BackgroundE-mental health holds promise for people with severe mental illness, but has a limited evidence base. This study explored the effect of e-health added to face-to-face delivery of the Illness Management and Recovery Programme (e-IMR).MethodIn this multi-centre exploratory cluster randomized controlled trial, seven clusters (n = 60; 41 in intervention group and 19 in control group) were randomly assigned to e-IMR + IMR or IMR only. Outcomes of illness management, self-management, recovery, symptoms, quality of life, and general health were measured at baseline (T0), halfway (T1), and at twelve months (T2). The data were analysed using mixed model for repeated measurements in four models: in 1) we included fixed main effects for time trend and group, in 2) we controlled for confounding effects, in 3) we controlled for interaction effects, and in 4) we performed sub-group analyses within the intervention group.ResultsNotwithstanding low activity on e-IMR, significant effects were present in model 1 analyses for self-management (p = .01) and recovery (p = .02) at T1, and for general health perception (p = .02) at T2, all in favour of the intervention group. In model 2, the confounding covariate gender explained the effects at T1 and T2, except for self-management. In model 3, the interacting covariate non-completer explained the effects for self-management (p = .03) at T1. In model 4, the sub-group analyses of e-IMR-users versus non-users showed no differences in effect.ConclusionBecause of confounding and interaction modifications, effectiveness of e-IMR cannot be concluded. Low use of e-health precludes definite conclusions on its potential efficacy. Low use of e-IMR calls for a thorough process evaluation of the intervention.
MULTIFILE
OBJECTIVE: to gain insight into what older adults after hip fracture perceive as most beneficial to their recovery to everyday life.DESIGN: qualitative research approach.SETTING: six skilled nursing facilities.PARTICIPANTS: 19 older community dwelling older adults (aged 65-94), who had recently received geriatric rehabilitation after hip fracture.METHODS: semi-structured interviews were conducted with 19 older adults after hip fracture. Coding techniques based on constructivist grounded theory were applied.RESULTS: four categories were derived from the data: 'restrictions for everyday life', 'recovery process', 'resources for recovery' and 'performing everyday activities'. Physical and psychological restrictions are consequences of hip fracture that older adults have struggled to address during recovery. Three different resources were found to be beneficial for recovery; 'supporting and coaching', 'myself' and 'technological support'. These resources influenced the recovery process. Having successful experiences during recovery led to doing everyday activities in the same manner as before; unsuccessful experiences led to ceasing certain activities altogether.CONCLUSION: participants highlight their own role ('myself') as essential for recovery. Additionally, coaching provides emotional support, which boosts self-confidence in performing everyday activities. Furthermore, technology can encourage older adults to become more active and being engaged in the recovery process. The findings suggest that more attention should be paid to follow-up interventions after discharge from inpatient rehabilitation to support older adults in finding new routines in their everyday activities.A conceptual model is presented and provides an understanding of the participants' experiences and perspectives concerning their process of recovery after hip fracture to everyday life.
This publication is a result of an international research project which took place from 2012-2014. Among the participators were four universities, number of service providers, NGOs and people with psychiatric and learning disabilities from Amersfoort and Maastricht in the Netherlands, Budapest in Hungary and Tallinn in Estonia. The aim of the project was to explore the wishes and needs of persons with psychiatric or learning difficulties with regard to community participation, and how services could be (more) supportive in order to meet these needs. We also looked at local policies, especially from the perspective of the UN Convention on the Rights of Persons with Disabilities (CRPD). From the research we learn that regardless of the country where people live, persons with disabilities have similar struggles to cope with vulnerability and deprivation. They also share the same desires as any other human being: the wish to live a good and valued life, to have meaningful activities and to belong to a social community. The stories in this book were selected from the interviews which were conducted by researchers during the project. The portraits illustrate experiences of illness, disability and recovery. They also reflect experiences of using social- and mental health services, exclusion and inclusion. By reading these stories we see, how multifaceted life can be, and what are the challenges towards the real participation in community
