5 research outputs found
Interventions for improving understanding and minimising the psychological impact of screening
This is the protocol for a review and there is no abstract. The objectives are as follows: The original broad objectives of this review were to identify and assess the effects of interventions that: a) aim to improve people's understanding of screening and the results of the screening process; and b) aim to minimise the adverse psychological impact and/or anxiety associated with screening
Shared decision-making interventions for people with mental health conditions
Background
One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society.
International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decisionâmaking (SDM) is one such partnership approach. Shared decisionâmaking is a form of service userâprovider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision.
This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010.
Objectives
To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decisionâmaking process (observations on the process of SDM; userâreported, SDMâspecific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes.
Search methods
We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies.
We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification.
Selection criteria
Randomised controlled trials (RCTs), including clusterârandomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria).
Data collection and analysis
We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence.
Main results
This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higherâincome countries. None of the studies included children or adolescents.
Primary outcomes
We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very lowâcertainty evidence.
For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences.
Regarding participation (by the person with the mental health condition) or level of involvement in the decisionâmaking process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very lowâcertainty evidence. On the other hand, SDM interventions may improve SDMâspecific userâreported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; lowâcertainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decisionâmaking processes.
Secondary outcomes
We are uncertain whether SDM interventions improve recovery compared with no intervention due to very lowâcertainty evidence.
We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically.
We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very lowâcertainty evidence.
Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI â0.24 to 0.41; 2 studies, 282 participants; moderateâcertainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very lowâcertainty evidence.
There were no adverse effects on health outcomes and no other adverse events reported.
Authors' conclusions
This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations.
Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area
Communication to promote and support physical distancing for COVID-19 prevention and control
Background
This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVIDâ19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally.
This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.
Objectives
To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVIDâ19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.
Secondary objective: to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.
Search methods
We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).
Selection criteria
Guidelines or reviews focusing on communication (information, education, reminders, facilitating decisionâmaking, skills acquisition, supporting behaviour change, support, involvement in decisionâmaking) related to physical distancing measures for prevention and/or control of COVIDâ19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.
Data collection and analysis
Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance.
Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.
Main results
This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies.
Synthesis identified six major themes, which can be used to inform policy and decisionâmaking related to planning and implementing communication about a public health emergency and measures to protect the community.
Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication
Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures.
Theme 2: Twoâway communication: involving communities to improve the dissemination, accessibility and acceptability of information
Twoâway communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time.
Theme 3: Development of and preparation for public communication: target audience, equity and tailoring
Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time.
Theme 4: Public communication features: content, timing and duration, delivery
Public communication needs to be based on clear, consistent, actionable and timely (upâtoâdate) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community.
Theme 5: Supporting behaviour change at individual and population levels
Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence.
Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication
Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.
Authors' conclusions
Implications for practice
Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death.
The approaches to effective communication identified in this review can be used by policymakers and decisionâmakers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVIDâ19 pandemic.
Implications for research
Despite massive growth in research during the COVIDâ19 period, gaps in the evidence persist and require highâquality, meaningful research. This includes investigating the experiences of people at heightened COVIDâ19 risk, and identifying barriers to implementing public communication and protective health measures particular to lowerâ and middleâincome countries, and how to overcome these