Benefits and Challenges of Implementing an Adaptation of Family Integrated Care in a Ugandan Setting.

BACKGROUND: Family Integrated Care (FICare) integrates parents as partners in neonatal intensive care unit care. Our team adapted and implemented this approach in a Ugandan unit for hospitalized neonates. PURPOSE: This qualitative descriptive study examined the perceptions of mothers and healthcare professionals (HCPs) of the benefits and challenges of this new approach to care. METHODS: Fifty-one mothers of hospitalized neonates born weighing greater than 2000 g participated in the program. They were taught to assess neonate danger signs, feeding, and weight. After discharge, a subsample (n = 15) participated in focus groups to explore benefits and challenges of their participation in care. Interviews with 8 HCPs were also conducted for the same purpose. Transcripts from focus groups and interviews were analyzed using inductive content analysis to describe the benefits and challenges from the perspectives of mothers and HCPs. RESULTS: For mothers a benefit was decreased stress. Both mothers and HCPs reported that the knowledge and skills mothers acquired were a benefit as was their ability to apply these to the care of their neonate. Improved relations between mothers and HCPs were described, characterized by greater exchange of information and HCPs' attentiveness to mothers' assessments. Mothers felt ready for discharge and used their knowledge at home. HCPs noted a decrease in their workload. Challenges included the need for mothers to overcome fears about performing the tasks, their own well-being and literacy skills, and access to equipment. IMPLICATIONS FOR PRACTICE: Mothers' participation in their neonates' care can have benefits for them and their neonate.

Facilitators and constraints to family integrated care in low-resource settings informed the adaptation in Uganda.

AIM: Family Integrated Care (FICare) was developed in high-income countries and has not been tested in resource-poor settings. We aimed to identify the facilitators and constraints that informed the adaptation of FICare to a neonatal hospital unit in Uganda. METHODS: Maternal focus groups and healthcare provider interviews were conducted at Uganda's Jinja Regional Referral Hospital in 2020. Transcripts were analysed using inductive content analysis. An adaptation team developed Uganda FICare based on the identified facilitators and constraints. RESULTS: Participants included 10 mothers (median age 28 years) and eight healthcare providers (seven female, median age 41 years). Reducing healthcare provider workload, improving neonatal outcomes and empowering mothers were identified as facilitators. Maternal stress, maternal difficulties in learning new skills and mistrust of mothers by healthcare providers were cited as constraints. Uganda FICare focused on task-shifting important but neglected patient care tasks from healthcare providers to mothers. Healthcare providers learned how to respond to maternal concerns. Intervention material was adapted to prioritise images over text. Mothers familiar with FICare provided peer-to-peer support to other mothers. CONCLUSION: Uganda FICare shares the core values of FICare but was adapted to be feasible in low-resource settings.

Parent Perceptions of Transitioning From a 6-Bed Pod to a Single Family Room in a Mixed-Room Design NICU.

BACKGROUND: As some neonatal intensive care units (NICUs) shift toward mixed-room designs, with different room types available throughout family's stays, there is a need to better understand parent perceptions of this transition. METHODS: This study used a qualitative descriptive design to describe parent perceptions of transitioning from a 6-bed pod to a single family room in a mixed-room design NICU. Purposive sampling was used to recruit 10 mothers and 7 fathers who were regularly present on the unit before and after the transition. Semistructured telephone interviews were conducted a minimum of 2 days after the transition occurred. Interviews were transcribed and then analyzed using reflexive thematic analysis. FINDINGS: Four themes were identified: going into the unknown; approaching the finish line; becoming comfortable in the new reality and seeing the benefits; and gaining autonomy and confidence in parenting. CONCLUSION: These results further our understanding of the transition process from a 6-bed pod to a single-family room for parents in the NICU. Staff should be sensitized to this experience to provide tailored information and support for parents throughout the transition.

Acceptability and Feasibility of a Patient-Oriented Music Intervention to Reduce Pain in the Intensive Care Unit: Protocol for a Crossover Pilot Randomized Controlled Trial.

BACKGROUND: Many patients experience pain in the intensive care unit (ICU) despite receiving pain medication. Research has shown that music can help reduce pain. Music interventions studied so far have not used music streaming to generate playlists based on patient preferences while incorporating recommended tempo and duration. Previous research has focused on postoperative ICU patients able to self-report, which is underrepresentative of the ICU population that might benefit from a music intervention for pain management. We developed a new patient-oriented music intervention (POMI) that incorporates features based on theoretical, empirical, and experiential data intended to be used in the ICU. Such a music intervention should consider the expertise of ICU patients, family members, and nursing staff, as well as the practicality of the intervention when used in practice. OBJECTIVE: The primary objectives of this study are to (1) evaluate the acceptability and feasibility of the POMI to reduce pain in ICU patients and (2) evaluate the feasibility of conducting a crossover pilot randomized controlled trial (RCT) for intervention testing in the ICU. A secondary objective is to examine the preliminary efficacy of the POMI to reduce pain in ICU patients. METHODS: A single-blind 2×2 crossover pilot RCT will be conducted. Patients will undergo 1 sequence of 2 interventions: the POMI which delivers music based on patients' preferences via headphones or music pillow for 20-30 minutes and the control intervention (headphones or pillow without music). The sequence of the interventions will be inverted with a 4-hour washout period. Timing of the interventions will be before a planned bed turning procedure. Each patient will undergo 1 session of music. Twenty-four patients will be recruited. Patients able to self-report (n=12), family members of patients unable to self-report (n=12), and nursing staff (n=12) involved in the bed turning procedure will be invited to complete a short questionnaire on the POMI acceptability. Data will be collected on the feasibility of the intervention delivery (ie, time spent creating a playlist, any issue related to headphones/pillow or music delivery, environmental noises, and intervention interruptions) and research methods (ie, number of patients screened, recruited, randomized, and included in the analysis). Pain scores will be obtained before and after intervention delivery. RESULTS: Recruitment and data collection began in March 2022. As of July 5, 2022, in total, 22 patients, 12 family members, and 11 nurses were recruited. CONCLUSIONS: Methodological limitations and strengths are discussed. Study limitations include the lack of blinding for patients able to self-report. Strengths include collecting data from various sources, getting a comprehensive evaluation of the intervention, and using a crossover pilot RCT design, where participants act as their own control, thus reducing confounding factors. TRIAL REGISTRATION: ClinicalTrials.gov NCT05320224; https://clinicaltrials.gov/ct2/show/NCT05320224. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40760.

Acceptability and feasibility of a digital educational intervention designed to improve the psychological well-being of parents with a preterm infant at the neonatal intensive care unit: A pilot project.

BACKGROUND: Families experience psychological distress when their preterm infant is in the Neonatal Intensive Care Unit. A tailored educational intervention may be beneficial for their psychological well-being. Unfortunately, existing websites have moderate to low information quality and there is no educational website for French-speaking parents. AIM: To measure the acceptability and feasibility of a digital educational intervention designed to improve the psychological well-being of parents with a preterm infant, as well as the acceptability and feasibility of the study methods used. METHODS: A pilot randomized controlled trial was conducted. Participants were randomized to have access to either an educational website or information pamphlet. They were invited to complete an online questionnaire about stress and depressive symptoms 2 and 4 weeks after recruitment. An online questionnaire regarding the acceptability of the intervention and the data collection process was completed 5 weeks after recruitment. RESULTS: Twenty parents participated. All participants with access to the website considered it was acceptable in terms of the appropriateness, convenience, and efficiency to meet their informational needs. 85 % of participants assigned to the website viewed it 1 to 3 times per day during the data collection period and 69.4 % consulted the website for 5 to 20 min each time. The data collection process was acceptable for 85 % to 95 % of participants. DISCUSSION: The educational website was an acceptable and feasible intervention and the data collection process used was acceptable according to participants.

Factors Influencing Parents' Perception of Their Infants' Transition From a 6-Bed Pod to Single Family Room in a Mixed-Room Neonatal Intensive Care Unit.

BACKGROUND: While hospitalized in the neonatal intensive care unit (NICU), infants and their families undergo multiple transitions, and these have been found to be a source of stress for families. Although mixed-room NICU designs allow for infants to benefit from different room types as their needs evolve during their stay, these can necessitate a transfer from one room type to another, which represents a transition for families. As some NICUs change to mixed-room designs, there is a need to better understand the factors impacting these particular transitions from the perception of parents. PURPOSE: Examine parent perceptions of factors affecting the transition from a 6-bed pod to single family room in a mixed-room design NICU. METHODS: Using a qualitative descriptive design, semistructured interviews were conducted with 17 parents whose infant had transitioned from a 6-bed pod to single family room. Interviews were transcribed verbatim and then analyzed using content analysis. RESULTS: Four categories of factors were identified: (1) framing, timing, and comprehensiveness of information provided by staff regarding the transition; (2) parents' perception of advantages and disadvantages of the new space; (3) parent's own well-being and quality of support from staff; and (4) parent's previous NICU and parenting experience. IMPLICATIONS FOR PRACTICE: Staff should frame the information they provide about this transition in a positive way to help parents adjust. A family-centered approach should also be used to provide tailored information and support to individual families. IMPLICATIONS FOR RESEARCH: Future studies are needed into intraunit transfers including sources of support for parents, as well as staff perceptions of these transitions.

Family Integrated Care in Uganda: a feasibility study.

OBJECTIVE: To determine the feasibility of adapting Family Integrated Care to a neonatal hospital unit in a low-income country. DESIGN: Single-centre, pre/post-pilot study of an adapted Family Integrated Care programme in Uganda (UFICare). SETTING: Special Care Nursery at a Ugandan hospital. PATIENTS: Singleton, inborn neonates with birth weight ≥2 kg. INTERVENTIONS: As part of UFICare, mothers weighed their infant daily, assessed for severe illness ('danger signs') twice daily and tracked feeds. MAIN OUTCOME MEASURES: Feasibility outcomes included maternal proficiency and completion of monitoring tasks. Secondary outcomes included maternal stress, discharge readiness and post-discharge healthcare seeking. RESULTS: Fifty-three mother-infant dyads and 51 mother-infant dyads were included in the baseline and intervention groups, respectively. Most mothers were proficient in the tasks 2-4 days after training (weigh 43 of 51; assess danger signs 49 of 51; track feeds 49 of 51). Mothers documented their danger sign assessments 82% (IQR 71-100) of the expected times and documented feeds 83% (IQR 71-100) of hospital days. In the baseline group, nurses weighed babies 29% (IQR 18-50) of hospitalised days, while UFICare mothers weighed their babies 71% (IQR 57-80) of hospitalised days (p<0.001). UFICare mothers had higher Readiness for Discharge scores compared with the baseline group (baseline 6.8; UFICare 7.9; p<0.001). There was no difference in maternal stress scores or post-discharge healthcare seeking. CONCLUSIONS: Ugandan mothers can collaborate in the medical care of their hospitalised infant. By performing tasks identified as important for infant care, mothers felt more prepared to care for their infant at discharge.

Understanding factors associated with emotional closeness in parents with a preterm infant in the neonatal intensive care unit.

BACKGROUND: There is a dearth of knowledge regarding the specific factors associated with emotional closeness in parents with an infant in the NICU. AIM: To determine if parental presence, involvement in infant care, holding, skin-to-skin contact (SSC), perceived family-centered care, depression symptoms, and sociodemographic characteristics are associated with the emotional closeness of parents with an infant hospitalized at the NICU. STUDY DESIGN: This longitudinal descriptive study was conducted in two Canadian level-three NICUs. A sociodemographic questionnaire was completed by parents at enrolment. A closeness diary was completed by each parent for 14 days to measure parental presence, involvement in infant care, holding, SSC, and emotional closeness. One question from the DigiFCC tool was sent daily via text message to the parents' cellphones to measure their perception of the quality of family-centered care they experienced. Parent depression symptoms were measured using the Edinburgh Postnatal Depression Scale at discharge. RESULTS: A total of 60 families were involved in the study. Increased parental presence (B = 0.21, p < 0.001), increased time involved in infant care (B = 0.14, p < 0.001), increased holding time (B = 0.53, p < 0.001), and greater time in SSC (B = 0.27, p = 0.01) were associated with greater parental emotional closeness. CONCLUSION: Several factors may enhance parents' emotional closeness when their infant is in the NICU. Care providers need to be aware and adapt their clinical practices accordingly to promote emotional closeness by encouraging parental presence, involvement in infant care, holding, and skin-to-skin contact.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit.

AIM: We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). METHODS: This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. We studied 132 mother-infant dyads: 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The mothers completed a questionnaire on NICU stress and their perceptions of family-centred care on enrolment and another on breastfeeding self-efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. RESULTS: The infants were born at a mean age of 29.8 ± 3.1 weeks. Greater family-centred care during early hospitalisation (p = 0.01) and greater breastfeeding self-efficacy in the period before discharge (p = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. CONCLUSION: The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

Nurses' Perception of Preterm Infants' Pain and the Factors of Their Pain Assessment and Management.

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices.

COVID-19 restrictions and psychological well-being of fathers with infants admitted to NICU-An exploratory cross-sectional study.

AIM: To describe the impact of the COVID-19 restrictions on the caregiving activities and psychological well-being of fathers with infants admitted to neonatal units. METHODS: Cross-sectional study using adapted COPE-IS and COPE-IU tools. Participants' recruitment occurred online via social media and parents' associations. Online survey in English, French and Italian were distributed and promoted via websites and social media platforms of parent's associations. The study was undertaken across 12 countries in Asia, Australia, Africa and Europe. RESULTS: A total of 108 fathers of NICU infants completed the survey. COVID-19 related restrictions were categorised into 3 types: no restrictions, partial and severe restrictions. Fathers who experienced partial restrictions reported more involvement in caregiving activities but high levels of emotional difficulties and sleeping problems compared to those who experienced full or no restrictions. CONCLUSION: Given the impact on the psychological well-being of fathers, restrictions should be avoided as much as possible in the neonatal unit and fathers given free access to their infants if they follow appropriate infection control precautions.

Comprehensive mapping of NICU developmental care nursing interventions and related sensitive outcome indicators: a scoping review protocol.

INTRODUCTION: Neurodevelopmental outcomes of preterm infant are still a contemporary concern. To counter the detrimental effects resulting from the hospitalisation in the neonatal intensive care unit (NICU), developmental care (DC) interventions have emerged as a philosophy of care aimed at protecting and enhancing preterm infant's development and promoting parental outcomes. In the past two decades, many authors have suggested DC models, core measures, practice guidelines and standards of care but outlined different groupings of interventions rather than specific interventions that can be used in NICU clinical practice. Moreover, as these DC interventions are mostly implemented by neonatal nurses, it would be strategic and valuable to identify specific outcome indicators to make visible the contribution of NICU nurses to DC. OBJECTIVES: The overarching objective of this review is to identify the nature, range, and extent of the literature regarding DC nursing interventions for preterm infants in the NICU. The secondary twofold objectives are to highlight interventions that fall into identified categories of DC interventions and suggest nursing-sensitive outcome indicators related to DC interventions in the NICU. INCLUSION CRITERIA: Papers reporting on or discussing a DC nursing intervention during NICU hospitalisation will be included. METHODS AND ANALYSIS: The Joanna Briggs Institute's methodology for scoping reviews will be followed. CINAHL, MEDLINE, Embase, PubMed, Web of Science, Scopus, ProQuest and PsycInfo databases from 2009 to the present will be searched. Any type of paper, published in English or French, will be considered. Study selection and data extraction will be conducted by pairs of two review authors independently. A qualitative content analysis will be conducted. ETHICS AND DISSEMINATION: No Institutional Review Board ethical approbation is needed. Results of this review will be presented in scientific meetings and published in refereed papers.

French Translation, Adaptation, and Initial Validation of the Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ).

PURPOSE: The purpose of this study was to translate, adapt and conduct initial psychometric validation of the French version of the Nurses' Attitudes and Perceptions of Pain Assessment in neonatal intensive care Questionnaire (NAPPAQ) developed by Polkki in 2010. BACKGROUND: Assessing nurses' perceptions, attitudes and knowledge about pain management in preterm infants is important to improve neonatal practices. METHODS: A sample of French-speaking nurses (n = 147) from Quebec and France working in neonatal intensive care was selected to validate the 46-item questionnaire. A French translation of the NAPPAQ, which includes Part I and II, was undertaken prior to its administration. The FIPM questionnaire was added as a Part III. Internal consistency and instrument structure were examined using Cronbach's alphas, inter-item and inter-scale correlations and exploratory factor analysis. RESULTS: The NAPPAQ-FIPM is divided into three parts. Part I of the French version had a Cronbach's alpha of 0.64 and was composed of five factors. Part II had good total internal consistency (0.79) and adequate structure, established by inter-item correlations. Part III had good total internal consistency (0.76), and factor analysis findings suggested the presence of five factors. CONCLUSIONS: The NAPPAQ-FIPM can be used for research purposes. Parts II and III obtained adequate psychometrics results. However, further refinement of Part I could improve its content and internal structure.

French translation and preliminary psychometric validation of a skin-to-skin contact instrument for nurses (SSC-F).

PURPOSE: To translate and conduct the preliminary psychometric validation of a skin-to-skin contact instrument in French (SSC-F) with a sample of nurses from Quebec and France working in neonatal intensive care units. METHODS: The 20 items of the SSC instrument containing four subscales (knowledge, attitudes and beliefs, training and education and implementation), developed by Vittner et al. (2017), was translated into French. The methodological steps used for psychometric validation included assessment of the item and subscale normality distributions, assessment of reliability using internal consistency, and assessment of validity using inter-item and inter-scale correlations and principal component analysis. RESULTS: The preliminary psychometric validation showed that all four subscales of the French version had adequate internal consistency (0.61-0.77), supporting the calculation of a total score for each subscale based on the English version of the instrument. The structural validity was supported by principal component analysis findings. PRACTICE IMPLICATIONS: Based on the findings of the preliminary psychometric validation of our study, the SSC-F instrument could be used in research with French-speaking neonatal nurses in Western countries, but gathering more evidence about its reliability and validity is warranted for clinical practice.

Factors Influencing Mothers' Quality of Sleep during Their Infants' NICU Hospitalization.

STUDY OBJECTIVES: The purpose of this study is to identify factors associated with Neonatal Intensive Care Unit (NICU) mothers' quality of sleep as measured with the General Sleep Disturbance Scale (GSDS). METHODS: Recruitment took place in a level 3 NICU. At enrollment, mothers completed a socio-demographic questionnaire, described their presence in the unit and their breast milk expression behavior. They also completed online or paper questionnaires about NICU-related stress, symptoms of postpartum depression, family-centered care, perception of noise and light in the unit, and sleep disturbances. Data regarding the infant's clinical condition were collected from their medical file. Pearson correlations were performed to identify associations between mothers' quality of sleep and other study variables. Subsequently, to compare mothers with a clinically significant GSDS score to mothers with a non-significant score, a binary logistic regression model was conducted. RESULTS: 132 mothers participated. Sleep disturbances of mothers with an infant hospitalized in the NICU was positively correlated with stress (r = 0.40; p = .00), depressive symptoms (r = 0.51; p = .00), and breast milk expression (r = 0.23; p = .01). In addition, for mothers with significant levels of depressive symptoms (OR = 1.19; p = .00), with greater presence in the unit (OR = 1.36; p = .04), or with other children at home (OR = 3.12; p = .04), the likelihood of clinically significant sleep disturbances was increased. CONCLUSIONS: These results improve our understanding of the factors influencing the quality of sleep of mothers whose premature infant is hospitalized for 2 weeks or more in the NICU. In addition, these results allow the identification of mothers having a higher possibility for sleep disturbance, which enables the implementation of targeted interventions to promote adequate sleep.

Emotional Closeness Among NICU Fathers: A Qualitative Descriptive Study.

BACKGROUND: The unique perspective of fathers with an infant in the neonatal unit on the development of emotional closeness toward their infant is not well understood. The purpose of this study is to explore experiences and instances of emotional closeness from the perspective of fathers as well as factors influencing emotional closeness during an infant's hospitalization in the neonatal unit. METHODS: This qualitative descriptive study employed one-on-one interviews with fathers recruited in a level 3 neonatal unit. The interview data were analyzed with thematic analysis, and emerging themes and subthemes were organized according to dimensional analysis. RESULTS: Eight fathers agreed to take part in this study. According to the participants, emotional closeness was a complex process composed of multiple dimensions. More specifically, emotional closeness was a difficult-to-describe, mixed, and growing feeling influenced by multiple factors such as the environment, co-parenting, and the father-infant relationship. It occurred in the contexts of presence and separation in the neonatal unit and was part of the development of the father-infant relationship. IMPLICATIONS FOR PRACTICE: The results presented in this article are important for neonatal intensive care unit nurses who support fathers in the development of their fathering role. By knowing more about the process and dimensions of emotional closeness, nurses can direct their interventions with fathers to enhance emotional closeness and better understand their experience. IMPLICATIONS FOR RESEARCH: No previous study has addressed emotional closeness as a complex process with multiple components like the current study. These findings contribute to our understanding of the process of emotional closeness for fathers.

Symptoms of depression in parents after discharge from NICU associated with family-centred care.

AIMS: The aim of this study was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents' depressive symptoms at discharge and at 4 months corrected for infant age. DESIGN: A longitudinal, multicentre cohort study was conducted from 2018 to 2020 in 23 NICUs across 15 countries. METHODS: Parents (n = 635 mothers, n = 466, fathers) of infants (n = 739) born before 35 weeks of gestation and admitted to the participating NICUs were enrolled to the study during the first weeks of their infants' hospitalizations. They responded to Digi-FCC daily text messages inquiring about their perception of family-centred care provided by NICU staff. In addition, they completed a questionnaire assessing their overall perception of family-centred care at discharge. Parents' depressive symptoms were measured by the Edinburgh Postnatal Depression Scale at discharge and again after discharge when their infants were at 4 months corrected for age. RESULTS: The mothers' and the fathers' perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents' participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents' perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents. CONCLUSIONS: Our study shows that family-centred NICU care associates with parents' depressive symptoms after a NICU stay. IMPACT: Depression is common in parents of preterm infants. The provision of family-centred care may protect the mental well-being of parents of preterm infants.

The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology: a systematic review and meta-analysis.

BACKGROUND: Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). METHODS: Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary 'snowball' search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. RESULTS: Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was - 0.47 [95% CI -0.73, - 0.21] as compared to control groups for the primary outcome of depression and - 0.53 [95% CI -0.91, - 0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. CONCLUSION: Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.

Workplace experience of parents coping with perinatal loss: A scoping review.

BACKGROUND: Perinatal loss affects many parents in the workforce. Yet, current knowledge about their workplace experience while facing this difficult event is sparse. OBJECTIVES: The goal of this study was to review and synthesize the extent of scientific literature on the specific experiences of workers coping with perinatal loss and the resulting bereavement. METHODS: A scoping review was carried out using eight different databases. A total of 15 references, all using a qualitative methodology, were identified. RESULTS: Most of the references focused on the experience of mothers and on late perinatal loss (from the 20th week of pregnancy). All references highlighted the taboo and the non-recognition of perinatal grief and bereavement in both organizational practices and interpersonal relationships with colleagues and immediate supervisors. They also emphasized the difficulties associated with returning to work after the loss and the significant changes in the meaning attributed to work. CONCLUSIONS: While the studies included in this review clearly indicate that perinatal loss can affect working life, larger, quantitative studies are needed to quantify this phenomenon and its impact on employees and their organizations.