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Some trials have evaluated peer support for people with mental ill health in high-income, mainly English-speaking countries, but the quality of the evidence is weak.
Aims
To investigate the effectiveness of UPSIDES peer support in high-, middle- and low-income countries.
Method
This pragmatic multicentre parallel-group wait-list randomised controlled trial (registration: ISRCTN26008944) with three measurement points (baseline and 4 and 8 months) took place at six study sites: two in Germany, and one each in Uganda, Tanzania, Israel and India. Participants were adults with long-standing severe mental health conditions. Outcomes were improvements in social inclusion (primary) and empowerment, hope, recovery, health and social functioning (secondary). Participants allocated to the intervention group were offered UPSIDES peer support.
Results
Of the 615 participants (305 intervention group), 337 (54.8%) identified as women. The average age was 38.3 (s.d. = 11.2) years, and the mean illness duration was 14.9 (s.d. = 38.4) years. Those allocated to the intervention group received 6.9 (s.d. = 4.2) peer support sessions on average. Intention-to-treat analysis showed effects on two of the three subscales of the Social Inclusion Scale, Empowerment Scale and HOPE Scale. Per-protocol analysis with participants who had received three or more intervention sessions also showed an effect on the Social Inclusion Scale total score (β = 0.18, P = 0.031, 95% CI: 0.02–0.34).
Conclusions
Peer support has beneficial impacts on social inclusion, empowerment and hope among people with severe mental health conditions across diverse settings. As social isolation is a key driver of mental ill health, and empowerment and hope are both crucial for recovery, peer support can be recommended as an effective component of mental healthcare. Peer support has the potential to move global mental health closer towards a recovery- and rights-based orientation.
OBJECTIVES/GOALS: As the number of older adults (≥65 years) with T1D grows, there are limited data to guide care. In a six-month trial, CGM reduced hypoglycemia in older adults, yet there are challenges for widespread uptake. Our objective is to characterize older adults experiences with using CGM and define suboptimal responses signaling a need for resources or support. METHODS/STUDY POPULATION: The study will engage key stakeholders (i.e., older adults with T1D, caregivers [recruited as patient-caregiver dyads], and providers [endocrinologists, geriatricians, diabetes educators]) for a Group Model Building (GMB). GMB is a participatory approach to system dynamics in which participants share perceptions and experiences with a problem and collaboratively explore the system structure that shapes those trends. A series of 8 GMB workshops will be held with 3-8 participants. The final study n will be determined by thematic saturation. Workshops comprise 1) a questionnaire, 2) a GMB session, and 3) a focus group discussion. GMB will follow a replicable process to generate a model of the complex web of causal determinants affecting CGM-related experiences, including optimal and suboptimal CGM responses. RESULTS/ANTICIPATED RESULTS: To date, the study has enrolled 33 participants, including 28 older adults living with T1D and 5 caregivers (mean age = 74 years, range 67-83 years). Twenty-four patient participants will be active CGM users and 4 will be CGM non-users. The study will report on patient data capture from the questionnaire and EMR, including demographics, experiences, familiarity, and confidence surrounding CGM use; diabetes duration; insulin pump use; history of severe hypoglycemia. Analysis of aggregated data will generate causal loop diagrams that integrate pertinent theoretical frameworks, lived experiences, and CGM outcomes. Maps will be used to identify a set of suboptimal CGM responses (i.e., key outcome trajectories) that signal a need for action, with a diagram of factors that interact to produce each response. DISCUSSION/SIGNIFICANCE: Delivering CGM to older adults with T1D demands new approaches. This study will yield critical evidence to tailor support and resources for effective CGM use in older adults. Findings may be translated into suite of pragmatic interventions to bolster CGM use and matched to individual patients expected to benefit using a precision medicine framework.
This chapter reviews research that examines the fundamental cognitive and social processes whereby people learn to read and write. The chapter discusses three types of literate knowledge. First, literacy can be general, such as the ability to decode words or engage in drafting and revision. Second, literacy can be task-specific: learning to read a novel and learning to read a recipe require different declarative and procedural knowledge. Third, literacy can be community-specific, in which members of a community approach a given text using different cognitive and interpretive frameworks. Learning how to read and write requires many distinct cognitive components, from decoding letters to composing and interpreting texts. Literacy also requires the ability to integrate these skills within communities of practice, and these findings are aligned with sociocultural perspectives on learning in all subjects.
Extraneous processing occurs when suboptimal instructional design causes learners to engage in cognitive processing irrelevant to the instructional goal. This chapter explores five principles for reducing extraneous processing in multimedia learning: coherence, signaling, redundancy, spatial contiguity, and temporal contiguity. The coherence principle is that people learn better when extraneous information is excluded from multimedia lessons. The signaling principle is that people learn better when cues are added to highlight the organization of the essential information. The redundancy principle is that people learn better when multimedia lessons include graphics and spoken text rather than graphics, spoken text, and printed text. The spatial contiguity principle is that people learn better when words and corresponding graphics are physically integrated rather than separated. The temporal contiguity principle is that people learn better when words and corresponding graphics are presented simultaneously rather than sequentially.
The multimedia principle is that people learn better from words and pictures than from words alone. For example, a multimedia lesson consists of an animation depicting the steps in lightning formation along with concurrent narration describing the steps in the lightning formation, whereas a single-medium lesson consists of narration alone. Based on research carried out by myself and my colleagues, in 13 out of 13 tests, learners who received text and illustrations or narration and animation (dual representation group) performed better on transfer tests than did learners who received text alone or narration alone (single representation group), with a median effect size of d = 1.35.
When a multimedia lesson containing complicated material is presented at a fast pace, the result can be a form of cognitive overload called essential overload. Three multimedia design methods intended to minimize essential overload are the segmenting, pre-training, and modality principles. The segmenting principle is that people learn more deeply when a multimedia message is presented in learner-paced segments rather than as a continuous unit. The pre-training principle is that people learn more deeply from a multimedia message when they know the names and characteristics of the main concepts. The modality principle is that people learn more deeply from a multimedia message when the words are spoken rather than printed.