Psychosocial treatment programs for people with both severe mental illness and substance misuse. Effects of an Oral Health Promotion Program in People with Mental Illness Predictors of levels of functioning among Chinese people with severe mental illness: a 12-month prospective cohort study. Enhancing health literacy and behavioural change within a tele‐care education and support intervention for people with type 2 diabetes Bespoke smoking cessation for people with severe mental ill health (SCIMITAR): a pilot randomised controlled trial. Approach to treatment of mental illness and substance dependence in remote Indigenous communities: results of a mixed methods study. Outcomes of a Randomized Small-Group HIV Prevention Intervention Trial for People with Serious Mental Illness A Qualitative Study of Client–Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use Effects of self-monitoring of glucose in non-insulin treated patients with type 2 diabetes: design of the IN CONTROL-trial Self-efficacy, outcome expectations and self-care behaviour in people with type 2 diabetes in Taiwan. The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care Prevalence of Mental Illness among Homeless People in Hong Kong A randomized, controlled trial of a community-based support program for families of children with chronic illness: pediatric outcomes. A Controlled Trial of Supported Employment for People With Severe Mental Illness and Justice Involvement. Neuropsychological profiles of young people with type 1 diabetes 12 yr after disease onset. The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study Peer support to decrease diabetes-related distress in patients with type 2 diabetes mellitus: design of a randomised controlled trial People living with psychotic illness in 2010: The second Australian national survey of psychosis Smoking Cessation Intervention for severe Mental Ill Health Trial (SCIMITAR): a pilot randomised control trial of the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation service. Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes. Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial. Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease A Randomized-Controlled, Pilot Intervention on Diabetes Prevention and Healthy Lifestyles in the New York City Korean Community The 6‐month effectiveness of Internet‐based guided self‐help for depression in adults with Type 1 and 2 diabetes mellitus Behavioural interventions for type 2 diabetes: an evidence-based analysis. Group Visits for Hmong Adults with Type 2 Diabetes Mellitus: A Pre-Post Analysis A multi-site randomised controlled trial of evidence-based supported employment for adults with severe and persistent mental illness. Nurse Case Management To Improve Glycemic Control in Diabetic Patients in a Health Maintenance Organization Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial A study protocol for a pilot randomised trial of a structured education programme for the self-management of Type 2 diabetes for adults with intellectual disabilities
Over 50 % of people with a severe mental illness also use illicit drugs and /or alcohol at hazardous levels . This review is based on the findings of 25 r and omized controlled trials which assessed the effectiveness of  psychosocial interventions , offered either as one-off treatments or as an integrated or nonintegrated program , to reduce substance use by people with a severe mental illness . The findings showed that there was no consistent evidence to support any one psychosocial treatment over another . Differences across trials with regard to outcome measures , sample characteristics , type of mental illness and substance used , setting s , levels of adherence to treatment guidelines , and st and ard care all made pooling results difficult . More quality trials are required that adhere to proper r and omization methods ; use clinical ly valuable , reliable , and vali date d measurement scales ; and clearly report data , including retention in treatment , relapse , and abstinence rates . Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions  for reducing substance use in this challenging population More knowledge is needed regarding what works to prevent oral health problems and reduce disparities in oral health . Motivational interviewing ( MI ) has demonstrated utility for improving health behavior , including among those with severe mental illness . This study tests whether MI enhances the efficacy of an oral health education intervention in individuals with severe mental illness . Sixty individuals were r and omly assigned to MI plus oral health education or oral health education alone .  Plaque scores , oral health knowledge , and self-regulation were assessed at baseline and at 4 and 8 weeks . Repeated- measures ANOVA showed improvement ( p < 0.05 ) in plaque , autonomous regulation , and oral health knowledge across time for both groups ; however , individuals receiving MI improved significantly more when compared with those receiving oral health education alone . Results suggest that MI is effective for enhancing short-term oral health behavior change for people with severe mental illness and may be useful for the general population AIM AND OBJECTIVES The aim of the study was to identify the predictors of functioning in Chinese people with serious mental illness . BACKGROUND Mental healthcare services for people suffering from serious mental illness are delivered to not only minimise their psychiatric symptoms but also enhance their levels of functioning in the community . Yet , there is insufficient research directed towards the associated or predictive factors that may influence different aspects of functioning , particularly in terms of patients ' psychosocial variables . DESIGN A longitudinal , prospect i ve cohort study design was adopted . METHODS A clustered r and om sample of 395 of 611 out patients with serious mental illness completed the same set of question naires at baseline and at 12 months . Changes in patients ' functioning as measured by self-maintenance , social functioning and community living skills were recorded over 12 months . Potential relationships between their level of functioning and symptom severity , self-esteem , self-efficacy , perceived negative familial response , negative self-stigma towards mental illness , re-hospitalisation rate and socio-demographic characteristics were investigated . RESULTS Most participants reported moderate to moderately high levels of overall functioning , self-efficacy , self-stigma and perceived negative familial response at baseline and there were significant observed correlations between these variables . Results of multiple regression models indicated that while symptom severity predicted functioning in patients with psychotic and affective disorders , a negatively perceived familial response only predicted negative changes in social functioning of the patients with psychotic disorders ( β = -0·25 ) . In addition , improvements in self-efficacy ( β = 0·23 ) and reduction in self-stigma ( β = -0·15 ) positively predicted changes in the community living skills of patients with affective disorders . CONCLUSION The findings indicate the significance of psychiatric patients ' symptom management and factors such as self-efficacy and self-stigma to predict their functioning over a 12-month follow-up . RELEVANCE TO CLINICAL PRACTICE Mental healthcare services should consider giving priority to self-stigma reduction and empowerment to manage illness especially in this population of patients and their families , thus effectively enhancing their self-care ability to cope with their illness and /or difficult life situations Abstract Background Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making . Health literacy provides an additional , potentially powerful explanatory framework to guide research and practice . Objective To examine the changes in the depth and detail of diabetes‐related knowledge and confidence for persons with type 2 diabetes . Design Two‐year , prospect i ve , observational study , using question naire data at two time points ( baseline and 2 years later ) and in‐depth interviews with a theoretically selected sub sample . Setting and participants A total of 319 patients initially recruited from a deprived urban area in north‐west Engl and Intervention Dedicated tele‐carer education and support , tailored to the individual circumstances of the patient . Main outcome measures Perceptions of confidence , levels of empowerment , learning for self‐care and most helpful aspects of the intervention . Results Over 90 % expressed confidence in keeping their blood sugar controlled , and high levels of perceived empowerment ( mean = 4.25 ; 95 % CI , 4.17–4.33 ) were found . Changes in the depth and detail of diabetes‐related knowledge and confidence , from the specific to the more general , were observed and enhanced competence in translating knowledge into practice . Discussion and conclusions The intervention , built within a developed working partnership between tele‐carer and patient , operated at two levels : health literacy , enhancing knowledge , developing personal skills and enabling self‐control ; and socio‐psychological behavioural change , tailored to individuals within their socio‐economic environments , enabling increased motivation and supportive problem‐solving . Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data BACKGROUND People with severe mental ill health are three times more likely to smoke but typically do not access conventional smoking cessation services , contributing to widening health inequalities and reduced life expectancy . We aim ed to pilot an intervention targeted at smokers with severe mental ill health and to test methods of recruitment , r and omisation , and follow up before implementing a full trial . METHODS The Smoking Cessation Intervention for Severe Mental Ill Health Trial ( SCIMITAR ) is a pilot r and omised controlled trial of a smoking cessation strategy design ed specifically for people with severe mental ill health , to be delivered by mental health nurses and consisting of behavioural support and drugs , compared with a conventional smoking cessation service ( ie , usual care ) . Adults ( aged 18 years or older ) with bipolar disorder or schizophrenia , who were current smokers , were recruited from NHS primary care and mental health setting s in the UK ( York , Scarborough , Hull , and Manchester ) . Eligible participants were r and omly allocated to either usual care ( control group ) or usual care plus the bespoke smoking cessation strategy ( intervention group ) . R and omisation was done via a central telephone system , with computer-generated r and om numbers . We could not mask participants , family doctors , and research ers to the treatment allocation . Our primary outcome was smoking status at 12 months , verified by carbon monoxide measurements or self-report . Only participants who provided an exhaled CO measurement or self-reported their smoking status at 12 months were included in the primary analysis . The trial is registered at IS RCT N.com , number IS RCT N79497236 . FINDINGS Of 97 people recruited to the pilot study , 51 were r and omly allocated to the control group and 46 were assigned to the intervention group . Participants engaged well with the bespoke smoking cessation strategy , but no individuals assigned to usual care accessed NHS smoking cessation services . At 12 months , 35 ( 69 % ) controls and 33 ( 72 % ) people assigned to the intervention group provided a CO measurement or self-reported their smoking status . Smoking cessation was highest among individuals who received the bespoke intervention ( 12/33 [ 36 % ] vs 8/35 [ 23 % ] ; adjusted odds ratio 2·9 , 95 % CI 0·8 - 10·5 ) . INTERPRETATION We have shown the feasibility of recruiting and r and omising people with severe mental ill health in a trial of this nature . The level of engagement with a bespoke smoking cessation strategy was higher than with a conventional approach . The effectiveness and safety of a smoking cessation programme design ed particularly for people with severe mental ill health should be tested in a fully powered r and omised controlled trial . FUNDING National Institute of Health Research Health Technology Assessment Programme OBJECTIVE To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness . DESIGN A mixed methods design in which an exploratory phase of qualitative research was followed by a nested r and omised controlled trial . SETTING Psycho-education re sources and a brief intervention , motivational care planning ( MCP ) , were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia . PARTICIPANTS A total of 49 patients with mental illness and 37 carers were recruited to a r and omised controlled trial that compared MCP ( n = 24 ) with a clinical control condition ( treatment as usual , n = 25 ) . INTERVENTION The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months . MAIN OUTCOME MEASURES The primary outcome was mental health problem severity as measured by the health of the nation outcome scales . Secondary measures of well-being ( Kessler 10 ) , life skills , self-management and substance dependence were chosen . Outcome assessment s were performed at baseline , six-month , 12-month and 18-month follow up . RESULTS R and om effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales ( P < 0.001 ) and Kessler 10 ( P = 0.001 ) , which were sustained over time . There was also significant advantage for treatment for alcohol dependence ( P = 0.05 ) , with response also evident in cannabis dependence ( P = 0.064 ) and with changes in substance dependence sustained over time . CONCLUSIONS These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities HIV prevalence is alarmingly high among persons with serious mental illness and severely mentally ill adults frequently engage in high-risk behavior practice s. This study evaluated the effectiveness of a small-group HIV risk reduction intervention offered to 189 men and women in outpatient programs for severely mentally ill adults . Participants screened for HIV risk were r and omly assigned to attend either a 7-session small-group cognitive-behavioral HIV risk reduction intervention or a time-matched comparison intervention and were followed at 3-month intervals for one year . Participants who attended the HIV risk reduction intervention increased their condom use , had a higher percentage of intercourse occasions protected by condoms , and held more positive attitudes toward condoms . Women showed greater response to the intervention than men . While many behavior change effects were present at 3- , 6- and 9-month followup assessment s , most diminished by the 12-month followup . These results underscore the need for tailored but ongoing HIV prevention efforts integrated into community programs that serve people with serious mental illness abstract Objective : Mobile health ( mHealth ) approaches have the potential to transform prevention , wellness , and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients ' natural environments . However , little is known about how clients interact with mHealth interventions to manage their illness . This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges . Methods : Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management . The clinician ( i.e. , mobile interventionist ) sent daily text messages to participants ' privately owned mobile phones to assess their medication adherence and clinical status . The clinician provided other illness management and wellness suggestions flexibly , in response to participants ' needs and preferences . In this qualitative study we conducted a thematic analysis of the client – clinician text exchanges that occurred over the course of the intervention . Results : Seven major content themes in client – clinician text message exchanges were identified : mental health symptoms ; mental health coping strategies ; mental health treatment and management ; lifestyle behaviors ; social relationships and leisure activities ; motivation and personal goal setting ; and independent living . Participants were interested in discussing strategies for coping with mental health symptoms ( e.g. , cognitive restructuring , social support ) and health behavior change ( e.g. , increased physical activity , dietary changes ) . Conclusions : Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis . This approach is able to offer coping strategies that are tailored to clients ' needs and preferences in real time when help is needed Background Diabetes specific emotional problems interfere with the dem and ing daily management of living with type 2 diabetes mellitus ( T2DM ) . Possibly , offering direct feedback on diabetes management may diminish the presence of diabetes specific emotional problems and might enhance the patients ' belief they are able to manage their illness . It is hypothesized that self-monitoring of glucose in combination with an algorithm how and when to act will motivate T2DM patients to become more active participants in their own care leading to a decrease in diabetes related distress and an increased self-efficacy . Methods and design Six hundred patients with T2DM ( 45 ≤ 75 years ) who receive care in a structured diabetes care system , HbA1c ≥ 7.0 % , and not using insulin  will be recruited and r and omized into 3 groups ; Self-monitoring of Blood Glucose ( SMBG ) , Self-monitoring of Urine Glucose ( SMUG ) and usual care ( n = 200 per group ) . Participants are eligible if they have a known disease duration of over 1 year and have used SMBG or SMUG less than 3 times in the previous year . All 3 groups will receive st and ardized diabetes care . The intervention groups will receive additional instructions on how to perform self-monitoring of glucose and how to interpret the results . Main outcome measures are changes in diabetes specific emotional distress and self-efficacy . Secondary outcome measures include difference in HbA1c , patient satisfaction , occurrence of hypoglycaemia , physical activity , costs of direct and indirect healthcare and changes in illness beliefs . Discussion The IN CONTROL-trial is design ed to explore whether feedback from self-monitoring of glucose in T2DM patients who do not require insulin can affect diabetes specific emotional distress and increase self-efficacy . Based on the self-regulation model it is hypothesized that glucose self-monitoring feedback changes illness perceptions , guiding the patient to reduce emotional responses to experienced threats , and influences the patients ability to perform and maintain self-management skills . Trial registration Current Controlled Trials IS RCT AIMS To explore differences in self-care behaviour according to demographic and illness characteristics ; and relationships among self-care behaviour and demographic and illness characteristics , efficacy expectations and outcome expectations of people with type 2 diabetes in Taiwan . BACKGROUND Most people with diabetes do not control their disease appropriately in Taiwan . Enhanced self-efficacy towards managing diseases can be an effective way of improving disease control as proposed by the self-efficacy model which provides a useful framework for underst and ing adherence to self-care behaviours . DESIGN AND METHODS The sample comprised 145 patients with type 2 diabetes aged 30 years or more from diabetes outpatient clinics in Taipei . Data were collected using a self-administered question naire for this study . One-way anova , t-tests , Pearson product moment correlation and hierarchical regression were analysed for the study . RESULTS Significant differences were found : between self-care behaviour and complications ( t = -2.52 , p < 0.01 ) and patient education ( t = -1.96 , p < 0.05 ) . Self-care behaviour was significantly and positively correlated with duration of diabetes ( r = 0.36 , p < 0.01 ) , efficacy expectations ( r = 0.54 , p < 0.01 ) and outcome expectations ( r = 0.44 , p < 0.01 ) . A total of 39.1 % of variance in self-care behaviour can be explained by duration of diabetes , efficacy expectations and outcome expectations . CONCLUSIONS Findings support the use of the self-efficacy model as a framework for underst and ing adherence to self-care behaviour . RELEVANCE TO CLINICAL PRACTICE Using self-efficacy theory when design ing patient education interventions for people with type 2 diabetes will enhance self-management routines and assist in reducing major complications in the future Context Many patients have both diabetes and depression . Some hypothesize that treating depression might improve diabetes outcomes . Contribution In this r and omized trial , 12 months of depression care management for depressed patients with diabetes improved depression-related outcomes and increased the frequency of exercise . However , care management did not affect diet , diabetes medication adherence , glucose testing , or glycemic control . Caution s The study sample had reasonably good diabetes control at baseline . Whether patients with poorly controlled diabetes would benefit from depression care is not known . The Editors Major depression and dysthymic disorder affect 5 % to 10 % of older adults seen in primary care setting s ( 1 - 3 ) .  Late-life depression  is often chronic or recurrent ( 4 - 6 ) and is associated with substantial suffering , functional impairment , and diminished health-related quality of life ( 7 ) . Diabetes mellitus affects 7.8 % of all adults and almost 1 in 5 of those age 60 years and older ( 8) . Individuals with diabetes mellitus have a 2-fold higher rate of major depression than those without diabetes ( 9 , 10 ) . Depression adversely affects the course of coexisting medical illness , contributing to increased symptom burden , functional impairment , and mortality ( 11 , 12 ) . For patients with diabetes mellitus , depression is associated with decreased glycemic control and increased number of micro- and macrovascular complications ( 13 , 14 ) . The mechanism of effect is not understood but may be related to depression-induced abnormalities in neuroendocrine and neurotransmitter function or decreased self-care behaviors ( 15 - 20 ) . Integrating evidence -based depression care for persons with diabetes may improve both depression and diabetes outcomes . Three small r and omized , controlled trials have studied the effect of treatment for  depression on affective and glycemic outcomes in patients with depression and diabetes mellitus ( 21 - 23 ) . These studies have consistently shown improvements in affective outcomes , but effects on glycemic control have been mixed . Primary care physicians are well positioned to provide integrated care for depression and diabetes mellitus but face many barriers . Controlled trials report that  treatment for depression  is efficacious in approximately 70 % of persons who complete treatment compared with 30 % of those who receive placebo ( 24 ) . However , these results are difficult to replicate in routine primary care practice . Barriers to high- quality care include suboptimal recognition ; inconsistent treatment with lack of close follow-up and monitoring ; and organizational barriers , such as brief visits , poor integration with specialty mental health care , competing clinical priorities , and lack of decision support systems ( 25 - 27 ) . Simple interventions , such as depression screening and physician education , have little impact on these barriers and patient outcomes ( 28 - 30 ) . Treatment models that use a depression specialist working collaboratively with primary care physicians have shown clinical ly important improvement in patient outcomes ( 31 - 37 ) . We recently reported robust effects of such a model for older adults with major depression or dysthymia ( 37 ) . In this preplanned analysis , we evaluate the effects on affective and diabetes-specific outcomes . If effective care for depression also benefits adherence to self-care regimens , functional status , and other medical illness outcomes , it would add powerful quality -of-care and economic incentives for the dissemination and maintenance of these models . In addition , if effective care for depression improves self-care behaviors , it may also positively affect other chronic medical illnesses with important self-care components . For this prespecified subgroup analysis , we focused on older adults with clinical depression and coexisting diabetes mellitus . We hypothesized that the collaborative care intervention would improve affective symptoms , functional status , self-care behaviors , and glycemic control . In addition , we hypothesized that effects on glycemic control would be greatest for patients with baseline hemoglobin A1c values of 8.0 % or greater . Methods The Improving MoodPromoting Access to Collaborative Treatment ( IMPACT ) study is a multisite r and omized , controlled trial of a collaborative care intervention program for late-life depression in primary care ( 37 , 38 ) . Institutional review boards at participating sites approved study protocol s , and all participants gave written informed consent . Patients Seven study sites representing 8 diverse health care organizations with a total of 18 primary care clinics in 5 states participated in the study . From July 1999 to August 2001 , depressed older adults were recruited through referrals from primary care practitioners and other clinic staff or through systematic depression screening with a 2-item depression screener adapted from the Primary Care Evaluation of Mental Disorders ( 39 ) . Of the 2190 patients referred to the study , 308 ( 14 % ) declined the initial eligibility screening or additional interviews , 54 ( 3 % ) had incomplete initial screenings , and 202 ( 9 % ) were ineligible because they were younger than 60 years of age or they did not plan to use the participating clinic over the coming 12 months . Of the 32908 patients approached for screening , 5246 ( 16 % ) declined the initial screening or follow-up interviews . A total of 1791 ( 5 % ) of the initial screenings were incomplete and 23233 ( 71 % ) of those screened were not eligible because they did not have one of the core depression symptoms ( 95 % ) or because of logistic reasons such as lack of transportation or access to a telephone ( 5 % ) . The remaining 1626 ( 74 % ) of those referred and 2638 ( 8 % ) of those screened completed a computer-assisted structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , to assess whether patients met research diagnostic criteria for major depression or dysthymia ( 40 ) . Inclusion criteria were age 60 years or older , plans to use one of the participating clinics as the main source of general medical care in the coming year , and a diagnosis of current major depression or dysthymic disorder according to the structured clinical interview for DSM-IV . Otherwise eligible persons were excluded because of a current drinking problem ( a score of 2 on the CAGE question naire ) ( 41 ) , a history of bipolar disorder or psychosis ( 38 ) , ongoing treatment with a psychiatrist , or severe cognitive impairment defined by a score less than 3 on a 6-item cognitive screener ( 42 ) . We identified 2102 eligible older adults with major depression or dysthymic disorder , of whom 1801 ( 86 % ) enrolled in the study . As part of the structured baseline interview , enrolled patients were asked Has a doctor or another health care worker diagnosed you with or treated you for high blood sugar or diabetes in the past 3 years ? The 417 patients who endorsed this question are the focus of the diabetes-specific analyses . After the baseline interview , we r and omly assigned participants to the IMPACT intervention or usual care . The r and omization was stratified by recruitment method ( screening or referral ) and clinic . R and omization information was contained in a set of numbered , sealed envelopes for each stratum that were used sequentially for newly enrolled patients at each clinic ( 38 ) . Diagnoses were communicated to enrolled patients and their primary care physicians . Intervention Patients in the intervention group received a 20-minute educational videotape and a booklet about late-life depression and were encouraged to have an initial visit with a depression care manager at the primary care clinic ( 43 , 44 ) . Care managers were nurses or psychologists who were trained for the study as a depression clinical specialist ( 38 , 45 ) . During the initial visit , the depression clinical specialist conducted a clinical and psychosocial history , review ed the educational material s , and discussed patient preferences for  depression treatment ( antidepressant medications or psychotherapy ) . New patients and patients needing treatment plan adjustments were discussed with a supervising team psychiatrist and a liaison primary care physician during a weekly team meeting . The depression clinical specialist then worked with the patient and his or her regular primary care provider to establish a treatment plan according to an evidence -based treatment algorithm ( 38 ) . The IMPACT algorithm suggested an initial choice of an antidepressant ( usually a selective serotonin reuptake inhibitor ) or a course of Problem-Solving Treatment in Primary Care ( PST-PC ) , which consisted of 6 to 8 brief sessions of structured psychotherapy for depression , delivered by the depression clinical specialist in primary care ( 46 - 49 ) . For patients who were already receiving antidepressant medications but who were still depressed , the recommendation for partial responders was to increase the dose or augment the antidepressant with a trial of PSTPC ; the recommendation for nonresponders was to switch to a different medication or use a trial of PSTPC . Depression clinical specialists also encouraged patients to increase behavioral activation and referred them to additional health or social services , as clinical ly indicated . The intervention did not specifically address diabetes mellitus or other coexisting medical illnesses . As care managers , depression clinical specialists attempted to follow patients for up to 12 months ; they monitored treatment response with the Primary Care Evaluation of Mental Disorders Patient Health Question naire ( 50 ) and a Web-based clinical information system ( 51 ) . During the acute treatment phase , in-person or telephone follow-up contacts were suggested at least every other week . Patients who recovered from depression ( 50 % reduction in the Patient Health Question naire score and <3 of 9 symptoms of major depression ) were engaged in developing a relapse prevention plan and were then Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years . Design Three year follow-up of a multicentre cluster r and omised controlled trial in primary care , with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 731 of the 824 participants included in the original trial were eligible for follow-up . Biomedical data were collected on 604 ( 82.6 % ) and question naire data on 513 ( 70.1 % ) participants . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) levels . The secondary outcomes were blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , emotional impact of diabetes , and drug use at three years . Results HbA1c levels at three years had decreased in both groups . After adjusting for baseline and cluster the difference was not significant ( difference −0.02 , 95 % confidence interval −0.22 to 0.17 ) . The groups did not differ for the other biomedical and lifestyle outcomes and drug use . The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years ( P<0.01 ) . Depression scores and quality of life did not differ at three years . Conclusion A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs . Trial registration Current Controlled Trials IS RCT N17844016 Metholodogy This study examined the prevalence and correlates of  mental illness in homeless people in Hong Kong and explored the barriers preventing their access to health care . Ninety-seven Cantonese-speaking Chinese who were homeless during the study period were selected at r and om from the records of the three organisations serving the homeless population . The response rate was 69 % . Seventeen subjects could not give valid consent due to their poor mental state , so their responses were excluded from the data analysis . A psychiatrist administered the  Structured Clinical Interview for DSM-IV Axis-I disorders ( SCID-I )  and the  Mini -Mental State Examination .  Consensus diagnoses for subjects who could not complete the SCID-I were established by three independent psychiatrists . Findings The point prevalence of mental illness was 56 % . Seventy-one percent of the subjects had a lifetime history of mental illness , 30 % had a mood disorder , 25 % had an alcohol use disorder , 25 % had a substance use disorder , 10 % had a psychotic disorder , 10 % had an anxiety disorder and 6 % had dementia . Forty-one percent of the subjects with mental illness had undergone a previous psychiatric assessment . Only 13 % of the subjects with mental illness were receiving psychiatric care at the time of interview . The prevalence of psychotic disorders , dementia and the rate of under treatment are hugely underestimated , as a significant proportion ( 18 % ) of the subjects initially selected were too ill to give consent to join the study . Conclusion The low treatment rate and the presence of this severely ill and unreached group of homeless people reflect the fact that the current mode of service delivery is failing to support the most severely ill homeless individuals BACKGROUND Children with chronic illnesses have a heightened risk for mental health problems . OBJECTIVES To develop , implement , and evaluate child outcomes of a 15-month , community-based , family-support intervention design ed to reduce risk for poor adjustment and mental health problems in children with 1 of 4 chronic illnesses ( diabetes mellitus , sickle cell anemia , cystic fibrosis , or moderate to severe asthma ) and their mothers . DESIGN R and omized , controlled clinical trial design with multiple measures of mental health based on both child and parent reports taken 1 year apart . SETTING Community-based intervention linked to subspecialty and general pediatric clinics and practice s in Baltimore , Md. PARTICIPANTS One hundred thirty-six mothers and children aged 7 to 11 years with diabetes mellitus , sickle cell anemia , cystic fibrosis , or moderate to severe asthma . INTERVENTION The program , provided by " experienced mothers " and child life specialists , included telephone contacts , face-to-face visits , and special family events . MAIN OUTCOME MEASURES Outcomes were measured using the following instruments : the Personal Adjustment and Role Skills Scale III , the Children 's Depression Inventory , the Revised Children 's Manifest Anxiety Scale , and the Self-Perception Profile for Children . RESULTS The experimental group 's mean adjustment score increased over the intervention period while the control group 's mean adjustment score decreased . Analysis of variance demonstrated that the intervention had a significant main effect on postintervention adjustment controlling for baseline scores ( P = .01 ) . Using a cutoff score indicating maladjustment , the percentage of experimental group children in the maladjustment range fell from 19 % at baseline to 10 % after the intervention ; the percentage of control group children in the maladjustment range rose from 15 % at baseline to 21 % after the intervention . The effect of the intervention was more pronounced for children who had low physical self-esteem than for those who had moderate to high physical self-esteem at the beginning of the program . CONCLUSIONS Our results demonstrate modest positive effects of a family support intervention in promoting the adjustment of children with selective chronic health conditions . Including child life specialists in a community-based intervention may be especially salient for children with chronic illnesses who have low physical self-esteem . The intervention had a similar outcome for all diagnostic groups , suggesting that it could be effective for children with any chronic illness and implemented in a variety of pediatric setting OBJECTIVE Employment is a key to participation in community life for people with severe mental illness , especially those who have been involved in the criminal justice system . Although the Individual Placement and Support ( IPS ) model of supported employment has been established as an evidence -based practice for helping people with severe mental illness attain competitive employment , little is known about whether IPS is effective for people with severe mental illness who have a history of arrest or incarceration . This study examined this question . METHODS A r and omized controlled trial examined competitive employment outcomes for 85 participants with severe mental illness and justice involvement who were assigned to IPS or to a comparison group that offered a job club approach with peer support .  RESULTS At one-year follow-up , a greater proportion of participants in the IPS group than in the comparison group had obtained competitive employment ( 31 % versus 7 % ; p<.01 ) . The IPS and comparison groups did not differ significantly during follow-up in rates of hospitalization ( 51 % versus 40 % ) or justice involvement-either arrests ( 24 % versus 19 % ) or incarceration ( 2 % for both groups ) . CONCLUSIONS Although IPS was shown to be an effective model for helping justice-involved clients with severe mental illness achieve employment , the outcomes were modest compared with those in prior IPS studies . The IPS model provided a useful framework for employment services for this population , but augmentations may be needed BACKGROUND Lowered neuropsychological performance is evident in youth with type 1 diabetes , although evidence for associations with specific illness variables is inconsistent . This study examined the neuropsychological profiles of a cohort of youth with type 1 diabetes studied prospect ively from diagnosis 12 yr previously . METHODS A total of 106 youth with type 1 diabetes and 75 healthy controls participated . There were no significant group differences on Full-scale IQ assessed on study entry 12 yr previously , current socioeconomic status , gender distribution , or age . Neuropsychological tests assessed eight cognitive domains : verbal abilities , perceptual reasoning , new learning , working memory , non-verbal processing speed , mental efficiency , divided attention , and sustained attention . Episodes of serious hypoglycemia and HbA(1c ) levels were recorded from diagnosis . RESULTS Youth with type 1 diabetes performed more poorly than controls on working memory ( p < .05 ) . Early onset diabetes was related to poorer sustained ( p < .001 ) and divided attention ( p = .001 ) , new learning , and mental efficiency ( both p < .05 ) . Hypoglycemia was found to adversely effect verbal abilities , working memory , and non-verbal processing speed ( all p < .05 ) . Poorer working memory was associated with hyperglycemia ( p < .05 ) . Youth with any combination of two or three illness risk factors ( i.e. , early onset diabetes , hypo- , hyperglycemia ) , performed more poorly than controls and youth with no or one risk on verbal abilities , working memory , and mental efficiency . CONCLUSIONS This study documents poorer neuropsychological performance and its association with illness risk factors in youth with type 1 diabetes . Findings suggest that early disease onset and hypoglycemia impact on the developing central nervous system , with hyperglycemia playing a lesser role Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal . More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of re sources needed for long-term condition self-management to be effective . Aim To determine how the social networks of people with long-term conditions ( diabetes and heart disease ) are associated with health-related outcomes and changes in outcomes over time . Methods Patients with chronic heart disease ( CHD ) or diabetes ( n = 300 ) r and omly selected from the disease registers of 19 GP practice s in the North West of Engl and . Data on personal social networks collected using a postal question naire , alongside face-to-face interviewing . Follow-up at 12 months via postal question naire using a self-report grid for network members identified at baseline . Analysis Multiple regression analysis of relationships between health status , self-management and health-economics outcomes , and characteristics of patients ' social networks . Results Findings indicated that : ( 1 ) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being ; ( 2 ) support work undertaken by personal networks exp and s in accordance with health needs helping people to cope with their condition ; ( 3 ) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs . Health service costs were significantly ( p<0.01 ) reduced for patients receiving greater levels of illness work through their networks . Conclusions Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon . This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and re sources for producing a more desirable and cost-effective way of supporting long term illness management 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 : Objective : The 2010 Survey of High Impact Psychosis ( SHIP ) is Australia ’s second national psychosis survey . This paper provides an overview of its findings , including comparisons with the first psychosis survey and general population data . Methods : The survey covered 1.5 million people aged 18–64 years , approximately 10 % of Australians in this age group . A two-phase design was used . In phase 1 , screening for psychosis took place in public mental health services and non-government organizations supporting people with mental illness . In phase 2 , 1825 of those screen-positive for psychosis were r and omly selected and interviewed . Data collected included symptomatology , substance use , functioning , service utilization , medication use , education , employment , housing , and physical health including fasting blood sample s. Results : The estimated 1-month treated prevalence of psychotic disorders in public treatment services was 3.1 people per 1000 population ; the 12-month treated prevalence was 4.5 people per 1000 . The majority ( 63.0 % ) of participants met ICD-10 criteria for schizophrenia/schizoaffective disorder . One-half ( 49.5 % ) reported attempting suicide in their lifetime and two-thirds ( 63.2 % ) were rated as impaired in their ability to socialize . Over half ( 54.8 % ) had metabolic syndrome . The proportion currently smoking was 66.1 % . Educational achievement was low . Only 21.5 % were currently employed . Key changes in the 12 years since the first survey included : a marked drop in psychiatric inpatient admissions ; a large increase in the proportion attending community mental health clinics ; increased use of rehabilitation services and non-government organizations supporting people with mental illness ; a major shift from typical to atypical antipsychotics ; and large increases in the proportions with lifetime alcohol or drug abuse/dependence . Conclusion : People with psychotic illness face multiple challenges . An integrated approach to service provision is needed to ensure that their living requirements and needs for social participation are met , in addition to their very considerable mental and physical health needs BACKGROUND There is a high prevalence of smoking among people who experience severe mental ill health ( SMI ) . Helping people with disorders such as bipolar illness and schizophrenia to quit smoking would help improve their health , increase longevity and also reduce health inequalities . Around half of people with SMI who smoke express an interest in cutting down or quitting smoking . There is limited evidence that smoking cessation can be achieved for people with SMI . Those with SMI rarely access routine NHS smoking cessation services . This suggests the need to develop and evaluate a behavioural support and medication package tailored to the needs of people with SMI . OBJECTIVE The objective in this project was to conduct a pilot trial to establish acceptability of the intervention and to ensure the feasibility of recruitment , r and omisation and follow-up . We also sought preliminary estimates of effect size in order to design a fully powered trial of clinical effectiveness and cost-effectiveness . The pilot should inform a fully powered trial to compare the clinical effectiveness and cost-effectiveness of a bespoke smoking cessation ( BSC ) intervention with usual general practitioner ( GP ) care for people with SMI . DESIGN A pilot pragmatic two-arm individually r and omised controlled trial ( RCT ) . Simple r and omisation was used following a computer-generated r and om number sequence . Participants and practitioners were not blinded to allocation . SETTING Primary care and secondary care mental health services in Engl and . PARTICIPANTS Smokers aged > 18 years with a severe mental illness who would like to cut down or quit smoking . INTERVENTIONS A BSC intervention delivered by mental health specialists trained to deliver evidence -supported smoking cessation interventions compared with usual GP care . MAIN OUTCOME MEASURES The primary outcome was carbon monoxide-verified smoking cessation at 12 months . Smoking-related secondary outcomes were reduction of number of cigarettes smoked , Fagerstrom test of nicotine dependence and motivation to quit ( MTQ ) . Other secondary outcomes were Patient Health Question naire-9 items and Short Form Question naire-12 items to assess whether there were improvements or deterioration in mental health and quality of life . We also measured body mass index to assess whether or not smoking cessation was associated with weight gain . These were measured at 1 , 6 and 12 months post r and omisation . RESULTS The trial recruited 97 people aged 19 - 73 years who smoked between 5 and 60 cigarettes per day ( mean 25 cigarettes ) . Participants were recruited from four mental health trusts and 45 GP surgeries . Forty-six people were r and omised to the BSC intervention and 51 people were r and omised to usual GP care . The odds of quitting at 12 months was higher in the BSC intervention ( 36 % vs. 23 % ) but did not reach statistical significance ( odds ratio 2.9 ; 95 % confidence interval 0.8 % to 10.5 % ) . At 3 and 6 months there was no evidence of difference in self-reported smoking cessation . There was a non-significant reduction in the number of cigarettes smoked and nicotine dependence . MTQ and number of quit attempts all increased in the BSC group compared with usual care . There was no difference in terms of quality of life at any time point , but there was evidence of an increase in depression scores at 12 months for the BSC group . There were no serious adverse events thought likely to be related to the trial interventions . The pilot economic analysis demonstrated that it was feasible to carry out a full economic analysis . CONCLUSIONS It was possible to recruit people with SMI from primary and secondary care to a trial of a smoking cessation intervention based around behavioural support and medication . The overall direction of effect was a positive trend in relation to biochemically verified smoking cessation and it was feasible to obtain follow-up in a substantial proportion of participants . A definitive trial of a bespoke cessation intervention has been prioritised by the National Institute for Health Research ( NIHR ) and the SCIMITAR pilot trial forms a template for a fully powered RCT to examine clinical effectiveness and cost-effectiveness . TRIAL REGISTRATION Current Controlled Trials IS RCT N79497236 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment , Vol . 19 , No. 25 . See the NIHR Journals Library website for further project information Background Addressing the increasing prevalence , and associated disease burden , of diabetes is a priority of health services internationally . Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications . The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment . Self-Management Support for Blood Glucose ( SMS4BG ) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences , demographics , clinical characteristics , and culture . This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes . This paper outlines the rationale and methods of the trial . Methods / design A two-arm , parallel , r and omised controlled trial will be conducted across New Zeal and health districts . One thous and participants will be r and omised at a 1:1 ratio to receive SMS4BG , a theoretically based and individually tailored automated text message-based diabetes self-management support programme ( intervention ) in addition to usual care , or usual care alone ( control ) . The primary outcome is change in glycaemic control ( HbA1c ) at 9 months . Secondary outcomes include glycaemic control at 3 and 6 months , self-efficacy , self-care behaviours , diabetes distress , health-related quality of life , perceived social support , and illness perceptions . Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction . Discussion This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes . If found to be effective it has the potential to provide individualised support to people with diabetes across New Zeal and ( and internationally ) , thus extending care outside the clinic environment . Trial registration Australian New Zeal and Clinical Trials Registry : ACTRN12614001232628 OBJECTIVE Evaluate a 16-week decision support and goal - setting intervention to compare diet quality , decision , and diabetes-related outcomes to a control group . METHODS Adults with type 2 diabetes ( n=54 ) were r and omly assigned to an intervention or control group . Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls . Participants reported previous goal attempts and set diet- and /or physical activity-related goals during coaching calls . Control group participants received information about local health care re sources on the same contact schedule . RESULTS There was a significant difference between groups for diabetes empowerment ( p=0.045 ) . A significant increase in diet quality , diabetes self-efficacy , and diabetes empowerment , and a significant decrease in diabetes distress and depressive symptoms ( all p≤0.05 ) occurred in the intervention group . Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end ( both p≤0.05 ) . CONCLUSIONS Setting specific diet-related goals may promote dietary change , and telephone coaching can improve psychosocial outcomes related to diabetes self-management . PRACTICE IMPLICATION S Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals ' lifestyle . Decision coaching may empower patients to improve self-management practice s and reduce distress BACKGROUND An international six-centre r and omised controlled trial comparing individual placement and support ( IPS ) with usual vocational rehabilitation  for people with serious mental illness found IPS to be more effective for all vocational outcomes . AIMS To determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes . METHOD Patient characteristics and early process variables were tested as predictors of employment outcomes . Service characteristics were explored as predictors of the effectiveness of IPS . RESULTS Patients with previous work history , fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer . Remission and swifter service uptake were associated with working more . Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness . CONCLUSIONS The IPS service was found to be more effective for all vocational outcomes . In addition , maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions , leading to improved employment outcomes . Motivation to find work may be decreased by satisfaction with current life circumstances The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development , borne out of powerful advocacy using public health , economic and human rights arguments . As funding comes on line for scale-up of evidence -based mental health care by task-sharing with primary care , it is time to take stock about care for people affected by severe mental illness ( SMI ) . The existing evidence base for task shared care for SMI provides an imperative to get started , but is skewed towards relatively more affluent and urban population s in middle-income countries where specialist mental health professionals provide most of the care . R and omised , controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving underst and ing of the quality , safety , effectiveness and acceptability of more widely generalisable care for people with SMI . A sub-group of people with SMI have more complex and long-term needs for care , with a high risk of homelessness , imprisonment and human rights violations as family and social supports become overwhelmed . Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation , recovery and empowerment of people with SMI , but rigorous comparative studies are needed to identify the most efficient , effective and scalable approaches to care . Health system constraints are emerging as the over-riding barriers to successful task-sharing , highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality , improving wellbeing and achieving better social outcomes . Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI Objective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions . Design Cluster r and omised controlled trial . Setting 36 general practice s in the north west of Engl and . Participants 387 patients with a record of diabetes or heart disease , or both , who had depressive symptoms ( ≥10 on patient health question aire-9 ( PHQ-9 ) ) for at least two weeks . Mean age was 58.5 ( SD 11.7 ) . Participants reported a mean of 6.2 ( SD 3.0 ) long term conditions other than diabetes or heart disease ; 240 ( 62 % ) were men ; 360 ( 90 % ) completed the trial .  Interventions Collaborative care included patient preference for behavioural activation , cognitive restructuring , grade d exposure , and /or lifestyle advice , management of drug treatment , and prevention of relapse . Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service ; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse . Usual care was st and ard clinical practice provided by general practitioners and practice nurses . Main outcome measures The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale ( SCL-D13 ) at four months after baseline assessment . Secondary outcomes included anxiety symptoms ( generalised anxiety disorder 7 ) , self management ( health education impact question naire ) , disability ( Sheehan disability scale ) , and global quality of life ( WHOQOL-BREF ) . Results 19 general practice s were r and omised to collaborative care and 20 to usual care ; three practice s withdrew from the trial before patients were recruited . 191 patients were recruited from practice s allocated to collaborative care , and 196 from practice s allocated to usual care . After adjustment for baseline depression score , mean depressive scores were 0.23 SCL-D13 points lower ( 95 % confidence interval −0.41 to −0.05 ) in the collaborative care arm , equal to an adjusted st and ardised effect size of 0.30 . Patients in the intervention arm also reported being better self managers , rated their care as more patient centred , and were more satisfied with their care . There were no significant differences between groups in quality of life , disease specific quality of life , self efficacy , disability , and social support . Conclusions Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity . The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine setting s with a deprived population with high levels of mental and physical multimorbidity . Trial registration IS RCT N80309252 Asian Americans experience diabetes at a higher rate than non-Hispanic whites . Diabetes prevention programs using lifestyle interventions have been shown to produce beneficial results , yet there have been no culturally-tailored programs for diabetes prevention in the Korean community . We explore the impact and feasibility of a pilot Community Health Worker ( CHW ) intervention to improve health behaviors and promote diabetes prevention  among Korean Americans using a r and omized controlled trial . Between 2011 and 2012 , a total of 48 Korean Americans at risk for diabetes living in New York City ( NYC ) participated in the intervention . Participants were allocated to treatment or control groups . A community-based participatory research approach guided development of the intervention , which consisted of 6 workshops held by CHWs on diabetes prevention , nutrition , physical activity , diabetes complications , stress and family support , and access to health care . Changes over 6 months were examined for clinical measurements ( weight , BMI , waist circumference , blood pressure , glucose , and cholesterol ) ; health behaviors ( physical activity , nutrition , food behaviors , diabetes knowledge , self-efficacy , and mental health ) ; and health access ( insurance and self-reported health ) . In this small pilot study , changes were seen in weight , waist circumference , diastolic blood pressure , physical activity nutrition , diabetes knowledge , and mental health . Qualitative findings provide additional context ual information that inform ways in which CHWs may influence health outcomes . These findings demonstrate that a diabetes prevention program can be successful among a Korean American population in NYC , and important insight is provided for ways that programs can be tailored to meet the needs of vulnerable population AIM The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes . METHODS Participants ( n = 260 ) with Type 1 or 2 diabetes and elevated depressive symptoms [ Center for Epidemiological Studies Depression Scale ( CES-D ) ≥ 23 ] were r and omly assigned to a guided Internet-based self-help intervention or a control condition ( treatment as usual + online psychoeducation about depression ) . The primary outcome was a change in depressive symptom severity ( CES-D ) from baseline to 6-month follow-up . The secondary outcomes included numbers of people achieving treatment response ( reliable change of depressive symptoms ) and remission ( CES-D ≤ 16 ) , as well as the effects on glycaemic control , diabetes-related emotional distress and diabetes acceptance . Repeated measures analysis of variance examined between-group differences using intent-to-treat principles . RESULTS Both conditions showed improvements in depression severity : intervention condition , d = 1.48 [ 95 % confidence interval ( 95 % CI ) : 1.21 to 1.76 ] ; control condition d = 0.55 ( 95 % CI : 0.30 to 0.80 ) . Changes were significantly greater in the intervention condition with a large between-group effect size ( d = 0.83 , 95 % CI : 0.57 to 1.08 ) . Accordingly , effects on response [ relative risk ( RR ) = 2.60 ( 95 % CI : 2.01 to 3.36 ) , P < 0.001 ] and remission [ RR = 3.36 ( 95 % CI : 2.98 to 5.44 ) , P < 0.001 ] were in favour of the intervention group , as were differences in change in diabetes emotional distress ( d = 0.50 , 95 % CI : 0.04 to 0.54 ) , and physical and mental functioning [ Short Form Health Survey ( SF-12 ) Physical d = 0.27 ( 95 % CI : 0.01 to 0.51 ) and SF-12 Mental d = 0.68 ( 95 % CI : 0.11 to 0.40 ) ] . The intervention group was not superior with regard to glycaemic control , diabetes self-management and diabetes acceptance . CONCLUSIONS The trial indicates that Internet-based guided self-help treatments for  depression in people with diabetes can have sustained effects on depressive symptoms , well-being and emotional distress associated with diabetes 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 Hmong refugees with type 2 diabetes mellitus ( DM2 ) have poor glycemic control . For Hmong adults with DM2 , group visits were instituted at a community health center and evaluated for their influence on diabetes management . Pre- and postintervention measures of physical health , mental health , and behavior were collected on 39 participants ( 64 % participation rate ) . Baseline characteristics and clinical outcomes of 39 group visit participants were compared with 22 Hmong DM2 adults who refused to participate and 216 nonparticipating Hmong DM2 adults from a local diabetes registry . Baseline characteristics were similar among the three groups . Although participants received good medical services and their mental health improved ( p < 0.05 ) , clinical outcomes did not significantly improve . Although group visits are feasible for providing medical services for Hmong adults with DM2 , clinical outcomes remain outside of recommended targets . Addressing mental health in this population may be necessary before people can institute behavioral changes that improve diabetes management BACKGROUND / AIM The Individual Placement and Support ( IPS ) approach is an evidence -based form of supported employment for people with severe and persistent mental illness . This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA . One previous Australian r and omised controlled trial found that IPS is effective for young people with first episode psychosis . The aim of the current trial was to assess the effectiveness of evidence -based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems . METHODS A four-site r and omised control trial design ( n = 208 ) was conducted in Brisbane ( two sites ) , Townsville and Cairns . The intervention consisted of an IPS supported employment service hosted by a community mental health team . The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area . RESULTS At 12 months , those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition ( 42.5 % vs. 23.5 % ) . The conditions did not differ on secondary employment outcomes including job duration , hours worked , or job diversity . Attrition was higher than expected in both conditions with 28.4 % completing the baseline interview but taking no further part in the study . CONCLUSION The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment . IPS can be successfully implemented this way in Australia , but with a loss of effect strength compared to previous USA trials The Diabetes Control and Complications Trial ( DCCT ) and the Kumamoto study [ 1 , 2 ] showed that near-normal glycemic control reduces the development and progression of microvascular and neuropathic complications by approximately 50 % in type 1 and type 2 diabetes mellitus . Additional analyses [ 3 - 5 ] indicate that therapy to achieve near normalization of blood glucose levels is cost-effective compared with other treatments . Thus , the American Diabetes Association has recommended that all persons with diabetes attempt to achieve near normalization of blood glucose levels [ 6 ] . This recommendation is not routinely followed in medical practice . In a 1989 national survey of physician practice behaviors in the United States , 64 % of physicians agreed that achieving target HbA1c values is very important but only 18 % reported that they ordered HbA1c tests every 2 to 3 months for patients with type 1 diabetes [ 7 ] . Although 98 % agreed that patient education improves glucose control , only 55 % reported that they routinely used a dietitian or a diabetes educator in patient care . Studies indicate that bringing clinical practice into line with scientific knowledge can be difficult . Methods used to achieve diabetes control in clinical trials are re source intensive . The American Diabetes Association currently recommends that patients with diabetes see their primary care physicians two to four times per year . Data from the National Health Interview Survey , a nationally representative survey [ 8 ] , indicate that most patients with diabetes are seen by nonspecialists and that 69 % of physician visits last less than 15 minutes . Algorithms for diabetes care exist but may be complex and difficult for physicians to follow , given patient load , diversity of patients seen , lack of information systems , and time constraints . Simple , low-cost methods of translating guidelines into clinical care are required . One solution may be to make greater use of personnel other than physicians . Nurse case management was an integral part of intensive therapy in the DCCT and has proven to be effective in reducing smoking and cholesterol levels after acute myocardial infa rct ion [ 3 , 9 ] . A nonr and omized study [ 10 ] of more than 700 patients with diabetes in a health maintenance organization suggests that nurse case management may be effective in improving metabolic control . Other studies [ 11 , 12 ] show a strong association between algorithm-directed nurse interventions and improved glycemic control . To our knowledge , no r and omized , controlled clinical trial of nurse case management in diabetes has yet been published . In a 12-month r and omized , controlled trial , we compared a nurse case management model of diabetes care with usual diabetes management in a primary care setting . Methods Patients Our study was approved by the institutional review board of the Prudential Center for Health Care Research , and all patients gave written informed consent . Participants were recruited from two of the largest clinics within the Jacksonville Health Care Group , which is the largest provider of primary care services for the Prudential HealthCare HMO plan of Jacksonville , Florida . The Jacksonville Health Care Group is a group of 43 primary care physicians who provide care in eight clinics to more than 75 000 Prudential HealthCare plan members . Potential study participants were identified through a data base used to support quality -improvement activities . Prudential HealthCare HMO members who had diabetes were included in the data base if they had visited a physician for diabetes ( International Classification of Diseases , 9th Revision , codes 250.0 to 250.9 ) , had had a hospital cl aim processed for diabetes , had been seen by the utilization management nurse , or had been referred to an ophthalmologist for a diabetic retinal examination . This data base is up date d regularly . A list with each member 's name , address , telephone number , medical record number , member identification number , age , sex , physician , and clinic was generated by merging the data from the data base with enrollment information . In addition , a list of members who may have had diabetes was created by using pharmacy data . Adult members with diabetes who were potential study participants each received a recruitment call and were invited to schedule an appointment with a research assistant to discuss participation in the study . We made a total of 14 calls at different times and on different days before coding a member as unavailable . After consent was given and the eligibility assessment was completed , baseline information was obtained and an HbA1c test was ordered if the result of one given within the previous 60 days was not available . Patients were ineligible for the study if they had a recent HbA1c value less than 7.0 % ; had uncontrolled hypertension ( blood pressure > 180/110 mm Hg ) ; had unstable angina ( class 4 ) ; had had a myocardial infa rct ion in the past 3 months ; had had two or more episodes of seizures ; had alcoholism or drug abuse documented in the chart ; had late-stage complications of diabetes or other chronic conditions , such as severe immunodeficiency or cirrhosis ; were pregnant or were planning to become pregnant in the next 12 months ; or were unable to perform self-management . Patients were r and omly assigned in blocks to either the nurse case management ( intervention ) group or the usual care group . R and omization was based on a 1:1 allocation ratio and a block size of three . Each block contained six patients , three in each study group . This r and omization scheme ensured that the desired allocation ratio-one intervention patient to one usual care patient-was maintained after sequential enrollment of every sixth patient . Outcome Measures Change in HbA1c value was the primary outcome measure . Decreased HbA1c values correlate directly with reduced risk for diabetes-related microvascular and neuropathic complications in type 1 and type 2 diabetes [ 1 , 3 ] . We also assessed health-related quality of life by using four generic questions developed by the Centers for Disease Control and Prevention for the Behavioral Risk Factor Surveillance System ( BRFSS ) [ 13 , 14 ] . These questions evaluate key conceptual domains of health-related quality of life : 1 ) patient-perceived general health status , 2 ) patient-perceived physical dysfunction during the previous 30 days , 3 ) patient-perceived mental dysfunction during the previous 30 days , and 4 ) patient-perceived functional incapacity during the previous 30 days for either mental or physical reasons . The BRFSS quality -of-life measures have been vali date d in a national sample of adults in the United States [ 15 ] . Patient-perceived health was found to be a good proxy indicator for chronic disease conditions . The other three domains further characterize general health functioning and quality of life [ 15 ] . In this analysis , we report findings related to the patient-perceived general health status domain . Intervention and Follow-up The nurse case manager was a registered nurse and a certified diabetes educator . She was trained to follow a set of detailed management algorithms under the direction of a board-certified family medicine physician and an endocrinologist who were responsible for all diabetes management decisions for patients in the intervention group but were not primary care providers for these patients . The algorithms were specific for type of diabetes and were developed by a multidisciplinary team on which endocrinology , family medicine , nursing , pharmacy , health services research , and epidemiology were represented . The algorithms progressively moved a patient toward improvement of glycemic control through adjustments in medication , meal planning , and reinforcement of exercise ( Figure 1 ) . Figure 1 . Algorithm for management of type 2 diabetes mellitus . Patients assigned to receive nurse case management met with the nurse for an initial assessment , were instructed about a blood glucose monitoring schedule , and returned for a follow-up visit 2 weeks later . The initial visit with the nurse averaged 45 minutes . At the 2-week follow-up visit , the nurse review ed the patient 's blood glucose log ; explained the algorithm step to which the patient had been assigned ; and used this information as the baseline for subsequent medication adjustments , meal planning , and exercise reinforcement . Patients receiving nurse case management  were also referred to a 5-week , 12-hour diabetes education program that included individual counseling by a dietitian , individual counseling by an exercise therapist , and group diabetes education classes . Subsequent in-person follow-up visits occurred quarterly . Patients in the nurse case management group  who were taking insulin  received weekly follow-up telephone calls . After the nurse review ed the blood glucose log and discussed glucose values with the patient , medication regimens were adjusted as needed and meal planning and exercise were reinforced . Patients treated with oral agents or diet and exercise  received follow-up telephone calls every 2 weeks . The nurse case manager met at least biweekly with the family medicine physician and the endocrinologist to review patient progress , medication adjustments , and other issues related to diabetes care . All medication adjustments or changes were communicated to the patients ' regular primary care physicians . Patients assigned to receive usual care were given blood glucose meters and strips , were encouraged to discuss enrollment in the diabetes education class with their physicians if they had not done so in the past year , and continued to receive diabetes care and follow-up from their primary care physicians . The 5-week diabetes education program is a st and ard , free-of-charge benefit for all HMO members with diabetes . All Jacksonville Health Care Group primary care physicians participate in an annual diabetes care seminar and undergo regular peer review of their adherence to published diabetes care st and ards . Tests to Objective To evaluate the effectiveness of a structured group education programme on biomedical , psychosocial , and lifestyle measures in people with newly diagnosed type 2 diabetes . Design Multicentre cluster r and omised controlled trial in primary care with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 824 adults ( 55 % men , mean age 59.5 years ) . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures Haemoglobin A1c levels , blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , and emotional impact of diabetes at baseline and up to 12 months . Main results Haemoglobin A1c levels at 12 months had decreased by 1.49 % in the intervention group compared with 1.21 % in the control group . After adjusting for baseline and cluster , the difference was not significant : 0.05 % ( 95 % confidence interval −0.10 % to 0.20 % ) . The intervention group showed a greater weight loss : −2.98 kg ( 95 % confidence interval −3.54 to −2.41 ) compared with 1.86 kg ( −2.44 to −1.28 ) , P=0.027 at 12 months . The odds of not smoking were 3.56 ( 95 % confidence interval 1.11 to 11.45 ) , P=0.033 higher in the intervention group at 12 months . The intervention group showed significantly greater changes in illness belief scores ( P=0.001 ) ; directions of change were positive indicating greater underst and ing of diabetes . The intervention group had a lower depression score at 12 months : mean difference was −0.50 ( 95 % confidence interval −0.96 to −0.04 ) ; P=0.032 . A positive association was found between change in perceived personal responsibility and weight loss at 12 months ( β=0.12 ; P=0.008 ) . Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes result ed in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A1c levels up to 12 months after diagnosis . Trial registration Current Controlled Trials IS RCT N17844016 Background The need for structured education programmes for type 2 diabetes is a high priority for many governments around the world . One such national education programme in the United Kingdom is the DESMOND Programme , which has been shown to be robust and effective for patients in general . However , these programmes are not generally targeted to people with intellectual disabilities ( ID ) , and robust evidence on their effects for this population is lacking . We have adapted the DESMOND Programme for people with ID and type 2 diabetes to produce an amended programme known as DESMOND-ID.This protocol is for a pilot trial to determine whether a large-scale r and omised trial is feasible , to test if DESMOND-ID is more effective than usual care in adults with ID for self-management of their type 2 diabetes , in particular as a means to reduce glycated haemoglobin ( Hb1Ac ) , improve psychological wellbeing and quality of life and promote a healthier lifestyle . This protocol describes the rationale , methods , proposed analysis plan and organisational and administrative details . Methods / Design This trial is a two arm , individually r and omised , pilot trial for adults with ID and type 2 diabetes , and their family and /or paid carers . It compares the DESMOND-ID programme with usual care .  Approximately 36 adults with mild to moderate ID will be recruited from three countries in the United Kingdom . Family and /or paid carers may also participate in the study . Participants will be r and omly assigned to one of two conditions using a secure computerised system with robust allocation concealment . A range of data will be collected from the adults with ID ( biomedical , psychosocial and self-management strategies ) and from their carers . Focus groups with all the participants will assess the acceptability of the intervention and the trial . Discussion The lack of appropriate structured education programmes and educational material s for this population leads to secondary health conditions and may lead to premature deaths . There are significant benefits to be gained globally , if structured education programmes are adapted and shown to be successful for people with ID and other cognitive impairments . Trial registration Registered with International St and ard R and omised Controlled Trial ( identifier : IS RCT N93185560 ) on 10 November 2014
Research ers noted small improvements in body mass index immediately after the intervention was provided and at six months , along with improved weight post intervention .
Diabetes knowledge and self efficacy improved immediately following receipt of the intervention , and knowledge also at six months .
The intervention did not improve blood pressure .
Evidence is insufficient to show whether type 2 diabetes self management interventions for people with severe mental illness are effective in improving outcomes .
BACKGROUND People with severe mental illness are twice as likely to develop type 2 diabetes as those without severe mental illness .
Treatment guidelines for type 2 diabetes recommend that structured education should be integrated into routine care and should be offered to all .
However , for people with severe mental illness , physical health may be a low priority , and motivation to change may be limited .
These additional challenges mean that the findings reported in previous systematic review s of diabetes self management interventions may not be generalised to those with severe mental illness , and that tailored approaches to effective diabetes education may be required for this population .
OBJECTIVES To assess the effects of diabetes self management interventions specifically tailored for people with type 2 diabetes and severe mental illness .