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Person-centred care requires improved documentation of nursing home resident wellbeing, e.g. by nursing staff proxy assessments. Previous studies mainly focused on proxy self-report agreement of quality of life of people with dementia, using lengthy questionnaires. This is the first study to investigate how well nursing staff assess residents’ wellbeing after training, using a single-question assessment method of happiness and engagement. We conducted a cross-sectional mixed-method study, including proxy assessments from 49 nursing staff, and self-reports from 49 nursing home residents without dementia (mean age 85). We explored agreement between colleagues, and between proxy assessments and self-reports, and potential nursing staff characteristics associated to this (age, experience, hours worked per week). Brief written motivations were evaluated on nursing staffs’ understanding of the happiness and engagement concepts. The results showed low agreement between colleagues, and low agreement between proxy assessments and self-reports. Nursing staff assessed happiness and engagement substantially higher than residents’ self-reports. Hours worked per week was related to happiness proxy assessments, but none of the included nursing staff characteristics were related to proxy self-report agreement. Nursing staff interpreted the concepts in diverse ways. Overestimating resident wellbeing when using this single-assessment method may undermine subsequent efforts to improve wellbeing. We could not identify which nursing staff could best provide wellbeing assessments. For now, proxy wellbeing assessments should always be combined with regular self-reports whenever possible.

Person-centered care (PCC) interventions have the potential to improve resident well-being in nursing homes, but can be difficult to implement. This study investigates perceived facilitators and barriers reported by nursing staff to using a PCC intervention consisting of three components: assessment of resident well-being, planning of well-being support, and behavioral changes in care to support resident well-being. Our explorative mixed method study combined interviews (n = 11) with a longitudinal survey (n = 132) to examine which determinants were most prevalent and predictive for intention to use the intervention and actual implementation 3 months later (n = 63). Results showed that perceived barriers and facilitators were dependent on the components of the intervention. Assessment of resident well-being required a stable nursing home context and a detailed implementation plan, while planning of well-being support was impeded by knowledge. Behavioral changes in nursing care required easy integration in daily caring tasks and social support. (C) 2020 The Author(s). Published by Elsevier Inc.

Objective: Self-criticism is a self-condemning and self-compassion a supportive style of self-to-self relating. These concepts have increasingly been studied in people with cancer, but mainly with quantitative studies. This study is the first to explore how adult cancer patients experience self-criticism and self-compassion in the context of their illness.Design: A multimethod qualitative study design was used, combining individual and group semi-structured interviews. Participants were 26 people with cancer who familiarized themselves with the topic by doing various self-compassion exercises for 2 weeks prior to the interview. Individual and group interviews were analyzed together using thematic analysis.Results: Four themes regarding self-criticism were identified: (1) being harsh or strict with yourself, (2) feeling guilty or angry, (3) feeling useless or like a burden, (4) feeling ashamed and not wanting to show weakness. Six themes regarding self-compassion were identified: (1) being mild to yourself, (2) guarding your boundaries, (3) accepting the illness and limitations, (4) maintaining a positive perspective, (5) connecting to others, and (6) taking responsibility for your health.Conclusion: Our findings offer insights into practical and daily life experiences of self-criticism and self-compassion of people with cancer, which can aid the further development of theory, scales and interventions.

The job demands-resources (JD-R) model has hardly been studied in volunteer organizations and there is a scarcity of studies evaluating self-compassion as a personal resource within the JD-R model. The present study addresses these gaps in current knowledge, first by examining the applicability of the JD-R model in a crisis line volunteer organization. Second, self-compassion is examined, both in terms of its moderating role on the exhaustion process as well as its role on the motivation process. Structural equation modelling was used for the analyses. The influence on the organizational outcome ‘compassion towards others’ was examined using a multiple regression analysis. The results showed that the JD-R model has an acceptable fit on this sample and supports the central assumption that exhaustion and motivation are two independent but related processes. This study provides evidence that self-compassion is a valuable addition to the JD-R model, as it has an indirect effect on both processes, and increases the explained variance in compassion towards others by 7% through the exhaustion process and by 3% through the motivational process. These findings point to the importance of focusing on self-compassion in training and supervision in volunteer organizations.

Background:Crisis line services, run by volunteers, offer a listening ear 24/7 to people who cannot or do not want to use professional help. Although previous studies have identified various potential stressors crisis line volunteers face, as yet a comprehensive assessment is lacking with regards to the frequency and perceived stressfulness of work- and organization-related demands, and their relationship with distress and a volunteer's intention to leave.Objective:To identify the frequency and impact of particular stressful situations (demands). In addition, to examine the extent to which these demands are associated with volunteers' demographics, distress and intention to leave the crisis line service.Method:In a cross-sectional study among 543 volunteers of a Dutch crisis line service the participants filled out a questionnaire about their experience of a large number of work- and organization-related demands and their perceived stressfulness. To calculate the impact of demands, the occurrence and stressfulness were multiplied. In addition, work-related distress, intention to leave the crisis line service as well as a number of demographics and work-related characteristics were assessed.Results:Work-related demands with the highest impact on volunteers were calls from people with psychiatric problems and suicidal intentions. “Having no time for a break” was the organization-related demand with the highest impact on volunteers. Eighteen percentage of the volunteers scored moderate or high on distress and 4% had the intention to leave the crisis line service within 1 year. Most work- and organization-related demands were positively associated with volunteers' distress and intention to leave the organization. Being older, being male and spending more hours per week volunteering were significantly, positively correlated with work-related demands. The total explained variance for distress was 16% and for intention to leave 13%.Conclusion:Although most crisis line volunteers experienced low impact from work- and organization-related demands, these demands were significantly related to experienced distress and the intention to leave crisis line service. For volunteers with moderate to high distress it can be useful to implement interventions aimed at increasing personal resources to help them deal with the challenges of the work at the crisis line.

There is growing evidence that positive psychology interventions (PPIs) are effective in enhancing mental well-being and reducing depressive symptoms. However, there is a knowledge gap regarding the motives of people to seek such PPIs. This study qualitatively identifies help-seeking motives and quantitatively examines which motives relate to client satisfaction, adherence and an impact on mental well-being, anxiety and depressive symptoms. We analyzed 123 introductory emails of people with suboptimal levels of mental well-being who assigned to a comprehensive 9-week PPI with email support, of which its efficacy was investigated in a randomized controlled trial. Results showed that 49% mentioned mainly suffering-related motives (i.e. distress and stressful events/circumstances) and 51% mentioned mainly growth-related motives (i.e. mental well-being and developing resources). Hardly any motive was significantly related to beneficial outcomes, albeit developing resources and suffering were positively—though weak—correlated with adherence. The present study indicates that this PPI was effective for a broad audience, namely for those with suffering-related and with growth-related motives. This finding underscores the great relevance of PPIs to reach people who might be at risk for future mental disorders who otherwise do not seek help.

Objective. Compassion-based interventions show promise in enhancing well-being and reducing distress, however little is known about their applications for people with long-term physical conditions. The current study investigates compassion-based interventions for this population: what are their differing elements (content, structure, tailoring, use of technology), feasibility and acceptability, effects and experienced benefits? Methods. A mixed-methods systematic review was conducted. Four bibliographic databases were searched without time or study design restrictions. Meta-synthesis was used to integrate quantitative results of effects, and qualitative results of experienced benefits. Results. Twenty studies met the inclusion criteria, of which most targeted people with cancer or persistent pain. Interventions were either comprehensive with 6-12 face-to-face sessions, or brief based on a single compassion exercise. Participants highly rated feasibility and accessibility. Amongst a plethora of outcomes, reductions in depression and anxiety were the most common findings. Our qualitative synthesis yielded participants’ perceived benefits of (1) acceptance of the condition; (2) improved emotion regulation skills; (3) reduced feelings of isolation. Little overlap was found between quantitative and qualitative outcomes. Conclusion. While the field is still in its infancy, this review highlights the potential benefits of compassion-based interventions for people with long-term physical conditions and discusses recommendations for further intervention research and development.

Crisis line services, operated by volunteers, have been proven to be effective in decreasing psychological pain and preventing suicidality. Although working at the crisis line may be rewarding, for some the confrontation with highly complex topics (i.e., suicidality, abuse, and loneliness) in combination with inappropriate calls (i.e., sexually abusive calls), may lead to distress or vicarious trauma. The aim of this paper is to systematically review the studies that have examined mental wellbeing of crisis line volunteers and the factors associated with it. Thirteen published empirical studies on the topic were found. These showed that crisis line volunteers are at increased risk of declined mental wellbeing. However, a wide range of operationalizations were used and most studies did not use validated instruments. On the other hand, studies showed that many volunteers experience satisfaction and gratification from their work. This review gives insight into some of the work-related, organization-related, and volunteer-related factors that may be associated with the decrease of mental wellbeing. More high quality, comprehensive, and quantitative research using validated instruments is urgently needed to assess the impact of the work on mental wellbeing and the relative impact of influencing factors.

The efficacy of several multicomponent positive psychology interventions (PPIs) have been demonstrated, but little is known about its possible mechanisms of change. We examined (1) the efficacy of an email guided self-help PPI on six core well-being processes (positive emotion, use of strengths, optimism, self-compassion, resilience and positive relations) and (2) the mediating role of these processes on mental well-being, anxiety and depressive symptoms. Adults ≥ 18 years were recruited in the general population and randomized into the intervention (n = 137) or wait-list control group (n = 138). Repeated measures analyses showed that the intervention group improved significantly more than the control group on all six processes. Improvement (t0–t1) on each process statistically mediated improvement (t0–t2) on mental well-being, anxiety and depressive symptoms. Simple-mediation analyses revealed small to moderate effect sizes. Multiple-mediation analyses revealed most pronounced results for positive relations and self-compassion, suggesting that these processes might be key mechanisms in promoting well-being.

Background Nursing staff in nursing homes is at risk for stress-related problems. Positive psychology interventions have been shown to effectively improve well-being and decrease depressive symptoms, and may be beneficial for nursing staff. However, controlled studies with nursing staff are missing. Objectives and design This is the first study to test the effectiveness and acceptability of an online multi-component positive psychology intervention in nursing home staff. This study used a cluster-randomized controlled design, with an intervention group and a control group, and measurements at baseline (T0) and following the training period (T1). We hypothesized that the intervention would improve general well-being, job satisfaction and work engagement, especially for people with low initial well-being, satisfaction or engagement. Furthermore, we explored the acceptability of such an intervention for nursing home staff. Settings and Participants All nursing staff of the units for physically frail older adults of four Dutch nursing homes belonging to one care organization were invited to participate in this study. A sample of 128 nursing staff completed T0, and 107 nursing staff completed T1, mostly licensed practical nurses with a mean age of 42 years. Methods The 8-week online intervention concerned information and evidence-based exercises of six topics of Positive Psychology, which were completed individually at home. General well-being, job satisfaction and work engagement were measured, and participants evaluated the intervention. Results No time by group interaction effect was found on general well-being nor on work engagement, but there was a small effect on job satisfaction. No moderation effects of baseline outcome measures were found. The evaluation of the intervention varied: a majority positively valued the intervention, in particular the topics “positive emotions” and “strengths”, but most agreed that there was too much text and too many exercises. Conclusions The online multi-component positive psychology intervention had only very limited effectiveness, as the decrease in job satisfaction in the control group may reflect a regression to the mean. The high baseline levels of well-being and engagement, intervention content, obligatory character of the intervention, and individuality are discussed as possible reasons for these results. Opportunities lie in creating a concise, work focused positive psychology intervention for nursing staff, including some form of autonomy support.

Background There is growing interest in measuring the eudaimonic perspective of mental well-being (social and psychological well-being) alongside existing measures of the hedonic perspective of mental well-being (subjective well-being). The Flourishing Scale (FS) assesses core aspects of social-psychological functioning and is now widely used in research in practice. However, the reliability and validity of eudaimonic measures such as the FS has not yet been tested in people with low or moderate levels of well-being. This group is at risk for developing mental disorders and, therefore, an important target group for public mental health. Methods We extensively evaluated the psychometric properties of the 8-item FS in a sample of adults with low or moderate levels of well-being in The Netherlands (N = 275) using confirmatory factor analysis (CFA), item response theory analysis and a multitrait matrix. Results The unidimensional structure of the scale was confirmed with CFA and an adequate fit to the Rasch model. However, our sample showed positive skewness of the scale, but lacked measurement precision at the higher end of the social-psychological continuum. In general, the multitrait matrix demonstrated the convergent validity of the scale, with strong to weak correlations between the FS and (1) overall well-being, (2) social and psychological well-being (3) positive eudaimonic states, (4) hedonic states, (5) psychopathology and (6) personality traits. Nevertheless, relatively low correlations were found, specifically in comparison with the Mental Health Continuum-Short Form (MHC-SF). Conclusions The FS seems a reliable and valid instrument for measuring social-psychological functioning in adults with suboptimal well-being, but its use in intervention studies and clinical practice might be debatable. Therefore, the FS seems most suitable to include in epidemiological studies alongside existing hedonic measures to more fully capture mental well-being. Future research should examine the temporal stability of the FS and the consequences of the positive skewness and limited external validity of the scale found in the current study.

Informal caregivers of patients with Amyotrophic Lateral Sclerosis (ALS) or Progressive Muscular Atrophy (PMA) face stressful demands due to severe impairments and prospect of early death of the patients they care for. Caregivers often experience feelings of psychological distress and caregiver burden, but supportive interventions are lacking. The objective of this study is to investigate the effectiveness of a psychosocial support program aimed at enhancing feelings of control over caregiving tasks and reducing psychological distress. This support program is based on an existing program for adult partners of people with cancer and is adapted to meet the needs of ALS caregivers. This study is a randomized controlled trial using a wait-list control design. One hundred and forty caregiver-patient dyads, recruited from a nationwide database and through the website of the Dutch ALS Center, will be either randomized to a support program or a wait-list control group. The blended intervention is based on Acceptance and Commitment Therapy and consists of 1 face-to-face contact, 6 online guided modules and 1 telephone contact. The intervention can be worked through in 8 weeks. The effectiveness and the participants’ satisfaction with the intervention will be evaluated using a mixed method design. Caregivers and patients will be asked to fill in questionnaires on 4 occasions during the study: baseline, 3 months, 6 months and 9 months. The main study outcome is the psychological distress of the caregiver assessed with the Hospital Anxiety and Depression Scale. Secondary outcomes are caregiver burden, caregiver quality of life, quality of life of the patient and psychological distress of the patient. Group differences in primary and secondary outcomes at 6 months will be compared with linear mixed model analysis. In a subgroup of caregivers we will explore experiences with the support program through semi-structured interviews. Usage of the online modules will be logged. The study will provide insights into the effectiveness of a blended psychosocial support program on psychological distress of caregivers of patients with ALS or PMA, as well as into indirect relations with patients’ wellbeing. Netherlands Trial Registry NTR5734 , registered 28 March 2016.

This study examined partners of cancer patients intention to use a web-based psychological intervention, their preferences regarding its preconditions, functionalities and topics, and factors related to their intention. One hundred and sixty-eight partners completed a questionnaire about these aspects. Forty-eight percent of the partners would (maybe) make use of a web-based intervention. Partners who intended to participate were significantly younger, used the Internet more often, and perceived more caregiver strain. Most partners preferred an intervention that takes less than 1 hour/week, lasts five weeks or more, and contains information and peer support. Half of the partners would like to receive online guidance.

Background Detrimental effects of women’s negative feelings during pregnancy have been extensively examined and documented, but research on the influence of positive feelings and protective factors on their prenatal mental health is scarce. Evidence from the positive psychology field has shown that practicing some brief positive exercises, called positive psychology interventions, can maximize well-being by increasing positive emotions, engagement, and meaning. Aim The aim of this study is to examine the effect of a positive psychology web-based intervention on indices of women’s prenatal well-being. Methods Specifically, a case series design was adopted, and data from six women are presented. Participants were involved in a 5-week online positive psychology intervention that includes a set of positive psychology interventions specifically adapted for pregnant women. Measures of women’s mental well-being, depression, pregnancy-related anxiety, life satisfaction, and social support were measured at pre- and post-intervention. Compliance with the intervention and exercise preferences were assessed at post-test. Single-item related well-being measures were assessed weekly. Findings and discussion The findings of this case series study indicate potential effects of the intervention on supporting mental well-being and decreasing depressive symptomatology in these pregnant women. Furthermore, this study provides some suggestions for developing future online-based positive interventions addressed to pregnant women. However, these findings are preliminary, and future studies are needed in order to assess the effects of the intervention in a wider population of pregnant women.

Background There is growing evidence that fostering mental well-being and flourishing might effectively prevent mental disorders. In this study, we examined whether a 9-week comprehensive positive self-help intervention with email support (TL-E) was effective in enhancing well-being and flourishing and decreasing anxiety and depressive symptoms in a non-clinical sample. Methods A total of 275 participants with low or moderate well-being (mean age = 48 years, 86% female) were randomly assigned to a TL-E (n = 137) or wait-list control group (WL; n = 138). Participants completed online self-reporting questionnaires at baseline and at 3, 6 and 12 months. Results Repeated measure analyses revealed significant more improvement on mental well-being (F = 42.00, p ≤ 0.001, d = 0.66, 95% CI = 0.42–0.90), anxiety (F = 21.65, p ≤ 0.001, d = 0.63, 95% CI = 0.39–0.87) and depression (F = 13.62, p ≤ 0.001, d = 0.43, 95% CI = 0.19–0.67) in the TL-E group versus the WL group. The proportion of flourishing in the TL-E group increased from 7 to 30% after 3 months (NNT = 5.46) and to 34% after 6 months (NNT = 5.25). All within group effects were maintained up to 12 months. We found no meaningful dose-response relationship for adherence, nor a clear moderator pattern. Limitations It is unknown whether results were influenced by the email support that accompanied the self-help intervention since TL-E was only compared to a wait-list condition. The generalizability of the findings is limited by the self-selected sample of mainly higher-educated women. Conclusion A guided positive self-help intervention might be considered as a new mental health promotion strategy because it has the potential to improve well-being up to the status of flourishing mental health, and to decrease anxiety and depressive symptomatology., Highlights • We evaluated a comprehensive self-help positive psychology intervention with email support. • The intervention appeared to be effective in promoting flourishing. • Anxiety and depressive symptoms reduced more compared to a wait-list group. • Adherence and client satisfaction were high, drop-out was low. • Offering a multicomponent positive psychology intervention seems a worthwhile public mental health strategy.

Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P

Developing motivational technology to support long-term behavior change is a challenge. A solution is to incorporate insights from behavior change theory and design technology to tailor to individual users. We carried out two studies to investigate whether the processes of change, from the Transtheoretical Model, can be effectively represented by motivational text messages. We crowdsourced peer-designed text messages and coded them into categories based on the processes of change. We evaluated whether people perceived messages tailored to their stage of change as motivating. We found that crowdsourcing is an effective method to design motivational messages. Our results indicate that different messages are perceived as motivating depending on the stage of behavior change a person is in. However, while motivational messages related to later stages of change were perceived as motivational for those stages, the motivational messages related to earlier stages of change were not. This indicates that a person’s stage of change may not be the (only) key factor that determines behavior change. More individual factors need to be considered to design effective motivational technology.

Objective: While most existing health literacy (HL) measures focus primarily on reading comprehension, the functional, communicative and critical HL scales from Ishikawa et al. [19] aim to measure a broader HL spectrum. The objective of this study was to evaluate the validity of the Dutch translation of this instrument. Methods: Two survey studies (n = 79 and n = 209) and one cognitive interview study (n = 18) were performed among samples of breast cancer patients and patients with rheumatic diseases. Results: Analyses showed the scales measured three distinct factors and convergent validity was satisfactory for communicative and critical HL. Nevertheless, the comprehension of the items and the suitability of the response options raised some problems. Conclusion: The HL scales seem promising to measure a broad definition of HL. By revising some of the items and response options as proposed in this article, the scale will become more understandable for people with low HL skills, which might increase the content validity and the distributional properties of the scale. Practice implications: The scale should be revised and revalidated. An improved version should be used in practice to gain insight into HL levels of patients. This will help to develop suitable education programs for people with low HL skills.

This study examined the construct validity of the Dutch Life Orientation Test-Revised (LOT-R) in two samples; one sample of patients with psychiatric disorders (n=157) and one sample of patients with rheumatoid arthritis (RA, n=83). Confirmatory factor analyses showed that the LOT-R was not sufficiently unidimensional and could be better explained by two underlying factors consisting of positively and negatively worded items, respectively. This two-factor solution fitted the data significantly better than the onefactor solution in both groups, but satisfied all criteria for good model fit in the psychiatric patient sample only. One-factor models allowing correlated error terms between the positively or negatively worded items performed equally better than the original one-factor solution in both groups, indicating that the two factors may be the result of the specific wording of the items. However, the two factors were differentially associated with other relevant psychological constructs and correlation patterns differed substantially between both populations, indicating possible conceptual differences between optimism and pessimism. Overall, the findings suggest that the positively and negatively worded items of the Dutch LOT-R do not reflect a true unidimensional construct, but two underlying factors which may reflect a complex combination of methodological artefact and substantive differences. Therefore, researchers using the Dutch LOT-R are encouraged to not only rely on total scale scores, but to use additional sub-scores for optimism and pessimism to better examine possible relationships and effects in optimism research.

We studied the success and success factors of online support groups (OSGs) for patients, and the motives and goals of people who start such groups. We interviewed 23 webmasters of OSGs for patients with breast cancer, fibromyalgia and arthritis. The majority were women ( n = 20) and most were patients ( n = 21). Analysis of the interviews revealed that webmasters had altruistic and intrinsic motives for initiating an online support group. They defined success as the fulfilment of the goals they had in mind when they initiated their groups. To be able to make a group successful, decisions about its organization and management need to be coherent with these goals. Most webmasters stressed that promoting the group, keeping it alive and moderating the messages were vital success factors during the evolution stage. Management of the OSGs took up much of the webmasters' time and energy. On average webmasters were occupied with the group for 10–15 hours a week. Our study provides an overview of the pros and cons of differing decisions that have to be made when initiating an OSG.

People in stressful circumstances, such as serious health conditions, often turn to support groups. With the increase in the availability and popularity of the Internet, the possibility has arisen to join support groups online. Various authors have raised potential disadvantages of these groups, such as the lack of control of the quality of the information that is exchanged and the concern that the exchange within the group might include socially inappropriate remarks. In this study we explored to what extent these potential disadvantages actually occur. In addition, we explored who uses Dutch online support groups and what is exchanged by the participants. By means of ''content analysis'' we analyzed a random sample of 1500 messages from publicly available online support groups for patients with breast cancer, arthritis and fibromyalgia. It appeared that the online support groups under study were mainly used by female patients. A major part of the postings contained ''off topic'' remarks. Popular health related topics were ''restrictions in daily life'' and ''regular medication''. Only in a minor proportion of the postings, potential disadvantages were present. Therefore this study suggests that online support groups are a viable option for support.

BackgroundPositive psychology interventions have been found to enhance well-being and decrease clinical symptomatology. However, it is still unknown how flourishing can also be increased. Although multicomponent interventions seem to be necessary for this purpose, different formats can be used. A cost-effective approach could be a positive psychology-based self-help book with tailored email support to reach large target groups and to prevent dropout. ObjectiveThis study will evaluate the efficacy of a comprehensive multicomponent self-help intervention with or without email support on well-being and flourishing, and will seek to determine the working mechanisms underlying the intervention. MethodsIn this 3-armed, parallel, randomized controlled trial, 396 participants with low or moderate levels of well-being and without clinical symptomatology will be randomly assigned to (1) a self-help book condition with weekly email support, (2) a self-help book condition without email support but with a weekly information email, or (3) a waiting list control condition. Online measurements will be assessed at baseline, at post-test (3 months after baseline), and at 6 and 12 months after baseline. ResultsThe primary outcomes are well-being and flourishing (ie, high levels of well-being). Secondary outcomes are the well-being components included in the intervention: positive emotion, use of strengths, optimism, self-compassion, resilience, and positive relations. Other measures include depressive and anxiety symptoms, personality traits, direct medical and non-medical costs, life-events, and client satisfaction. ConclusionsThis study will add knowledge to the efficacy and cost-effectiveness of a multicomponent positive psychology intervention. We will also explore who can benefit most from this intervention. If the intervention is found to be effective, our results will be especially relevant for public mental health services, governments, and primary care. Trial RegistrationThe Netherlands Trial Register NTR4297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4297 (Archived by WebCite at http://webcitation.org/6Uwb5SUUM).

Objectives: Life review can be implemented within a group as well as on an individual level. There have been few discussions about which the format is most effective. This study investigates the social aspects of a life-review group intervention from the perspective of the client within the context of a large, randomized controlled trial. Method: This was an exploratory study using a qualitative methodology. We conducted semi-structured interviews to explore how participants felt about the benefits and barriers of receiving life review in a group. Transcripts of the interviews were analyzed using inductive analysis. Results: The social processes of life review in a group included experiencing a sense of belonging, feeling accepted, finding good company, disclosing oneself, learning to express oneself, finding recognition, realizing that others have problems too, being more successful at coping than others, learning from others, and being able to help others. Negative processes were less often mentioned and included having difficulties with sharing in a group, finding no recognition, and anxiety caused by the prospect of finding no recognition. These social processes can be divided into three categories: first, having a good atmosphere in the group; second, disclosure to peers; and third, relating to others. Conclusion: Our results reveal a variety of social processes that may facilitate the effects of life-review therapy. Future research, however, is needed to further examine the importance of these social processes and their effects on depression

Objective: To examine the structural validity, internal consistency, test-retest reliability, and construct validity of the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale in patients with osteoarthritis (OA). Methods: A cross-sectional sample of 224 outpatients with OA completed a survey containing the Dutch PEPPI-5 and other standardized measures assessing perceived health-management skills, general self-efficacy, social support, and health-related quality of life. A subsample of 100 patients completed the PEPPI-5 again approximately 3 weeks later. Results: Confirmatory factor analysis demonstrated good fit for a unidimensional model of the PEPPI-5. Additionally, the scale showed high internal consistency (alpha = 0.92) and fair test-retest reliability (ICC = 0.68). As hypothesized, the PEPPI-5 was strongly correlated with perceived health-management skills, moderately with social support and psychosocial aspects of health, and not with physical aspects of health. Contrary to expectations, however, it was not correlated with general self-efficacy. Conclusion: The Dutch PEPPI-5 demonstrated adequate validity and reliability in patients with OA. Practice implications: The PEPPI-5 is a brief and appropriate tool for measuring self-efficacy of patients with OA to interact with their physicians. Additional research into its sensitivity to change is needed before it can be confidently recommended as an outcome measure in intervention studies. (C) 2011 Elsevier Ireland Ltd. All rights reserved

BackgroundAlthough peer-to-peer contact might empower patients in various ways, studies show that only a few patients actually engage in support groups. ObjectiveThe objective of our study was to explore factors that facilitate or impede engagement in face-to-face and online peer support, using the Theory of Planned Behavior. MethodsA questionnaire was completed by 679 patients being treated for arthritis, breast cancer, or fibromyalgia at two Dutch regional hospitals. ResultsOur results showed that only a minority of the patients engaged in organized forms of peer support. In total 10% (65/679) of the respondents had engaged in face-to-face meetings for patients in the past year. Only 4% (30/679) of the respondents had contact with peers via the Internet in the past year. Patients were more positive about face-to-face peer support than about online peer support (P < .001). In accordance with the Theory of Planned Behavior, having a more positive attitude (P < .01) and feeling more supported by people in the social environment (P < .001) increased the intention to participate in both kinds of peer support. In addition, perceived behavioral control (P = .01) influenced the intention to participate in online peer support. Nevertheless, the intention to engage in face-to-face and online peer support was only modestly predicted by the Theory of Planned Behavior variables (R2 = .33 for face-to-face contact and R2 = .26 for online contact). ConclusionAlthough Health 2.0 Internet technology has significantly increased opportunities for having contact with fellow patients, only a minority seem to be interested in organized forms of peer contact (either online or face-to-face). Patients seem somewhat more positive about face-to-face contact than about online contact.

Ever since the rise of online support groups it has been presumed that there is an empowering effect from patients' participating in these groups, despite a lack of evidence to back up this assumption. In this study we explored if, and in which ways, patients feel empowered by participation. Additionally, we studied which empowering and disempowering processes occur as a result of taking part in these groups. To accomplish this aim, we interviewed 32 participants of online support groups. This analysis revealed the following empowering processes: exchanging information, encountering emotional support, finding recognition, sharing experiences, helping others, and amusement. Disempowering processes were mentioned far less often. Empowering outcomes mentioned were being better informed; feeling confident in the relationship with their physician, their treatment, and their social environment; improved acceptance of the disease; increased optimism and control; enhanced self-esteem and social well-being; and collective action. This article demonstrates that participation in online support groups can make a valuable contribution to the emergence of empowered patients.

BackgroundThe Internet increases the availability of health information, which consequently expands the amount of skills that health care consumers must have to obtain and evaluate health information. Norman and Skinner in 2006 developed an 8-item self-report eHealth literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). This instrument has been available only in English and there are no data on its validity. ObjectivesThe objective of our study was to assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations. MethodsWe examined the translated scale in a sample of patients with rheumatic diseases (n = 189; study 1) and in a stratified sample of the Dutch population (n = 88; study 2). We determined Cronbach alpha coefficients and analyzed the principal components. Convergent validity was determined by studying correlations with age, education, and current (health-related) Internet use. Furthermore, in study 2 we assessed the predictive validity of the instrument by comparing scores on the eHEALS with an actual performance test. ResultsThe internal consistency of the scale was sufficient: alpha = .93 in study 1 and alpha = .92 in study 2. In both studies the 8 items loaded on 1 single component (respectively 67% and 63% of variance). Correlations between eHEALS and age and education were not found. Significant, though weak, correlations were found between the eHEALS and quantity of Internet use (r = .24, P = .001 and r = .24, P = .02, respectively). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and nonsignificant: r = .18 (P = .09). The t tests showed no significant differences in scores on the eHEALS between participants who scored below and above median scores of the performance test. ConclusionsThe eHEALS was assessed as unidimensional in a principal component analysis and the internal consistency of the scale was high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS instrument requires further study, since the relationship with Internet use was weak and expected relationships with age, education, and actual performance were not significant. Further research to develop a self-report instrument with high correlations with people’s actual eHealth literacy skills is warranted.

Flourishing is the ultimate end-state in psychology and a key-concept in the field of positive psychology research. Flourishers are those individuals with both high levels of hedonic well-being and eudaimonic well-being. Although many researchers have focused on one or another of these domains, only a few have investigated the comprehensive state of flourishing. The purpose of this study was to examine the prevalence of flourishing and its association with socio-demographics, personality traits and situational factors. This study used data from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a national representative sample of adults in The Netherlands (n = 5303; 2010–2012). Findings were compared to having either high hedonic well-being or high eudaimonic well-being. Results showed that 37 % of the respondents were flourishers, mainly characterized by high levels of conscientiousness and extraversion and low levels of neuroticism. The situational factors of social support and positive life-events were significantly associated with flourishing when the analysis was controlled for socio-demographics and personality traits. Flourishing was most distinct from high hedonic well-being and showed parallelism with high eudaimonic well-being. More research is needed to establish a preferred flourishing instrument with validated cut-off points for flourishing and to understand the processes of situational factors that may underlie the promotion of flourishing. We recommend longitudinal designs and experience sampling studies to investigate the unique and modifiable predictors of flourishing. In addition, future research should include intervention studies that examine through which hedonic and eudaimonic pathways flourishing can be achieved.