Effect of kindness-based meditation on health and well-being: a systematic review and meta-analysis.

OBJECTIVE: Kindness-based meditation (KBM) is a rubric covering meditation techniques developed to elicit kindness in a conscious way. Some techniques, for example, loving-kindness meditation and compassion meditation, have been included in programs aimed at improving health and well-being. Our aim was to systematically review and meta-analyze the evidence available from randomized controlled trials (RCTs) comparing the effects of KBM on health and well-being against passive and active control groups in patients and the general population. METHOD: Searches were completed in March 2013. Two reviewers applied predetermined eligibility criteria (RCTs, peer-reviewed publications, theses or conference proceedings, adult participants, KBM interventions) and extracted the data. Meta-analyses used random-effects models. RESULTS: Twenty-two studies were included. KBM was moderately effective in decreasing self-reported depression (standard mean difference [Hedges's g] = -0.61, 95% confidence interval [CI] [-1.08, -0.14]) and increasing mindfulness (Hedges's g = 0.63, 95% CI [0.22, 1.05]), compassion (Hedges's g = 0.61, 95% CI [0.24, 0.99]) and self-compassion (Hedges's g = 0.45, 95% CI [0.15, 0.75]) against passive controls. Positive emotions were increased (Hedges's g = 0.42, 95% CI [0.10, 0.75]) against progressive relaxation. Exposure to KBM may initially be challenging for some people. RESULTS were inconclusive for some outcomes, in particular against active controls. The methodological quality of the reports was low to moderate. RESULTS suffered from imprecision due to wide CIs deriving from small studies. CONCLUSIONS: KBM showed evidence of benefits for the health of individuals and communities through its effects on well-being and social interaction. Further research including well-conducted large RCTs is warranted

Motivational interviewing competencies among UK family nurse partnership nurses:a process evaluation component of the building blocks trial

Background Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which is increasingly being used in public health settings, either as a stand-alone approach or in combination with other structured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed, preventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are additionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing effectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites in England. The aim of this process evaluation component of the trial is to determine the extent to which Motivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with clients. Methods Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected during the ‘pregnancy’ and ‘infancy’ phases of the FNP programme. They were analysed using The Motivational Interviewing Treatment Integrity (MITI) coding system. Results A competent level of overall MI adherent practice according to the MITI criteria for ‘global clinician ratings’ was apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner competency variables, there was a large variation in the percentage of recordings in which “beginner proficiency” levels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the ‘MI adherent behaviour’ variable in the pregnancy phase to 6.7 % for ‘percentage of questions coded as open’ in the infancy phase. Conclusions The results suggest that it is possible to deliver a structured programme in an MI-consistent way. However, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as open can be more difficult to achieve in such a context. This is an important consideration for those involved in designing effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both MI and the structured programme

Talking about human papillomavirus and cancer:development of consultation guides through lay and professional stakeholder coproduction using qualitative, quantitative and secondary data

Background High-risk human papillomaviruses (HPVs) cause all cervical cancer and the majority of vulvar, vaginal, anal, penile and oropharyngeal cancers. Although HPV is the most common sexually transmitted infection, public awareness of this is poor. In addition, many clinicians lack adequate knowledge or confidence to discuss sexual transmission and related sensitive issues. Complex science needs to be communicated in a clear, digestible, honest and salient way. Therefore, the aim of this study was to coproduce with patients who have cancer appropriate resources to guide these highly sensitive and difficult consultations. Methods A matrix of evidence developed from a variety of sources, including a systematic review and telephone interviews with clinicians, supported the production of a draft list of approximately 100 potential educational messages. These were refined in face-to-face patient interviews using card-sorting techniques, and tested in cognitive debrief interviews to produce a ‘fast and frugal’ knowledge tool. Results We developed three versions of a consultation guide, each comprising a clinician guidance sheet and patient information leaflet for gynaecological (cervical, vaginal, vulvar), anal or oropharyngeal cancers. That cancer could be caused by a sexually transmitted virus acquired many years previously was surprising to many and shocking to a few patients. However, they found the information clear, helpful and reassuring. Clinicians acknowledged a lack of confidence in explaining HPV, welcomed the clinician guidance sheets and considered printed information for patients particularly useful. Conclusion Because of the ‘shock factor’, clinicians will need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account, but we provide a novel, rigorously developed and tested resource which should have broad applicability in the UK National Health Service and other health systems

Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks):a pragmatic randomised controlled trial

SummaryBackgroundMany countries now offer support to teenage mothers to help them to achieve long-term socioeconomic stability and to give a successful start to their children. The Family Nurse Partnership (FNP) is a licensed intensive home-visiting intervention developed in the USA and introduced into practice in England that involves up to 64 structured home visits from early pregnancy until the child's second birthday by specially recruited and trained family nurses. We aimed to assess the effectiveness of giving the programme to teenage first-time mothers on infant and maternal outcomes up to 24 months after birth.MethodsWe did a pragmatic, non-blinded, randomised controlled, parallel-group trial in community midwifery settings at 18 partnerships between local authorities and primary and secondary care organisations in England. Eligible participants were nulliparous and aged 19 years or younger, and were recruited at less than 25 weeks' gestation. Field-based researchers randomly allocated mothers (1:1) via remote randomisation (telephone and web) to FNP plus usual care (publicly funded health and social care) or to usual care alone. Allocation was stratified by site and minimised by gestation (<16 weeks vs ≥16 weeks), smoking status (yes vs no), and preferred language of data collection (English vs non-English). Mothers and assessors (local researchers at baseline and 24 months' follow-up) were not masked to group allocation, but telephone interviewers were blinded. Primary endpoints were biomarker-calibrated self-reported tobacco use by the mother at late pregnancy, birthweight of the baby, the proportion of women with a second pregnancy within 24 months post-partum, and emergency attendances and hospital admissions for the child within 24 months post-partum. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN23019866.FindingsBetween June 16, 2009, and July 28, 2010, we screened 3251 women. After enrolment, 823 women were randomly assigned to receive FNP and 822 to usual care. All follow-up data were retrieved by April 25, 2014. 304 (56%) of 547 women assigned to FNP and 306 (56%) of 545 assigned to usual care smoked at late pregnancy (adjusted odds ratio [AOR] 0·90, 97·5% CI 0·64–1·28). Mean birthweight of 742 babies with mothers assigned to FNP was 3217·4 g (SD 618·0), whereas birthweight of 768 babies assigned to usual care was 3197·5 g (SD 581·5; adjusted mean difference 20·75 g, 97·5% CI −47·73 to 89·23. 587 (81%) of 725 assessed children with mothers assigned to FNP and 577 (77%) of 753 assessed children assigned to usual care attended an emergency department or were admitted to hospital at least once before their second birthday (AOR 1·32, 97·5% CI 0·99–1·76). 426 (66%) of 643 assessed women assigned to FNP and 427 (66%) 646 assigned to usual care had a second pregnancy within 2 years (AOR 1·01, 0·77–1·33). At least one serious adverse event (mainly clinical events associated with pregnancy and infancy period) was reported for 310 (38%) of 808 participants (mother–child) in the usual care group and 357 (44%) of 810 in the FNP group, none of which were considered related to the intervention.InterpretationAdding FNP to the usually provided health and social care provided no additional short-term benefit to our primary outcomes. Programme continuation is not justified on the basis of available evidence, but could be reconsidered should supportive longer-term evidence emerge.FundingDepartment of Health Policy Research Programme

Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study

Background Little is known about clinicians’ experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice. Aim To explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation. Design & setting Telephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture. Method Thematic analysis of semi-structured interviews. Results Most primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting ‘grey area’ results; reiterating that even ‘straightforward’ cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics. Conclusion Primary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation

Stemming the Tide of Antibiotic Resistance (STAR): A protocol for a trial of a complex intervention addressing the 'why' and 'how' of appropriate antibiotic prescribing in general practice

BACKGROUND: After some years of a downward trend, antibiotic prescribing rates in the community have tended to level out in many countries. There is also wide variation in antibiotic prescribing between general practices, and between countries. There are still considerable further gains that could be made in reducing inappropriate antibiotic prescribing, but complex interventions are required. Studies to date have generally evaluated the effect of interventions on antibiotic prescribing in a single consultation and pragmatic evaluations that assess maintenance of new skills are rare. This paper describes the protocol for a pragmatic, randomized evaluation of a complex intervention aimed at reducing antibiotic prescribing by primary care clinicians. METHODS AND DESIGN: We developed a Social Learning Theory based, blended learning program (on-line learning, a practice based seminar, and context bound learning) called the STAR Educational Program. The 'why of change' is addressed by providing clinicians in general practice with information on antibiotic resistance in urine samples submitted by their practice and their antibiotic prescribing data, and facilitating a practice-based seminar on the implications of this data. The 'how of change' is addressed through context-bound communication skills training and information on antibiotic indication and choice. This intervention will be evaluated in a trial involving 60 general practices, with general practice as the unit of randomization (clinicians from each practice to either receive the STAR Educational Program or not) and analysis. The primary outcome will be the number of antibiotic items dispensed over one year. An economic and process evaluation will also be conducted. DISCUSSION: This trial will be the first to evaluate the effectiveness of this type of theory-based, blended learning intervention aimed at reducing antibiotic prescribing by primary care clinicians. Novel aspects include feedback of practice level data on antimicrobial resistance and prescribing, use of principles from motivational interviewing, training in enhanced communication skills that incorporates context-bound experience and reflection, and using antibiotic dispensing over one year (as opposed to antibiotic prescribing in a single consultation) as the main outcome

Loving-Kindness Meditation Effects on Well-Being and Altruism: A Mixed-Methods Online RCT

BACKGROUND: Evidence suggests that facilitating empathy could improve individuals' well-being. Loving-kindness meditation (LKM) could be a facilitator, and online delivery a cost-effective format. METHODS: We conducted an internet-based randomised controlled trial recruiting 809 adults to test whether an LKM course improves well-being through evoking pleasant emotions, psychological resources, and altruism compared to a light physical exercise course (LE). Participants in both arms followed video-based instructions, completed post-intervention questionnaires, and used online diaries and forums. To measure altruism £10/$10 were offered to participants with a choice of donating all/half to charity. Thematic analysis was applied to diary/forum entries. RESULTS: Both courses increased well-being without significant differences. LKM participants were less anxious than LE participants (ß = -0.22, 95$5 (Relative Risk = 3.57, 95%CI [0.82, 15.50], p = .09). Attrition was high (82%). Participants engaged in diary/forum usage. LKM was an emotionally intense experience, generating deep reflections and increased connectedness but difficult for some to process. LE led to gentle increases in relaxation, generating a sense of achievement. CONCLUSIONS: Future research needs to confirm findings and devise ways of delivering online LKM effectively to diverse populations.This research was supported by a scholarship from Cardiff University School of Medicine

Effect of kindness-based meditation on health and well-being: A systematic review and meta-analysis.

OBJECTIVE: Kindness-based meditation (KBM) is a rubric covering meditation techniques developed to elicit kindness in a conscious way. Some techniques, for example, loving-kindness meditation and compassion meditation, have been included in programs aimed at improving health and well-being. Our aim was to systematically review and meta-analyze the evidence available from randomized controlled trials (RCTs) comparing the effects of KBM on health and well-being against passive and active control groups in patients and the general population. METHOD: Searches were completed in March 2013. Two reviewers applied predetermined eligibility criteria (RCTs, peer-reviewed publications, theses or conference proceedings, adult participants, KBM interventions) and extracted the data. Meta-analyses used random-effects models. RESULTS: Twenty-two studies were included. KBM was moderately effective in decreasing self-reported depression (standard mean difference [Hedges's g] = -0.61, 95% confidence interval [CI] [-1.08, -0.14]) and increasing mindfulness (Hedges's g = 0.63, 95% CI [0.22, 1.05]), compassion (Hedges's g = 0.61, 95% CI [0.24, 0.99]) and self-compassion (Hedges's g = 0.45, 95% CI [0.15, 0.75]) against passive controls. Positive emotions were increased (Hedges's g = 0.42, 95% CI [0.10, 0.75]) against progressive relaxation. Exposure to KBM may initially be challenging for some people. RESULTS were inconclusive for some outcomes, in particular against active controls. The methodological quality of the reports was low to moderate. RESULTS suffered from imprecision due to wide CIs deriving from small studies. CONCLUSIONS: KBM showed evidence of benefits for the health of individuals and communities through its effects on well-being and social interaction. Further research including well-conducted large RCTs is warranted

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