"Somebody was standing in my corner": a mixed methods exploration of survivor, coach, and hospital staff perspectives and outcomes in an Australian cancer survivorship program.

PURPOSE: Cancer survivorship in Australia continues to increase due to new methods for early detection and treatment. Cancer survivors face challenges in the survivorship phase and require ongoing support. A telephone-delivered cancer survivorship program (CSP), including health and mental health coaches, was developed, piloted, and evaluated in Eastern Australia. METHODS: Cancer survivors' (n = 7), coaches' (n = 7), and hospital staff (n = 3) experiences of the CSP were explored through semi-structured interviews. Quantitative data routinely collected throughout the pilot of the CSP was described (N = 25). RESULTS: Three syntheses and 11 themes were generated through thematic analysis. The first synthesis centred around operational factors and highlighted a need to streamline communication from the point of recruitment, through to program delivery, emphasising that the program could be beneficial when timed right and tailored correctly. The second synthesis indicated that the CSP focused on appropriate information, filled a gap in support, and met the needs of cancer survivors by empowering them. The third synthesis focussed on the value of mental health support in the CSP, but also highlighted challenges coaches faced in providing this support. Descriptive analysis of quantitative data indicated improvements in self-management, weekly physical activity, and meeting previously unmet needs. CONCLUSIONS: Cancer survivors expressed appreciation for the support they received through the CSP and, in line with other cancer survivorship research, predominantly valued just having somebody in their corner. IMPLICATIONS FOR CANCER SURVIVORS: Recommendations are made for improving cancer survivorship programs in the future.

Determining what constitutes an effective psychosocial 'return to work' intervention: a systematic review and narrative synthesis.

PURPOSE: Work can offer a myriad of social and health benefits. Long-term sick leave can be detrimental to employers, individuals, families, and societies. The burden of long-term sick leave has motivated the development of return to work (RTW) interventions. This study sought to determine what constitutes an effective psychosocial RTW intervention, which included exploring whether the level of intervention intensity and intervention characteristics matter to RTW outcomes. METHODS: A systematic review and narrative synthesis were undertaken. Studies were identified through six databases (Ovid Medline, CINAHL (EBSCOhost), PsycInfo (Ovid), ProQuest, Scopus, and Google Scholar) between 2011 and 3 September 2019. Randomised controlled trials (RCTs) or reviews published in English were eligible for inclusion if they targeted adults who were on sick leave/unemployed trying to return to full-capacity employment, had at least one structured psychosocial RTW intervention, and assessed RTW. Study quality was assessed using checklists from the Joanna Briggs Institute. RESULTS: Database searching yielded 12,311 records. Eighteen RCTs (comprising 42 intervention/comparison groups), seven reviews (comprising 153 studies), and five grey literature documents were included. Included studies were of moderate-to-high quality. Research was primarily conducted in Europe and focused on psychological or musculoskeletal problems. RTW outcomes included RTW status, time until RTW, insurance claims, and sick days. Participating in a RTW program was superior to care-as-usual. RTW outcomes were similar between diverse interventions of low, moderate, and high intensity. Common foundational characteristics seen across effective RTW interventions included a focus on RTW, psychoeducation, and behavioural activation. CONCLUSIONS: Evidence suggests that a low intensity approach to RTW interventions may be an appropriate first option before investment in high intensity, and arguably more expensive interventions, as the latter appear to provide limited additional benefit. More high-quality RCTs, from diverse countries, are needed to provide stronger evidence.

It.

ObjectiveMindStep™ is an Australian low-intensity cognitive behaviour therapy (LICBT) program for individuals with mild-to-moderate symptoms of anxiety and depression. UK-produced LICBT guided self-help (GSH) materials were originally used in the MindStep™ program. In 2017, Australian LICBT GSH materials were developed to better suit Australian users. This study explored whether the Australian-produced materials continued to achieve the benchmark recovery rates established in the UK and maintained in recent Australian studies.MethodsBinomial logistic regression was conducted using retrospective client data, including the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item scale, between 2016 and 2019.ResultsDuring time periods in which the Australian-produced materials were used, equivalent rates of reliable recovery and improvement were achieved compared with time periods in which the UK-produced materials were used. Australian-trained LICBT coaches, using Australian-produced LICBT GSH materials, achieve client recovery rates of up to 60%, reliable improvement rates of 58% and reliable recovery rates of 46% (with the probability of recovery increasing with client age).ConclusionsThese findings are particularly pertinent with COVID-19 changing the landscape of mental health service delivery, requiring greater flexibility in the use of teleservices to ensure access to effective mental health care for populations that may already experience problems with isolation, access and service engagement.What is known about the topic?LICBT is an acceptable, feasible and effective treatment approach for people experiencing mild-to-moderate anxiety and depression in Australia. LICBT GSH materials used with clients in Australia originated from the UK. However, according to guidelines, LICBT GSH materials should be contextualised to suit the audience they are being used with.What does this paper add?This paper demonstrates that LICBT GSH materials tailored to an Australian context can be used in place of UK-produced materials because they yield equivalent and consistent therapeutic outcomes. Although contextualising the LICBT GSH materials for health services users was important, it is likely that the evidence-based cognitive behaviour therapy techniques sitting 'under the hood' of these materials are most important to ensure successful therapeutic outcomes.What are the implications for practitioners?As we face unprecedented challenges following 2020, the physical, social, psychological and economic impacts of life-changing events must not inhibit access to treatments for common mental health conditions. It is anticipated that more non-traditional, alternative providers of mental health services will be needed to scale-up and respond to increasing demand. This paper shows that the provision of telephone-based LICBT in Australia, by trained coaches using Australian-produced GSH materials, is an evidenced-based support pathway that can reduce the access gap to treatments.

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment.

BACKGROUND: Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment. METHODS: One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis. RESULTS: Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours. CONCLUSIONS: Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis.

BACKGROUND: Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children's obesity prevalence remain poorly understood. METHODS: We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0-5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples. RESULTS: A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors. CONCLUSIONS: This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Preventing obesity in infants: the Growing healthy feasibility trial protocol.

INTRODUCTION: Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services. METHODS: This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself. ETHICS AND DISSEMINATION: This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations.