. Data was collected through documentary analysis and in depth questioning in the self-help group. The virtual field work was carried out during May and June 2020. During the pandemic, the main difficulties experienced by mothers of young children aged 3 to 12 years were: the overload of activities, stress, and exhaustion. This caused them feelings of anxiety, uncertainty, irritability, tiredness, and emotions of guilt and fear. The results made it possible to show the vulnerability of women, based on gender socialization, that has promoted an unequal distribution of roles and activities between both genders, assigning a greater burden of responsibilities to them. The importance of strengthening self-care, a social support network and co-responsibility with partners to face adverse situations is highlighted.

Positive technology for emotion regulation: A virtual self-help intervention

Emotions and stress experienced in the academic environment are known to be related to important outcomes such as health and well-being together with other comorbidities such as decreased academic performance, increased college dropouts, and increase of problematic online and offline behaviors. Today, the situation appears even more critical in relation to the COVID-19 pandemic. Drawing on positive technology framework, this study aims to promote well-being in university students who are facing the challenging period of graduation by increasing their ability to emotionally regulate. Emotion regulation is defined as the initiation, maintenance, and modification of the occurrence, intensity, and duration of feeling states. Forty-two university students voluntarily participated in a self-administered modular intervention of 6 sessions spread over three weeks that involves virtual scenarios (used in 2D). Students were randomly allocated to an experimental group and to a waiting list group that started the intervention after 3 weeks. The virtual scenarios consisted of narrative metaphors aimed at encouraging students to be aware of their emotions, and positive resources to cope with difficult situations and develop strategies to regulate their affective states. Before and after the six sessions, participants completed an assessment by filling in online questionnaires. The results showed a significant increase both in emotional well-being and psychological well-being in the experimental group compared to the waiting list group. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of COVID-19 on the Income of Entrepreneurs Who Borrowed from SHG

The COVID-19 pandemic has shaken the world. After liberalization in 1991, microfinance became a panacea for poor people without collateral and information asymmetry. The higher cost of microfinance and debt traps highlighted the need for the state to intervene in resource redistribution. In addition, national lockdowns and COVID-19 restrictions have made it difficult for emerging economies like India to achieve this sustainable development goal. The Reserve Bank of India introduced self-help group (SHG) bank linkage to ensure the financial inclusion of the poor. The difference-in-difference method examined how SHGs affect entrepreneur households' income. CMIE Consumer Pyramid dx data were used for analysis. The data establish that SHGs have increased the income of the households, and demographic factors such as education, income level and gender also impact the financial inclusion of the poor. © 2023 Management Centre for Human Values.

Accessibility at what price? Therapists' experiences of remote psychotherapy with children and adolescents during the COVID-19 pandemic

Psychotherapy has traditionally been delivered in person, but recent technological advances have made it possible to conduct remote treatments. There is currently strong evidence for the efficacy of guided self-help with online support from a therapist, but less is known about video-mediated psychotherapy. The COVID-19 pandemic has however forced many therapists to provide remote treatments. This transition might be especially trying for therapists of children and adolescents, but their experiences are underexplored. This study aimed to investigate their perceptions of video-mediated psychotherapy. Semi-structured interviews were conducted with 16 therapists and analyzed using thematic analysis. The therapists described how they struggled with technical and ethical issues and tried to overcome the loss of their usual therapeutic tools. They were concerned that the online format led to less effective treatments or could have negative effects, even if it might increase care availability. Generally, they felt frustrated, inadequate, and stressed, and experienced less job satisfaction. The therapists concluded that video-mediated sessions might be a good alternative for children and adolescents - provided the therapists themselves could determine for whom and when to offer video sessions. Implications of their experiences are discussed, including how psychotherapy training might have to incorporate issues related to remote psychotherapy. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

This study aimed to explore therapists' perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists' workload, (3) therapists' confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists' burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.Key learning aims(1) To understand which factors facilitated therapists' positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).(2) To understand what challenges acted as barriers to therapists' positive perceptions and acceptability of providing iACT4CARERS.(3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.

An Assessment Of A Guided Self-Help and Patient Initiated Review Pathway for Ulcerative Proctitis

Background: The COVID-19 pandemic has placed great strain on standard outpatient services including those with IBD. There has been interest in using guided self-management and patient-initiated review to allow patients to manage their condition, while at the same time reserving outpatient capacity for those needing seen urgently. We developed a pathway for patients with stable ulcerative proctitis, which included a leaflet on symptom managment and when to contact the IBD nurses if ongoing symptoms. Method(s): Patients were identified from clinic lists cancelled during the pandemic who had a diagnosis of ulcerative proctitis. Case notes were reviewed to ensure a correct diagnosis and inclusion criteria met(stable disease, no immunosuppressant treatment). These patients were sent a Guided Self-Management leaflet in the post. A follow on questionnaire was sent 6 months after ensuring patients were happy with the information received. Non-responders were sent a second questionnaire and/or telephone call. Result(s): 37 Patients were identified. We received responses (via post, phone or email) from 28/37 patients (76%). 10/28 (36%) didn't receive or do not recall receiving the leaflet. 18/28 (64%) received the leaflet. Of those who received the leaflet, 16/18 felt it was easy to understand and contained enough information to confidently manage their symptoms. 2 patients had 1 flare and 3 patients had multiple flares after receiving the leaflet. Of those with flares, 2 patients were able to self-manage their proctitis using the guided self help information. 2 patients had to contact the IBD nurses. These patients were called back within 24 hours and received useful advice. One patient had forgotten to use the leaflet. No one required rescue steroids or admission to hospital. Overall, 17/18 (94%) felt the service was good or excellent compared to previous clinic review systems. Conclusion(s): These results suggest patients are receptive to using guided self-management and patient-initiated review. Although we were not expecting to see many flares, given the low risk selected group, the results suggest patients can successfully manage flares and contact our services for support if required. It is a concern a significant proportion of patients did not recall receiving the leaflet. Although this is a small subgroup, the results show clinic time can be saved which remains a pressurised resource as we recover from the pandemic. The principles of guided self management and patient initiated review could be applied to other patient groups(eg stable UC patients not on immunosuppressants). In future it would be important to ensure patients receive and understand the leaflet. A clinic appointment prior to discharge into such pathways should be considered.