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Internet Interv ; 24: 100380, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33747798


Background: E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. Method: Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. Results: A total of N = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. Conclusion: The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.

BMJ Support Palliat Care ; 5 Suppl 1: A28, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25960514


BACKGROUND: The referral process in palliative care is influenced by the structure of the health care system and the understanding of the value of Palliative Care (PC) by healthcare practitioners and patients. Balsam-Lebanese Centre for Palliative Care is a non-governmental organisation that has been providing home-based palliative care services to patients in Greater Beirut since 2010. Lebanon has a highly privatised fee-for-service health care system. In this setting, treating physicians may resist seeking palliative care services for their patients for fear of losing the patient. A lack of awareness regarding the added value of palliative care can also be detrimental to referral rates. We aimed to gain physician acceptance by providing high quality care, consistent communication, and education. AIM: To assess the perceptions of referring physicians towards our home-based palliative care service. METHODS: A sample of primary physicians whose patients have been under the care of Balsam will be interviewed to assess their perceptions of the quality and value of our service to their patients as well as the impact of the service on their practice. 10-15 semi-structured interviews will be conducted transcribed and analysed thematically. RESULTS: Since the initiation of our in 2010, patient load has steadily increased. The pool of referring physicians has also increased from 3 physicians in the first year to 58 physicians to date in 2014. In this study, we will share the findings from our qualitative study with referring physicians. CONCLUSION: Understanding the fears and concerns of referring physicians will guide further interventions and may improve referral rates.