A Qualitative Exploration of Postoperative Bariatric Patients' Psychosocial Support for Long-Term Weight Loss and Psychological Wellbeing.

BACKGROUND: There is a paucity of research exploring postoperative psychosocial interventions for bariatric surgery patients exceeding 2 years, and therefore, an interdisciplinary postoperative approach is warranted. This qualitative study explored the psychosocial support that bariatric surgery patients feel they need to sustain long-term weight loss and their psychological wellbeing. METHODS: Fifteen postoperative patients participated in recorded semi-structured online interviews that were transcribed verbatim and analysed using a reflexive thematic analysis approach. RESULTS: Three themes and six subthemes emerged. Theme 1, Journey to surgery, has two subthemes: Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes: Continuity of care and Can't cut the problem out. Theme 3, Bridging the Gap, has two subthemes: Doing it together and Taking back the reigns. The inconsistencies participants experienced in their pre- and postoperative care led to dissonance, and they felt unprepared for the demands of life postoperatively. CONCLUSIONS: Bariatric surgery is a catalyst for physical change, but surgery alone is insufficient to ensure sustained change. Surgical and psychosocial interventions are interdependent rather than mutually exclusive. Patients favour an integrative, personalised, stepped-care approach pre- and postoperatively, with active participation fostering autonomy and access to ongoing support extending into the long-term.

Exploring the Experiences of Sexual Violence/Abuse Survivors Attending a Recovery Group: A Qualitative Study of Recovery and Evaluation Implications.

Sexual violence/abuse (SV/A) is increasingly recognized requiring improved, evidence-based treatments. Delivery of group-based support in survivor services is common but often lacks evaluation. This qualitative study explored how survivors experienced groups and wanted recovery measured. Semistructured interviews with survivors of SV/A from two groups (N = 13, female: 25-64 years: mainly White British, heterosexual) were analyzed using an inductive approach to thematic analysis. Three overarching themes were identified including "anger," recovery "in the company of" others and "different destinations." The work contributes recognition of the need for evaluation with meaning to survivors and the potential for anger to be used in group activism.

Systematic Review: Effectiveness of psychosocial interventions on wellbeing outcomes for adolescent or adult victim/survivors of recent rape or sexual assault.

Sexual assault and rape are common forms of sexual violence/abuse. The psychological/health consequences represent significant and ongoing harm. It seems imperative that victim/survivors receive evidence-based support within first response settings. To assess what psychosocial interventions work for victim/survivors of a recent sexual assault. Twenty-seven electronic databases were systematically searched. Narrative data synthesis was used to read across studies. Reporting format follows PRISMA checklist. Ten studies were identifed including range of interventions. The evidence is sparse and scientifically weak, common flaws are reviewed. There is some weak evidence for the impact of video and cognitive behavioural therapy (CBT) based interventions, especially trauma processing. There is a gap in the evidence base on psychosocial interventions for victim/survivors of sexual assault and higher quality research is required.

Which psychosocial interventions improve sex worker well-being? A systematic review of evidence from resource-rich countries.

OBJECTIVE: To establish the state of the evidence base around psychosocial interventions that support well-being in sex workers in order to inform policy and practice within a resource-rich geographical context. METHODS: Published and unpublished studies were identified through electronic databases (PsychINFO, CINHAL Plus, MEDLINE, EMBASE, The Cochrane Library and Open Grey), hand searching and contacting relevant organisations and experts in the field. Studies were included if they were conducted in high-income settings with sex workers or people engaging in exchange or transactional sex, and evaluated the effect of a psychosocial intervention with validated psychological or well-being measures or through qualitative evaluation. RESULTS: A total of 19 202 studies were identified of which 10 studies met the eligibility criteria. The heterogeneity found dictated a narrative synthesis across studies. Overall, there was very little evidence of good quality to make clear evidence-based recommendations. Despite methodological limitations, the evidence as it stands suggests that peer health initiatives improve well-being in female street-based sex workers. Use of ecological momentary assessment (EMA), a diary-based method of collecting real-life behavioural data through the use of twice-daily questionnaires via a smartphone, increased self-esteem and behaviour change intentions. CONCLUSIONS: Work with sex workers should be based on an evidence-based approach. Limitations to the existing evidence and the constraints of this work with vulnerable groups are recognised and discussed.

Are psychosocial interventions effective at increasing condom use among Black men? A systematic review.

Black men experience a disproportionate burden of sexually transmitted infections (STIs) in the United Kingdom (UK). STIs can seriously affect the health and well-being of affected individuals. With condoms effective at preventing STI transmission, this review aims to explore the evidence of effectiveness of psychosocial interventions at increasing condom use among Black men to inform UK-based interventions for this at-risk but unheard population. Nine databases were searched for qualifying studies. Two reviewers independently assessed the quality of studies. A narrative synthesis read across the heterogeneous studies for evidence of effectiveness. A total of 17 studies met the inclusion criteria. This review identified scientifically weak evidence of effectiveness in multifaceted psychosocial interventions to increase condom use among Black men, particularly men who have sex with women and men who have sex with men mainly from United States settings. The multifaceted nature of interventions provides obscure evidence on successful elements of interventions with positive effects. Despite the disproportionate STI burden among this group, no UK-based studies were identified. Future research should aim to better understand condom use behavioural experiences and motivators of condom use among UK Black men to inform ethnically culturally relevant and tailored interventions.

The effectiveness of interventions to improve psychosocial outcomes in parents of children with appearance-affecting health conditions: A systematic review.

BACKGROUND: Although many cope well, the impact of supporting a child with an Appearance-Affecting Health Condition (AAHC) can place a significant demand on parents. As such, it is vital that families have access to appropriate psychosocial support to reduce any potential difficulties. Although previous reviews have explored the effectiveness of psychosocial interventions for parents of Children and Young People (CYP) with general health conditions, the evidence of effectiveness remains limited. Further, little is known about the effectiveness of such interventions specifically among parents of CYP with AAHCs. This review aimed to identify and assess the evidence of effectiveness of psychosocial interventions among parents of CYP with AAHCs. METHODS: Database searches were conducted using MEDLINE, PsychARTICLES, PsychINFO, CINAHL Plus, the British Nursing Database and the Cochrane Library. Results were reviewed against the inclusion criteria and data were extracted. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and a narrative synthesis was conducted. RESULTS: Fifteen studies, evaluating 10 interventions, were included and overall seven interventions were found to be effective (effect sizes and methodological quality varied). CONCLUSIONS: This review finds moderate to strong evidence of effectiveness of the Triple P Positive Parenting Program, the Early Family Intervention Program and general parent education/training interventions. These findings offer useful insights relating to the delivery of current support, as well as for the development of future parent and family interventions. Finally, recommendations for future intervention evaluation studies in this area are made.

What adaptions are effective to cognitive behavioural interventions for adults with long-term conditions and medically unexplained symptoms? A systematic review / ¿Qué adaptaciones son efectivas para las intervenciones cognitivo-conductuales en adultos con condiciones a largo plazo y síntomas médicamente inexplicables? Una revisión sistemática

AIM: Improving Access to Psychological Therapies (IAPT) services were set up in the United Kingdom in 2008. Recent service expansion now accommodates patients with long-term conditions (LTC) and medically unexplained symptoms (MUS) through the use of cognitive-behaviour therapy (CBT). A systematic review is yet to be completed to identify specific adaptions that may be effective for improving outcomes. Many countries are building upon this model within the United Kingdom; therefore, the findings can inform developing services internationally. METHODS: Electronic databases were searched and studies were screened against an inclusion/exclusion criteria. Studies evaluating the effectiveness of CBT interventions on mental health outcomes for adults with LTC/MUS within primary care were included. Data were extracted for analysis and a narrative synthesis was conducted. Quality assessments were made using the Effective Public Health Practice Project tool. RESULTS: Of 14,380 papers, eight papers were included within the review. Moderate to strong evidence found CBT adaptions were effective in improving outcomes, including the specific focus on the LTC/MUS within treatment, the inclusion of collaborative care or implementing a range of therapeutic skills. Weak methodology was associated with selection bias, lack of blinding and reporting around the validity and reliability of data collection tools. CONCLUSIONS: CBT adaptions may be effective at improving mental health outcomes for those with LTC/MUS in the short term. Due to the small amount of studies included within the review, conclusions remain tentative. It is unclear as to whether interventions can sustain outcomes and provide financial gains in the long term

OBJETIVO: En 2008 se establecieron en el Reino Unido servicios de mejora del acceso a las terapias psicológicas (IAPT). La reciente ampliación de los servicios permite ahora atender a los pacientes con afecciones a largo plazo y síntomas médicamente inexplicados mediante el uso de la terapia cognitivo-conductual. Todavía no se ha completado un examen sistemático para identificar adaptaciones específicas que puedan ser eficaces para mejorar los resultados. Muchos países están aprovechando este modelo en el Reino Unido; por consiguiente, los resultados pueden servir de base para el desarrollo de servicios a nivel internacional. MÉTODOS: Se realizaron búsquedas en las bases de datos electrónicas y se examinaron los estudios en función de un criterio de inclusión/exclusión. Se incluyeron estudios que evaluaban la efectividad de las intervenciones de TCC en los resultados de salud mental para adultos con LTC/MUS dentro de la atención primaria. Se extrajeron los datos para el análisis y se realizó una síntesis narrativa. Las evaluaciones de la calidad se realizaron utilizando la herramienta del Proyecto de Práctica de Salud Pública Efectiva. RESULTADOS: De 14.380 trabajos, ocho fueron incluidos en la revisión. La evidencia moderada a fuerte encontró que las adaptaciones de la TCC fueron efectivas para mejorar los resultados, incluyendo el enfoque específico en el LTC/MUS dentro del tratamiento, la inclusión de la atención colaborativa o la implementación de una gama de habilidades terapéuticas. La metodología débil se asoció con el sesgo de selección, la falta de cegamiento y la presentación de informes sobre la validez y la fiabilidad de las herramientas de recopilación de datos. CONCLUSIONES: Las adaptaciones de la TCC pueden ser efectivas para mejorar los resultados de salud mental de aquellos con LTC/MUS a corto plazo. Debido a la pequeña cantidad de estudios incluidos en la revisión, las conclusiones siguen siendo tentativas. No está claro si las intervenciones pueden sostener los resultados y proporcionar ganancias financieras a largo plazo

The effectiveness of psychosocial interventions to support psychological well-being in post-operative bariatric patients: A systematic review of evidence.

BACKGROUND: Bariatric surgery is considered an effective obesity management intervention for individuals with a BMI greater than 40, or 35 with co-morbidities. However, research documents that psychological difficulties prevalent amongst individuals seeking surgery may persist post-operatively. This systematic review aims to assess the evidence to show which psychosocial interventions support psychological well-being post-operatively. METHODS: The review is registered with Prospero (CRD42018100280), complying with PRISMA guidelines. The research protocol included grey literature and database searches of psychosocial interventions for post-operative bariatric patients, between November 2017 and September 2019. The primary outcome was psychological well-being; secondary outcomes included weight loss maintenance and quality of life (QoL). The primary reviewer screened titles and extracted data. Study quality was assessed independently by two reviewers, using the Effective Public Health Practice Project criteria. Due to heterogeneity across studies, narrative synthesis was considered suitable for data analysis. RESULTS: Ten studies met inclusion criteria. Psychosocial intervention content was delivered in a variety of ways (e.g., clinic, internet-based). Overall, participants (N = 382, Mage = 46.4) receiving psychosocial interventions post bariatric surgery, demonstrated improvements in psychological well-being and weight loss maintenance, compared to baseline measures and/or controls. The strength of evidence is currently limited by the small number of studies found and study quality, limiting the power to detect clinically meaningful changes; findings should therefore be considered preliminary. CONCLUSION: Preliminary findings suggest that interdisciplinary interventions including acceptance-based approaches, psychoeducation, nutrition and lifestyle modification, delivered 1-year post-operative, are promising. Further scientific enquiry is warranted with well-designed studies and long-term follow-ups.

The effectiveness of health behavior change interventions in managing physical health in people with a psychotic illness: A systematic review.

PURPOSE: People living with psychotic illness disproportionately experience more comorbidities and have a markedly shorter life expectancy compared to the general population. This review evaluates the effectiveness of health behavior change interventions in improving health outcomes in this group. DESIGN AND METHODS: All studies included objective physical health measures or health behaviors as the main outcome measures and experimental design with baseline and follow-up quantitative data. Only studies of moderate and strong quality were included. Narrative synthesis was undertaken. FINDINGS: Included studies utilized a range of methodological designs and outcome measures. The majority reported significant intervention effect on most outcome measures. PRACTICE IMPLICATIONS: Health behavior change interventions can be effective in improving health outcomes in people with psychotic illness, with the potential benefit of improved psychiatric outcomes.

Exploring the way sexually explicit material informs sexual beliefs, understanding and practices of young men: A qualitative survey.

Little research has examined how exposure to sexually explicit material may affect beliefs, attitudes and actions of young men. This study explored self-reported effects on young males. A 'snowballed' sample of males aged 18-25 years was recruited within one workplace (11/40 response rate). The qualitative survey data were analysed using thematic analysis. Key themes included increased levels of availability/extreme content of sexually explicit material, seen by young men having negative effects on sexual attitudes/behaviours. Participants reported confusion between real and sexually explicit material which informed expectations of a healthy sex life but may be mediated by potential 'buffers' of family openness or sex education.

The effectiveness of interventions aiming to promote positive body image in adults: A systematic review.

Theory suggests promoting positive body image (PBI) through interventions would have a significant impact on health and well-being. However, little is known about the effectiveness of existing interventions. This review aimed to identify and assess the evidence of effectiveness of interventions to increase PBI in adults. Database searches were conducted using CINAHL Plus, Medline, PsychINFO, Wiley Online Library, and SCOPUS. Application of inclusion criteria and data extraction were conducted by two reviewers. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and narrative synthesis was conducted. Fifteen studies, evaluating 13 interventions, were included. Three studies, evaluating one online writing-based functionality intervention, were judged to have strong methodological quality and had evidence of improving body appreciation, body esteem, and functionality satisfaction. Six moderate quality studies found interventions using intuitive eating, CBT, self-compassion, and exercise improved PBI. There was limited evidence of effectiveness of interventions for men, suggesting future research is needed to better understand PBI mechanisms in men. Lack of heterogeneity of outcome measures is discussed as a limitation. Findings suggest existing interventions are effective at increasing aspects of PBI among women and support the development of interventions that target multiple components of PBI.

Evidence-based patient/public voice: a patient and public involvement audit in the field of sexual health.

BACKGROUND: The National Health Institute constitution enshrines the central role of patient and public involvement (PPI) in order to place patients at the heart of the NHS. The sexual health field presents unique challenges for PPI in the tension between current PPI practice versus the need for confidentiality/feelings of shame/stigma. However, there is little evidence around the goals, evaluation measures or theoretical underpinnings of PPI. OBJECTIVES: In order to improve current PPI practice in the sexual health field, audits were carried out on PPI plans in both service and research sectors. METHODS: 18 local sexual health service contacts completed the audit through snowballing. The tool was refined and five research projects completed the audit from the Health Protection Research Unit in BloodBorne and Sexually Transmitted Infections. Responses were collated and a thematic analysis by two independent researchers carried out. Common areas for improvement were identified. RESULTS: Audit tool responses evidenced wide variability in practice. Issues included conflation of PPI work and qualitative research; limited 'patient satisfaction' approaches; lack of PPI goals; methodological reliance on 'visible' methods such as focus groups; lack of responsiveness around patient needs and poor resourcing of PPI work. Research specific issues included 'late' PPI after key decisions had been made and poor lay summary validity. DISCUSSION: Two audits evidenced a range of areas for improvement of PPI practice in sexual health. Clear definition of 'what PPI is for' aligned with evaluation measures would begin to build an evidence base for the contribution of patient voice.

Contrasting Views of the Post-bariatric Surgery Experience between Patients and their Practitioners: a Qualitative Study.

BACKGROUND: The superiority of obesity surgery for improving medical and weight outcomes in severely obese patients when compared to other weight loss interventions remains undisputed. However, knowledge about the psychological impact of the procedure on patients' lives is limited. Systematic reviews indicate persisting psychological distress after surgery compared to control groups especially longer term, suggesting the need for postoperative psychological support and assessment. Research literature also infers limited knowledge regarding the postoperative patient experience of obesity surgery. This may form a barrier in health practitioners' understanding of these patients' ongoing needs. METHODS: Ten patients who had obesity surgery two or more years ago and eight obesity surgery practitioners were recruited within hospital settings and individually interviewed by the researcher to capture their accounts of the postoperative experience. Concordance between the two groups was explored to gauge awareness of patients' subsequent health needs. RESULTS: Thematic analysis of transcribed interviews elicited a key finding around 'post-surgical cliffs in patient care' within a heavily structured service. Participants reported some unmet needs, namely, psychological aftercare to facilitate adjustment following drastic weight loss and excess skin, acceptance of their non-obese self and perceived stigma. The impact of contrasting views of success between patients and practitioners on postoperative care within the service context was highlighted. CONCLUSIONS: Obesity surgery is a great weight loss catalyst for severe obesity. However, lack of psychological aftercare may threaten early gains in health outcomes over the longer term. More qualitative and quantitative studies are needed to validate current study results.

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity.

PURPOSE OF REVIEW: Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively. RECENT FINDINGS: Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.

Do Psychosocial Interventions Improve Quality of Life and Wellbeing in Adults with Neuromuscular Disorders? A Systematic Review and Narrative Synthesis.

Quality of life and well-being are frequently restricted in adults with neuromuscular disorders. As such, identification of appropriate interventions is imperative. The objective of this paper was to systematically review and critically appraise quantitative studies (RCTs, controlled trials and cohort studies) of psychosocial interventions designed to improve quality of life and well-being in adults with neuromuscular disorders. A systematic review of the published and unpublished literature was conducted. Studies meeting inclusion criteria were appraised using a validated quality assessment tool and results presented in a narrative synthesis. Out of 3,136 studies identified, ten studies met criteria for inclusion within the review. Included studies comprised a range of interventions including: cognitive behavioural therapy, dignity therapy, hypnosis, expressive disclosure, gratitude lists, group psychoeducation and psychologically informed rehabilitation. Five of the interventions were for patients with Amyotrophic Lateral Sclerosis (ALS). The remainder were for patients with post-polio syndrome, muscular dystrophies and mixed disorders, such as Charcot-Marie-Tooth disease, myasthenia gravis and myotonic dystrophy. Across varied interventions and neuromuscular disorders, seven studies reported a short-term beneficial effect of intervention on quality of life and well-being. Whilst such findings are encouraging, widespread issues with the methodological quality of these studies significantly compromised the results. There is no strong evidence that psychosocial interventions improve quality of life and well-being in adults with neuromuscular disorders, due to a paucity of high quality research in this field. Multi-site, randomised controlled trials with active controls, standardised outcome measurement and longer term follow-ups are urgently required.

Assessing the possibilities and challenges of patient involvement in sexual, reproductive and HIV/AIDS services.

BACKGROUND: Patient and public involvement (PPI) is a key feature of healthcare services in the UK. Sexual and reproductive health and HIV (SRHH) services face unique PPI challenges, as the anonymity and confidentiality required by service users can be a barrier to attracting patient input. PPI could improve sexual health services, through increased trust in services and the ability to tackle sexual health inequalities. However, specific practical guidance on how to address PPI in sexual health and the evidence to support it is sparse. METHODS: This research aims to begin building an evidence base for PPI in sexual health services through: 1) an audit of PPI in SRHH in the Bristol region; and 2) a parallel survey of potential users of sexual health services about their experiences of PPI. For the audit, 18 SRHH organisations from all those in the region invited complete a short online survey, representing a range of different service providers. For the survey, participants, through a convenience sample via the University of the West of England and social media, were invited to complete an anonymous online survey of their experiences of PPI in SSRHs; 96 people responded. RESULTS: Reliance on customer satisfaction approaches and patients not being asked for feedback or what PP is for are reported. Services cite under-resourcing and a lack of time as barriers. CONCLUSIONS: Improving the use of patient's voice in SRHH could be supported through clarity of purpose (measured against outcomes), better communication with patients, and the need for flexible methods.

The effectiveness of bariatric surgery on long term psychosocial quality of life - A systematic review.

BACKGROUND: Little is known about the psychological effects of bariatric surgery. This review aimed to assess long term effectiveness of bariatric surgery on psychosocial quality of life (QoL) of obese adults compared to non-surgical interventions. METHODS: A systematic review of the literature was conducted, six electronic databases, plus other relevant sources were searched from inception to January 2014. The main outcome sought was a QoL measure with a minimum 12 months follow-up. Three reviewers screened records, extracted data and independently read through full articles for eligibility and quality using standardised forms. Findings were analysed using narrative synthesis. RESULTS: Of 4383 identified references included in the review, 11 studies showed bariatric surgery to be effective long term for overall QoL than non-surgical treatments with specifically modest benefits psychosocially. Significant improvements in psychosocial QoL alongside improved physical QoL were observed after 2 year follow-up post-surgery compared to non-surgical interventions. However improvements in psychosocial QoL after surgery at 10 year follow up were minimal when compared to non-surgical interventions. When compared to untreated control groups, long term psychosocial QoL did not improve after bariatric surgery despite major improvements in physical QoL, significant weight loss and co-morbidities. CONCLUSIONS: Results on long term psychosocial QoL remain uncertain with some suggestion of psychological disorder persisting. This highlights need for psychological intervention post-surgery and further research to provide more data on long-term psychosocial QoL following bariatric surgery.

What is good qualitative research? A first step towards a comprehensive approach to judging rigour/quality.

Qualitative research has an enormous amount to contribute to the fields of health, medicine and public health but readers and reviewers from these fields have little understanding of how to judge its quality. Work to date accurately reflects the complexity of the theoretical debate required but may not meet the needs of practitioners attempting to apply qualitative work in reviews of evidence. This article describes a simple, practitioner-focused framework for assessing the rigour of qualitative research that attempts to be inclusive of a range of epistemological and ontological standpoints. An extensive review of the literature, contributions from expert groups and practitioners themselves lead to the generation of two core principles of quality: transparency and systematicity, elaborated to summarize the range of techniques commonly used, mirroring the flow of the research process. The complexities discovered are only summarized here. Finally, outstanding issues such as 'how much transparency is enough?', are flagged up.