Web-based stress management for newly diagnosed cancer patients (STREAM-1): a randomized, wait-list controlled intervention study Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Behavioural interventions for type 2 diabetes: an evidence-based analysis. An online randomised controlled trial to assess the feasibility, acceptability and potential effectiveness of 'Living with Bipolar': a web-based self-management intervention for bipolar disorder: trial design and protocol. Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project. The Effects of a Web-Based Intervention on Psychosocial Well-Being Among Adults Aged 60 and Older With Diabetes Designing and evaluating a web-based self-management site for patients with type 2 diabetes - systematic website development and study protocol Impact of Community Based Peer Support in Type 2 Diabetes: A Cluster Randomised Controlled Trial of Individual and/or Group Approaches The OnTrack Diabetes Web-Based Program for Type 2 Diabetes and Dysphoria Self-Management: A Randomized Controlled Trial Protocol Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies Web-based cognitive behavioural therapy (W-CBT) for diabetes patients with co-morbid depression: Design of a randomised controlled trial Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice Reducing the psychological distress of family caregivers of home-based palliative care patients: short-term effects from a randomised controlled trial. Web-Based Acceptance and Commitment Therapy for Depressive Symptoms With Minimal Support Happy@Work: protocol for a web-based randomized controlled trial to improve mental well-being among an Asian working population Effectiveness of web-based versus folder support interventions for young informal carers of persons with mental illness: a randomized controlled trial. HeLP-Diabetes: randomised controlled trial protocol Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review A Web-Based Dietary Intervention for People with Type 2 Diabetes: Development, Implementation, and Evaluation Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial
Background Being diagnosed with cancer causes major psychological distress , yet the majority of newly diagnosed cancer patients lack psychological support . Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place . We assess efficacy and feasibility of the first web-based stress management intervention ( STREAM : STREss-Aktiv-Mindern ) for newly diagnosed , German-speaking cancer patients . Methods / design In a prospect i ve , wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and r and omized between an immediate ( intervention group ) or delayed ( control group ) 8-week , web-based intervention . The intervention consists of eight modules with weekly written feedback by a psychologist ( “ minimal-contact ” ) based on well-established stress management manuals including downloadable audio-files and exercises . The aim of this study is to evaluate efficacy in terms of improvement in quality of life ( FACT-F ) , as well as decrease in anxiety and depression ( HADS ) , as compared to patients in the wait-list control group . A sample size of 120 patients allows demonstrating a clinical ly relevant difference of nine points in the FACT score after the intervention ( T2 ) with a two-sided alpha of 0.05 and 80 % power . As this is the first online stress management intervention for German-speaking cancer patients , more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials . These descriptive endpoints include : patients ’ characteristics ( type of cancer , type of treatment , socio-demographic factors ) , dropout rate and dropout reasons , adherence and satisfaction with the program . Discussion New technologies open new opportunities : minimal-contact psychological interventions are becoming st and ard of care in several psychological disorders , where their efficacy is often comparable to face-to-face interventions . With our study we open this field to the population of newly diagnosed cancer patients . We will not only assess clinical efficacy but also further refine the target population who has the most potential to benefit . An internet-based minimal-contact stress management program might be an attractive , time- and cost-effective way to effectively deliver psychological support to newly diagnosed cancer patients and an opportunity to include those who currently are not reached by conventional support . Trial registration Clinical Trials.gov NCT02289014 BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT BACKGROUND Bipolar Disorder ( BD ) is a common and severe form of mental illness . Pharmacotherapy is the main treatment offered , but has limited effectiveness , and there is increasing evidence that people with BD respond well to psychological interventions . Inequalities in access to face-to-face psychological interventions mean many people seek support outside of routine health services . AIM To assess a recovery informed web-based self-management intervention for BD to increase access to psychological support . METHOD A small online r and omised controlled trial ( RCT ) will evaluate the feasibility , acceptability and potential effectiveness of the intervention compared to treatment as usual ( TAU ) .  Feasibility and acceptability will be assessed by recruitment , adherence and dropout rates , website usage statistics , user satisfaction scales and a series of qualitative interviews . Effectiveness will be assessed on a range of outcome measures including quality of life , mood symptoms , coping , recovery , and illness beliefs . ANALYSIS Rates of adherence and dropout will be analysed using logistic regression models with health , socioeconomic and treatment factors as explanatory variables . Changes in quality of life mean scores , contrasting between arms , will be assessed using r and om effects models . An exploratory analysis will be performed on the secondary outcomes . Thematic analysis ( Braun & Clarke , 2006 ) will be used to analyse the qualitative interviews . DISCUSSION The benefits , challenges and method ological challenges of developing a web-based intervention and conducting an RCT online are discussed . CONCLUSION The results of this trial will inform a definitive trial ; and the implementation phase will aim to assess the potential for use within the NHS Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes .  Although national programs exist , there is no EU-wide strategy for diabetes self-management education , and patients with limited literacy face barriers to effective self-management . The Diabetes Literacy project , initiated with the support of the European Commission , aims to fill this gap . The project investigates the effectiveness of diabetes self-management education , targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States , as part of a comprehensive EU-wide diabetes strategy . National diabetes strategies in the EU , US , Taiwan , and Israel are compared , and diabetes self-management programs inventorized . The costs of the diabetes care pathway are assessed on a per person basis at national level . A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support , and the moderating role of health literacy , organization of the health services , and implementation fidelity of education programs are considered . Web-based material s are developed and evaluated by r and omized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy . The 3-year project started in December 2012 . Several literature review s have been produced and protocol development and research design are in the final stages . Primary and secondary data collection and analysis take place in 2014 . The results will inform policy decisions on improving the prevention , treatment , and care for persons with diabetes across literacy levels Purpose The purpose of this study is to investigate the impact of a 6-month Web-based intervention on the psychosocial well-being of older adults with diabetes . Methods This study was a r and omized controlled trial ( N = 62 ) comparing the effects of a 6-month Web-based intervention plus usual care with usual care alone among adults aged 60 years or older with diabetes . The outcomes included quality of life , depression , social support , and self-efficacy . Results The intervention group showed significant improvement , F(4.48 ) = 4.03 P = .007 , when compared with the control group on measures of depression , quality of life , social support , and self-efficacy when controlling for all baseline outcome variables ( age , gender , and number of years with diabetes ) . Conclusions These findings provide support for the conclusion that a Web-based intervention is effective in improving the psychosocial well-being of participants at a 6-month follow-up . Future research needs to investigate the long-term effectiveness of Web-based interventions for sustaining psychosocial well-being , including factors that may affect quality of life , such as diabetes-specific beliefs , attitudes , social support , and disease-specific coping skills Background Given that patients provide the majority of their own diabetes care , patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care . However , participation in self management programs is low . In addition , the efficacy of current behavioural interventions wanes over time , reducing the impact of self-management interventions on patient health . Web-based interventions have the potential to bridge the gaps in diabetes care and self-management . Methods Our objective is to improve self-efficacy , quality of life , self-care , blood pressure , cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention . This study consists of five phases : ( 1 ) intervention development ; ( 2 ) feasibility testing ; ( 3 ) usability testing ; ( 4 ) intervention refinement ; and ( 5 ) intervention evaluation using mixed methods . We will employ evidence -based strategies and tools , using a theoretical framework of self-efficacy , then elicit user feedback through focus groups and individual user testing sessions . Using iterative re design the intervention will be refined . Once finalized , the impact of the website on patient self-efficacy , quality of life , self-care , HbA1c , LDL-cholesterol , blood pressure and weight will be assessed through a non-r and omized observational cohort study using repeated measures modeling and individual interviews . Discussion Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care . However , their full potential is hindered by limited knowledge regarding their effectiveness , poor usability , and high attrition rates . Our development and research agenda aims to address these limitations by improving usability , identifying characteristics associated with website use and attrition , and developing strategies to sustain patient use in order to maximize clinical outcomes BACKGROUND Diabetes peer support , where one person with diabetes helps guide and support others , has been proposed as a way to improve diabetes management . We have tested whether different diabetes peer support strategies can improve metabolic and /or psychological outcomes . METHODS People with type 2 diabetes ( n = 1,299 ) were invited to participate as either '  peer ' or ' peer support facilitator '  ( PSF ) in a 2x2 factorial r and omised cluster controlled trial across rural communities ( 130 clusters ) in Engl and .  Peer support was delivered over 8 - 12 months by trained PSFs , supported by monthly meetings with a diabetes educator . Primary end point was HbA1c . Secondary outcomes included quality of life , diabetes distress , blood pressure , waist , total cholesterol and weight . Outcome assessors and investigators were masked to arm allocation . Main factors were 1:1 or group intervention . Analysis was by intention-to-treat adjusting for baseline . RESULTS The 4 arms were well matched ( Group n = 330 , 1:1(individual ) n = 325 , combined n = 322 , control n = 322 ) ; 1035 ( 79·7 % ) completed the mid-point postal question naire and 1064 ( 81·9 % ) had a final HbA1c . A limitation was that although 92.6 % PSFs and peers were in telephone contact , only 61.4 % of intervention participants attended a face to face session . Mean baseline HbA1c was 57 mmol/mol ( 7·4 % ) , with no significant change across arms . Follow up systolic blood pressure was 2·3 mm Hg ( 0.6 to 4.0 ) lower among those allocated group peer-support and 3·0 mm Hg ( 1.1 to 5.0 ) lower if the group support was attended at least once . There was no impact on other outcomes by intention to treat or significant differences between arms in self-reported adherence or medication . CONCLUSIONS Group diabetes peer support over 8 - 12 months was associated with a small improvement in blood pressure but no other significant outcomes . Long term benefits should be investigated . TRIAL REGISTRATION IS RCT N.com IS RCT N6696362166963621 Background The prevalence of type 2 diabetes is rising with the majority of patients practicing inadequate disease self-management . Depression , anxiety , and diabetes-specific distress present motivational challenges to adequate self-care . Health systems globally struggle to deliver routine services that are accessible to the entire population , in particular in rural areas .  Web-based diabetes self-management interventions can provide frequent , accessible support regardless of time and location Objective This paper describes the protocol of an Australian national r and omized controlled trial ( RCT ) of the OnTrack Diabetes program , an automated , interactive , self-guided Web program aim ed to improve glycemic control , diabetes self-care , and dysphoria symptoms in type 2 diabetes patients . Methods A small pilot trial is conducted that primarily tests program functionality , efficacy , and user acceptability and satisfaction . This is followed by the main RCT , which compares 3 treatments : ( 1 ) delayed program access : usual diabetes care for 3 months postbaseline followed by access to the full OnTrack Diabetes program ; ( 2 ) immediate program : full access to the self-guided program from baseline onward ; and ( 3 ) immediate program plus therapist support via Functional Imagery Training ( FIT ) . Measures are administered at baseline and at 3 , 6 , and 12 months postbaseline . Primary outcomes are diabetes self-care behaviors ( physical activity participation , diet , medication adherence , and blood glucose monitoring ) , glycated hemoglobin A1c ( HbA1c ) level , and diabetes-specific distress . Secondary outcomes are depression , anxiety , self-efficacy and adherence , and quality of life . Exposure data in terms of program uptake , use , time on each page , and program completion , as well as implementation feasibility will be conducted . Results This trial is currently underway with funding support from the Wesley Research Institute in Brisbane , Australia . Conclusions This is the first known trial of an automated , self-guided , Web-based support program that uses a holistic approach in targeting both type 2 diabetes self-management and dysphoria . Findings will inform the feasibility of implementing such a program on an ongoing basis , including in rural and regional locations . Trial Registration Australian and New Zeal and Clinical Trials Registration number : ACTRN12612000620820 ; https://anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12612000620820 ( Archived by WebCite at http://www.webcitation.org/6a3BeXC5 m ) Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes Background Depression is common among people with diabetes , negatively affecting quality of life , treatment adherence and diabetes outcomes . In routine clinical care , diabetes patients have limited access to mental health services and depression therefore often remains untreated . Web-based therapy could potentially be an effective way to improve the reach of psychological care for diabetes patients , at relatively low costs . This study seeks to test the effectiveness of a web-based self-help depression programme for people with diabetes and co-morbid depression . Methods / Design The effectiveness of a web-based self-help course for adults with diabetes with co-morbid depression will be tested in a r and omised trial , using a wait-list controlled design . The intervention consists of an 8-week , moderated self-help course that is tailored to the needs of persons living with diabetes and is offered on an individual basis . Participants receive feedback on their homework assignments by e-mail from their coach .  We aim to include 286 patients ( 143/143 ) , as power analyses showed that this number is needed to detect an effect size of 0.35 , with measurements at baseline , directly after completing the web-based intervention and at 1 , 3 , 4 and 6 months follow-up . Patients in the control condition are placed on a waiting list , and follow the course 12 weeks after r and omisation . Primary outcomes are depressive symptoms and diabetes-specific emotional distress . Secondary outcomes are satisfaction with the course , perceived health status , self-care behaviours , glycaemic control , and days in bed/absence from work . Question naires are administered via the Internet . Discussion The intervention being trialled is expected to help improve mood and reduce diabetes-specific emotional distress in  diabetes patients with depression , with subsequent beneficial effects on diabetes self-care and glycaemic outcomes . When proven efficacious , the intervention could be disseminated to reach large groups of patients with diabetes and concurrent depressive symptoms . Trial registration Current Controlled Trials IS RCT Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence -based , structured capacity . A need exists to better underst and the active components required for effective self-management support , how these might be delivered within primary care , and the training and system changes that would subsequently be needed . Objectives ( 1 ) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual st and ard of care ; and ( 2 ) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting . Method A systematic review of r and omized controlled trials evaluating self-management support interventions was conducted following the Cochrane h and book & PRISMA guidelines . Published literature was systematic ally search ed from inception to June 2019 in PubMed , Scopus and Web of Science . Eligible studies assessed the effectiveness of individualized interventions with follow-up , delivered face-to-face to adult patients with any condition in primary care , compared with usual st and ard of care . Matrices were developed that mapped the evidence and components for each intervention . The method ological quality of included studies were appraised . Results 6,510 records were retrieved . 58 studies were included in the final qualitative synthesis . Findings reveal a structured patient-provider exchange is required in primary care ( including a one-on-one patient-provider consultation , ongoing follow up and provision of self-help material s ) . Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient ’s disease or treatment knowledge ; independent monitoring of symptoms , encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations , psychological coping and stress management strategies , and enhancing responsibility in medication adherence and lifestyle choices . Follow-up may include tailored feedback , monitoring of progress with respect to patient set healthcare goals , or honing problem-solving and decision-making skills . Theoretical models provided a strong base for effective SMS interventions . Positive outcomes for effective SMS included improvements in clinical indicators , health-related quality of life , self-efficacy ( confidence to self-manage ) , disease knowledge or control . An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice . Conclusions These findings provide primary care professionals with evidence -based strategies and structure to deliver SMS in practice . For this collaborative partnership approach to be more widely applied , future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process BACKGROUND Palliative care is expected to incorporate comprehensive support for family caregivers given that many caregivers suffer psychological morbidity . However , systematic ally implemented evidence -based psychological support initiatives are lacking . AIM The objective of this study was to prepare caregivers for the role of supporting a patient with advanced cancer receiving home-based palliative care by offering a one-to-one psycho-educational intervention . We hypothesised that primary family caregivers who participated in the intervention would report decreased psychological distress ( primary outcome ) , fewer unmet needs and increased levels of perceived preparedness , competence and positive emotions . METHODS A three-arm r and omised controlled trial was conducted comparing two versions of the intervention ( one face-to-face visit versus two visits ) plus st and ard care to a control group ( st and ard care ) across four sites in Australia . RESULTS A total of 298 participants were recruited ; 148 were in the Control condition , 57 in Intervention 1 ( one visit ) and 93 in Intervention 2 ( two visits ) . Relative to participants in the control group ; the psychological well-being of participants in the intervention condition was improved by a small amount but non-significantly . No significant reduction in unmet needs or improvements in positive aspects of caregiving amongst the intervention group were identified . However , the intervention demonstrated significant improvements in participants ' levels of preparedness and competence for Intervention 2 . CONCLUSION / IMPLICATION S This research adds to accumulating body of evidence demonstrating that relatively short psycho-educational interventions can enable family caregivers to feel more prepared and competent in the role of supporting a dying relative . Further investigation is required to determine the longer term outcomes of such interventions Low-intensity interventions for people suffering from depressive symptoms are highly desirable . The aim of the present study was to investigate the outcomes of a web-based acceptance and commitment therapy (ACT)–based intervention without face-to-face contact for people suffering from depressive symptoms . Participants ( N = 39 ) with depressive symptoms were r and omly assigned to an Internet-delivered acceptance and commitment therapy ( iACT ) intervention or a waiting list control condition ( WLC ) . Participants were evaluated with st and ardized self-reporting measures ( Beck Depression Inventory [ BDI-II ] , Symptom Checklist–90 [ SCL-90 ] , Acceptance and Action Question naire [ AAQ-2 ] , Five Facet Mindfulness Question naire [ FFMQ ] , Automatic Thoughts Question naire [ ATQ ] , and White Bear Suppression Inventory [ WBSI ] ) at pre- and post-measurement . Long-term effects in the iACT group were examined using a 12-month follow-up . The iACT program comprised home assignments , online feedback given by master’s-level students of psychology over a 7-week intervention period , and automated email-based reminders . Significant effects were observed in favor of the iACT group on depression symptomatology ( between effect sizes [ ESs ] at post-treatment , iACT/WLC , g = .83 ) , psychological and physiological symptoms ( g = .60 ) , psychological flexibility ( g = .67 ) , mindfulness skills ( g = .53 ) , and frequency of automatic thoughts ( g = .57 ) as well as thought suppression ( g = .53 ) . The treatment effects in the iACT group were maintained over the 12-month follow-up period ( within-iACT ES : BDI-II , g = 1.33 ; SCL-90 , g = 1.04 ; ATQF/B [ Frequency/Believability ] , FFMQ , WBSI , AAQ-II , g = .74 - 1.08 ) . The iACT participants stated that they would be happy to recommend the same intervention to others with depressive symptoms . We conclude that an ACT-based guided Internet-delivered treatment with minimal contact can be effective for people with depressive symptoms Background Mental health issues pose a serious concern in the workplace for the huge productivity loss and financial burden associated with it . Unlike the traditional ‘ fixing-what-is-wrong ’ approach , positive psychology offers a less-stigmatized way to promote mental health . Psychological capital , a concept originated from positive psychology , has been proven effective in improving mental well-being and work performance . However , little evidence exists for its implementation among Asian working population or its cost-benefit for organizations adopting such promotion strategy . The current study is design ed to assess the protective effects of a web-based psychology capital intervention among Hong Kong working population on individuals ’ mental health and work performance , as well as organizations ’ return-on-investment . Methods / Design A two-arm r and omized controlled trial design will be adopted . Eligible working adults will be r and omly allocated to either the intervention group or the waiting-list control group , with 177 participants in each arm . The intervention , which consists of four web-based training sessions , each targeting one of the psychological capital components ( hope , efficacy , optimism and resilience ) , will be implemented over a 4-week period . On-line surveys will assess the participants in each group at baseline , intervention completion , 1 and 3 months after the completion . The primary outcome is individuals ’ psychological capital level ; secondary outcomes include individuals ’ well-being , depressive symptoms , work engagement and productivity . Return-on-investment will be calculated from the employers ’ perspective based on productivity gain , savings in medical expenditure , as well as operation and time costs . Analysis will follow the intention-to-treat principle . Discussion This is the first experimental study that explores the applicability of psychological capital development among Asian population . Through investigating changes in individuals ’ work productivity from absenteeism and presenteeism , this will be one of the few studies that quantify productivity gains from any type of mental health promotion . By demonstrating effectiveness in improving mental well-being and a positive return-on-investment rate , the study may help convince more uptake of similar positive psychology interventions at workplace in Asia and elsewhere . Trail Registration Number ( assigned by Centre for Clinical Trials , Clinical Trials Registry , The Chinese University of Hong Kong ) : CUHK_CCT00396 . Registration Date : OBJECTIVE Compare the impact of two interventions , a web-based support and a folder support , for young persons who care for people who suffer from mental illness . METHODS This study was a r and omized control trial , following the CONSORT statements , which compared the impact of two interventions . Primary outcome variable was stress , and secondary outcome variables were caring situation , general self-efficacy , well-being , health , and quality of life of young informal carers ( N=241 ) . Data were collected in June 2010 to April 2011 , with self- assessment question naires , comparing the two interventions and also to detect changes . RESULTS The stress levels were high in both groups at baseline , but decreased in the folder group . The folder group had improvement in their caring situation ( also different from the web group ) , general self-efficacy , well-being , and quality of life . The web group showed increase in well-being . CONCLUSION Young informal carers who take on the responsibility for people close to them ; suffer consequences on their own health . They live in a life-situation characterized by high stress and low well-being . This signals a need for support . PRACTICE IMPLICATION S The non-significant differences show that each intervention can be effective , and that it depends upon the individual 's preferences . This highlights the importance of adopting person-centered approach , in which young persons can themselves choose support strategy Background Type 2 Diabetes Mellitus ( T2DM ) is common , affecting nearly 400 million people worldwide . Achieving good health for people with T2DM requires active self-management ; however , uptake of self-management education is poor , and there is an urgent need to find better , more acceptable , cost-effective methods of providing self-management support . Web-based self-management support has many potential benefits for patients and health services . The aim of this trial is to determine the effectiveness and cost-effectiveness of a web-based self-management support programme for people with T2DM . Methods This will be a multi-centre individually r and omised controlled trial in primary care , recruiting adults with T2DM who are registered with participating general practice s in Engl and . Participants will be r and omised to receive either an evidence -based , theoretically informed , web-based self-management programme for people with T2DM which addresses medical , emotional , and role management , called Healthy Living for People with type 2 Diabetes ( HeLP-Diabetes ) or a simple information website . The joint primary outcomes are glycated haemoglobin ( HbA1c ) and diabetes-related distress , measured by the Problem Areas In Diabetes ( PAID ) question naire . Secondary outcomes include cardiovascular risk factors , depression and anxiety , and self-efficacy for self-management of diabetes . Health economic data include health service use , costs due to the intervention , and EQ-5D for calculation of Quality Adjusted Life Years ( QALYS ) . Data will be collected at baseline , 3 months and 12 months , with the primary endpoint at 12 months . Practice nurses , blinded to patient allocation , collect clinical data ; patients complete online question naires for patient reported measures . A sample size of 350 recruited participants allows for attrition of up to 15 % and will provide 90 % power of detecting at a 5 % significance level a true average difference in the PAID score of 4.0 and 0.25 % change in HbA1c ( both small effect sizes ) . The analysis will follow a pre-specified analysis plan , based on comparing the groups as r and omised ( intention-to-treat ) . Discussion The findings of this trial are likely to be of interest to policy makers , clinicians , and commissioners , all of whom are actively seeking additional forms of self-management support for people with T2DM.Trial registration The Trial Registration number is IS RCT N02123133 ; date of registration 14.2.13 OBJECTIVES The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . INCLUSION CRITERIA Types of participants Adult caregivers who provide support for people with dementia living in the community ( non-institutional care).Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta-analyses , systematic review s , r and omised control trials , quasi-experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . SEARCH STRATEGY The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . ASSESSMENT OF QUALITY Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . DATA COLLECTION AND ANALYSIS St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta- analysis . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . RESULTS A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty-five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta- analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta- analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well-being , self-efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta- analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . EFFECTIVENESS OF INTERVENTION TYPE Four categories of intervention were included in the review - psycho-educational , support , multi-component and other . Psycho-educational Thirteen studies used  psycho-educational interventions  , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta- analysis . No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being , self-efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta- analysis and demonstrated a small but significant improvement on caregiver burden . Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy , depression , subjective well-being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta- analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits . Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . EFFECTIVENESS OF INTERVENTIONS USING SPECIFIC OUTCOME CATEGORIES In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on caregiver depression was available for meta- analysis from eight studies . This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta- analysis and findings indicated that there were no significant effects of any of interventions . No meta- analysis was possible for the outcome categories of health , self-efficacy or subjective well-being . IMPLICATION S FOR PRACTICE From this review there is evidence to support the use of well- design ed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Factors which do not appear to have benefit in interventions are those which PURPOSE This report up date s the Cancer Care Ontario Program in Evidence -Based Care guideline for the management of  depression in adult patients with cancer . This guideline covers pharmacologic , psychological , and collaborative care interventions , with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer . METHODS Recommendations were developed by synthesizing information from extant guidelines and review s and search ing for r and omized controlled trials from the date of data base inception ( 1964 for MEDLINE and 1974 for EMBASE ) to January 2015 . Quality assessment of guidelines and systematic review s were conducted by using the Appraisal of Guidelines for Research and Evaluation II ( AGREE II ) , Assessment of Multiple Systematic Review s ( AMSTAR ) , and Cochrane Risk of Bias tools . Final recommendations were developed through a st and ardized Program in Evidence -Based Care multidisciplinary expert and knowledge user review process . RESULTS Two high- quality relevant clinical practice guidelines , eight pharmacologic trials , nine psychological trials , and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed . Eight specific recommendations were made to establish a st and ard of care for the management of depression in patients with cancer . The recommendations and practical management tools were review ed as being well organized and helpful , although systemic barriers to implementation were identified . CONCLUSION This up date d guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and /or pharmacologic interventions , without evidence for the superiority of any specific treatment over another . New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community ( non‐institutional care ) . Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team ‐ for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta‐analyses , systematic review s , r and omised control trials , quasi‐experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . Assessment of quality Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . Data collection and analysis St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta‐ analysis . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . Results A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty‐five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta‐ analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta‐ analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well‐being , self‐efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta‐ analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . Effectiveness of intervention type Four categories of intervention were included in the review ‐ psycho‐educational , support , multi‐component and other . Psycho‐educational Thirteen studies used  psycho‐educational interventions , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta‐ analysis . No significant impact of psycho‐educational interventions was found for the outcome categories of subjective well‐being , self‐efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta‐ analysis and demonstrated a small but significant improvement on caregiver burden . Multi‐component Twelve of the studies report multi‐component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self‐efficacy , depression , subjective well‐being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta‐ analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits .  Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on  caregiver depression was available for meta‐ analysis from eight studies . This indicated that multi‐component and psycho‐educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta‐ analysis and findings indicated that there were no significant effects of any of interventions . No meta‐ analysis was possible for the outcome categories of health , self‐efficacy or subjective well‐being . Implication s for practice From this review there is evidence to support the use of well‐ design ed psycho‐educational or multi‐component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved Encourage active participation in educational interventions for caregivers Offer individualised programs rather than group sessions Provide information on an ongoing basis , with specific information about services and coaching regarding their new role Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which : Simply refer caregivers to support groups Only provide self help material s Only offer peer Background Diabetes is becoming a very important health issue in rapidly developing nations and there is an urgent need to improve overall diabetes self-management education in these countries . Although e-health is an emerging theme , only a few successful web-based studies on diabetes self-management have been reported . Purpose We describe the development , implementation , and process evaluation of an Internet-delivered dietary intervention program ( myDIDeA ) for diabetic patients in a developing country . MethodS pecific dietary components to be included in the intervention module were first identified through a comprehensive review of literature and guidelines . The lesson plans and the study website were then developed based on the evidence , Transtheoretical Model ’s Stages of Change and user-centered design approach . Finally , the effectiveness of the website was tested through a r and omized-controlled trial to promote dietary change in patients with type 2 diabetes . The participants in the intervention group ( n = 66 ) were given access to myDIDeA for 6 months . Process evaluation in form of intervention adherence and program reception were conducted at post intervention . Results The response rate for the process evaluation was 89 % . On average , each participant logged in at least once for each lesson plan and spent almost 12 min on the site . The participants ’ content satisfaction , acceptability , and usability scores were satisfactory . The primary outcome of the trial , Dietary Knowledge , Attitude , and Behavior score was strongly correlated with content satisfaction ( r = 0.826 , p < 0.001 ) , acceptability ( r = 0.793 , p < 0.001 ) and usability of the website ( r = 0.724 , p < 0.001 ) , and moderately correlated with frequency of log-in ( r = 0.501 , p < 0.05 ) and duration spent in the website ( r = 0.399 , p < 0.05 ) . Conclusion The process evaluation of myDIDeA demonstrates its feasibility , and future studies should identify the possibility of extending the use of Internet-based intervention programs to other health behaviors and issues related to self-management of chronic conditions . In addition , interactivity , peer support via social media , and other means to stimulate the interest of participants can be explored Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration Background Many type 2 diabetes mellitus patients face difficulties self-managing their illness , which can lead to high levels of diabetes-related distress . Diabetes distress may be decreased by peer support , as peers underst and and have dealt with similar problems , and can help motivate each other . A recent systematic review concluded that evidence of benefits of peer support in patients with type 2 diabetes mellitus is too inconsistent due to weak theoretical foundation of the interventions . This study describes the design of a trial evaluating the effectiveness of a group-based , peer support programme with a strong theoretical foundation on diabetes-related distress in type 2 diabetes patients . Methods This is a parallel group r and omised controlled trial of a six session group-based peer support intervention , delivered by peer leaders and group psychotherapists , compared with one educational meeting on diabetes .  At least 152 patients with a type 2 diabetes duration of three years or more and between 50 and 70 years of age , recruited via their general practitioner , will be r and omised to receive the peer support intervention or one educational meeting . The intervention is developed in line with three key stages of research development of the Medical Research Council framework . The primary outcome measure for this study is diabetes-related distress . Secondary outcomes include self-management behaviour , well-being and health-related quality of life . Perceived social support is a process measure . Outcomes will be measured one month before , and 6 , and 12 months after the intervention by means of self-reported question naires . Analysis will be on an intention-to-treat basis . Discussion This article contains a description of the design of a study that will investigate the effect of a group-based , peer support intervention on diabetes-related distress in type 2 diabetes patients . The intervention was developed in recognition of the limited evidence , and the importance of a theoretical foundation and its implementation . Findings will contribute to knowledge in the field of peer support and patient-important outcomes in type 2 diabetes patients .Trial registration Dutch Trial Registry :
Interventions with a duration of 2 - 6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes .
While the meta-analyses demonstrated nonsignificant results for depression and distress scores , this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes .
BACKGROUND Poor diabetes self-care can have a negative impact on psychological well-being and quality of life .
Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs , Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions .
However , there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes .
OBJECTIVE This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes .