Training interventions for healthcare providers offering group-based patient education. A scoping review

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Review Article

Training interventions for healthcare providers offering group-based patient education. A scoping review

Olöf Birna Kristjansdottir

^a,

*, André Vågan

^a

, Margrét Hrönn Svavarsdóttir

^b

,

Hilde Blindheim Børve

^a

, Kari Hvinden

^a

, Veerle Duprez

^c

, Ann Van Hecke

^c,d

, Lena Heyn

^e

, Hilde Strømme

^f

, Una Stenberg

^a,g

aTheNorwegianNationalAdvisoryUnitonLearningandMasteryinHealth,OsloUniversityHospital,Oslo,Norway

bSchoolofHealthSciences,UniversityofAkureyri,Akureyri,Iceland

cUniversityCentreforNursingandMidwifery,DepartmentofPublicHealthandPrimaryCare,FacultyofMedicineandHealthSciences,GhentUniversity, Ghent,Belgium

dStaffMemberNursingDepartment,GhentUniversityHospital,Ghent,Belgium

eFacultyofHealthandSocialSciences,DepartmentofNursingandHealthSciences,UniversityofSouth-EasternNorway,Drammen,Norway

fUniversityLibrary,MedicalLibrary,UniversityofOslo,Oslo,Norway

gFrambuCompetenceCenterforRareDiagnoses,Siggerud,Norway

ARTICLE INFO Articlehistory:

Received25August2020

Receivedinrevisedform18November2020 Accepted13December2020

Keywords:

Professionalcompetence Training

Patienteducation Groups

Self-Managementsupport Scopingreview

ABSTRACT

Objectives:Toprovideoverviewofresearchontraininginterventionsforhealthcareprovidersaimedat promotingcompetenciesindeliveringgroup-basedpatienteducation.

Methods:Asystematicliteraturesearchidentiﬁedrelevantstudies.Datawasextractedontrainingdetails, studydesign,outcomesandexperiences.Resultsweresummarizedandqualitativedataanalyzedusing contentanalysis.

Results:Twenty-sevenstudiesexploringvarioustraininginterventionswereincluded.Tenstudiesused qualitativemethods,eightquantitativeandninemixedmethods.Useofacomparisongroup,validated instrumentsandfollow-upmeasureswasrare.Healthcareproviders’reactionstotrainingweremostly positive.Severalstudiesindicatedpositiveshort-termeffectsonself-efﬁcacyandknowledge.Resultson observedskillsandpatientoutcomeswereinconclusive.Resultsonhealthcareproviders’experienceof deliveryofgroup-basedpatienteducationfollowingtrainingwerecategorizedinto1)Beneﬁtsoftraining interventions,2)Barrierstoimplementationand3)Deliverysupport.

Conclusions:Further evaluation oftraining forhealthcare providersdeliveringgroup-based patient educationis neededbeforeconclusions on trainingefﬁcacycanbe drawn.Theresultsindicate an expandingresearchﬁeldstillinmaturation.

Practiceimplications:Efﬁcacystudiesevaluatingtheoreticallygroundedtrainingwithclearattentionon groupfacilitationandfollow-upsupportareneeded.Inclusionofvalidatedinstrumentsandlong-term outcomesisencouraged.

Contents

1. Introduction ... 1031

2. Methods ... 1031

2.1. Stage1 ... 1031

2.2. Stage2 ... 1031

2.3. Stage3 ... 1032

2.4. Stage4 ... 1032

2.5. Stage5 ... 1032

*Correspondingauthorat:OsloUniversityHospital,TheNorwegianNationalAdvisoryUnitonLearningandMasteryinHealth,Postbox4959Nydalen,0424Oslo,Norway.

E-mailaddress:olof@mestring.no(O.B.Kristjansdottir).

https://doi.org/10.1016/j.pec.2020.12.006

ContentslistsavailableatScienceDirect

Patient Education and Counseling

j o u r n al h o m e p a g e : w w w . el s e v i e r . c o m / l o c a t e / p a t ed u c o u

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3. Results ... 1032

3.1. Screeningprocess ... 1032

3.2. Characteristicsoftheincludedstudies ... 1034

3.2.1. Publicationyearandcountryoforigin ... 1034

3.2.2. Designandsamplesizes ... 1034

3.2.3. Methodologicalquality ... 1034

3.3. Traininginterventioncharacteristics ... 1034

3.3.1. Theoreticalbackground,componentsandmethods ... 1034

3.3.2. Trainingdurationandfollow-up ... 1034

3.3.3. Targetgroupandsetting ... 1034

3.4. Trainingimpactandoutcomemeasures ... 1034

3.4.1. Reactionstotraining ... 1034

3.4.2. Learningoutcomes ... 1038

3.4.3. Behavioroutcomes ... 1038

3.4.4. Resultsonpatientoutcomes ... 1044

3.4.5. HCPs’experiencesofofferingPEingroups ... 1044

4. Discussionandconclusion ... 1045

4.1. Discussion ... 1045

4.2. Conclusion ... 1046

4.3. Practiceimplications ... 1046

Fundingdetails ... 1046

Acknowledgements ... 1046

References ... 1046

1.Introduction

Chronicconditionsarealeadingcauseofdisabilityanddeath worldwide[1,2].Self-management,whichisessentialforpeople affected,refers tothe individual’sability tomanagesymptoms, treatment, physicaland psychosocialconsequencesand lifestyle changesthatfollowachroniccondition[1].Healthcareproviders (HCPs)playakeyroleinprovidingself-managementsupportwith patienteducation(PE) [3,4]. Patienteducationis theprocessof inﬂuencing patient behavior and generating the changes in knowledge, attitudesand skills neededtomaintain orimprove health [5]. Self-management support may include providing information,emotionalsupportandassistanceinlifestylechanges [6]. Patienteducationcan bedelivered individuallyand/or in a groupandtheformatshavetheirdifferentstrengths.Group-based PEallowspatientstodevelopself-efﬁcacyinself-managementby learning withand fromeachother[7,8]. Effectivenessand cost- effectivenessofgroup-basedprogramsonpatientoutcomeshas beenestablishedforseveralconditions[4,9,10].

Healthcare providers’ education competencies have been deﬁnedas“integrationofprofessionalism,teaching,andempow- ering in the co-creation of knowledge and skills to achieve behavioralchange”[11].ToprovideeffectivePEingroups,HCPs alsoneedtohandletheaddedcomplexityofthegroupelementand managethegroupasawhole[12];HCPsmustbalancedidactic, experiential and interactive elements in a way that facilitates sharingofknowledgeandexperiences,andtailorcontenttosuit group member needs [13]. Succeeding with this may require changesinmindset,knowledgeandskills.

ObservationsofandreportsbyHCPsindicatelackoftrainingin group-based PE, speciﬁcallyin the theorybehind PE and skills relatedtogroupenablementandself-managementsupportsuch as goal setting [14–18]. Healthcare providers’ unmet learning needsandlackofcompetenceisconcerningsinceitmayleadtoPE beingdisseminatedwithsub-optimalquality,thuscompromising effectiveness[14,16].

Severalrecentreviewshavestudiedtheoutcomeoftrainingto promotePEcompetenciesonHCPs’knowledge,conﬁdence,skills orperformancewhenprovidingPEinpractice.Theysuggestthat importanttrainingelementsincludeacleartheoreticalframework, experientiallearning withfeedback,reﬂection, interactivityand follow-up[19–21].ThosereviewsexploretraininginPEwithout

speciﬁcattentiontothegroupformat.Giventheimportanceof skills in group-based PE, dissemination of research on group- targetedtrainingiswarranted.Theaimofthisstudyistogivean overviewoftrainingforHCPsinprovidingPEingroupsandthe potentialimpactonHCPscompetencies.

Thefollowingquestionsareaddressed:

1.Whatstudydesigns,outcomesandmeasuresaredescribed?

2.Whatkindsoftraininginterventionsaredescribed?

3.Whatoutcomesandexperiencesareassociatedwithparticipat- inginthetraining?

2.Methods

Preliminarysearches indicated a limitednumber of relevant studiesandascopingreviewmethodwasthereforechosentodraw evidencefromdifferentstudydesigns,beneficialinanemerging field[22].Thisreviewwasguidedbyafive-stageframework[22].

2.1.Stage1

A studygroupwas assembled andinitialresearchquestions deﬁned.ThegroupconsistedofsevenPEresearchersandtwoHCPs experiencedingroup-basedPEandintrainingHCPs.

2.2.Stage2

A systematic search was conducted by a medical research librarian. The following electronic databases were searched:

MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), ERIC (Ovid), AMED(Ovid),CINAHL(EBSCO),SveMed +andCochraneLibrary (Wiley).Searchesincludedsubjectheadingsandtextwordswith synonyms for 1) HCPs, 2) training, 3) PE, 4) professional competenceand5)group.Studieswereincludedifthey:involved training in group-based PE, described training aimed at HCPs, reported outcomes associated with HCPs’ competencies, were published between January 2000 and February 2019, were in English, Danish, Norwegian or Swedish and reported primary research (see Appendix A in Supplementary material). Some criteriawereadjusted duringthe earlyscreening process.First, training in recovery-oriented approaches was excluded since

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recent reviewsexist[23,24]. Second,studieswhere thePE was deﬁnedastherapywereexcludedasthiswasconsideredbeyond thescopeofthisreview.Lastly,studiesdescribingtoolsforgroup- basedprograms,butnottraininginusingthem,wereexcluded.

After eliminating duplicates, we removed obviously irrelevant studiesbasedontitles.

2.3.Stage3

Twoauthorsindependentlyscreenedtheremainingabstracts.

Full-text articleswere screened independently bytwo authors.

Disagreementwasresolvedbyadiscussionbetweenauthors.To identifyasmanyrelevantstudiesaspossible,asnowballingsearch wasperformedbysearchingreferencelistsandreferencesciting theincludedstudies.Atthispointweincludedstudiespublished after our original search timeframe. If titles were considered relevant the abstract was read and when found relevant, two authorsindependentlyscreenedthefull-text.

2.4.Stage4

Followingdatawasextracted:1)characteristicsofthetraining (aim, theoretical background, key content, training methods, duration and trainers), 2) HCPs’ characteristics and setting, 3) PatientpopulationandtypeofPEand4)Studydesign,methods, samplesizeandkeyresults.

2.5.Stage5

Keystudyresultswere summarized.Tomaptheimpact of training we used the four-level model of Kirkpatrick (1996),

widelyusedforappraisalofevidenceoftraining[25].Hence,the outcomes were categorized as: 1) reactions to training; 2) learning (acquired attitudes, knowledge and/or skills) and3) behavior (ability to apply knowledge and skills in practice), and 4) results (patient outcomes). Todocument results from qualitativestudiesingreaterdetail,acategoryon“experiences of delivery” was included containing HCPs’ (participating in training)experiencesofgroup-basedPE.Thisdatawasanalyzed bytwoauthorswithaninductiveconventionalcontentanalysis approach [26].They read the resultssections of the relevant qualitativestudiesandidentiﬁedpreliminarythemes.Prelimi- nary themes were discussed, adjusted and ﬁnally broad themeswere agreedupon by theresearch group.The quality of the included studies was assessed independently by two authorsusingtheMixedmethodsappraisaltool(MMAT)[27].

Disagreements were resolved indiscussion between the two authors.

3.Results

3.1.Screeningprocess

Thesearchidentiﬁed9681records,6560ofwhichwereunique.

Removalofirrelevanttitlesleft3941records.Abstractscreening eliminatedallbut242studies,ofwhich82wereonlyavailablein abstractform.Oftheremaining160studies,146wereexcluded, mostfrequently because: 1)thetraining didnot involvegroup format,2)notprimaryresearchor3)HCPsoutcomesnotincluded.

Snowballing gave13 additional studies, resultingin 27 studies beingincludedin thereview.Theselectionprocessisshownin Fig.1.

Fig.1.Searchandscreeningprocess.

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Table 1

Summary of study characteristics.

First author; year; country Design Quantitative methods Qualitative methods Sample

size (n)

Comment Single

group Two groups

Three groups

Randomization Questionnaires Observations Interviews Focus groups

Observations Written replies Pre-

and post

Post only

Follow- up

Pre- and post

Post only

Abdel-All; 2018; Australia x x x x x 15

Adolfsson; 2004; Sweden x x 16

Andersen; 2014; Denmark x x x 11

Brooks; 2012; USA x x x 17

Brooks; 2013; USA x x x 19

Burlingame; 2002; USA x x 25 19 groups were observed. The control

condition did not receive the training

Burlingame; 2007; USA x x x 12 Sub-study 1 (n = 12) compared two

conditions and sub-study 2 (n = 11) compared two conditions in the same sample

Christou; 2019; UK x x 7

Cooper; 2019; USA x x x 82 31 provided qualitative data

Dures; 2019; UK x x x 14

Hammond; 2005; UK x x 62

Hurley; 2019; Ireland x x x x 13 5 groups were observed and 5

participated in interviews

Keogh; 2018; Ireland x x x 13 Observations: n = 8

Keogh; 2018; Ireland x x 8 Same sample as in Keogh et al., 2018

Matsuda; 2015; Japan x x x 40 Group interviews

Parahoo; 2017; Ireland x x x x 5 A co-author had the role of co-

facilitator and was included as participant

Peters; 2019; New Zealand x x 6 Interviews both immediately after

delivery of the PE groups for theﬁrst and 6 months later

Richmond; 2016; UK x x x x x 35 Interviews: n = 8

Richmond; 2018; UK x x 11 Sub-sample of Richmond et al., 2016

Sanchez; 2017; USA x x x 4 Observation of case study discussions

during training

Sawtell: 2015; UK x x x x 27–30 Implementation statistics also

included. Observations during both training and group delivery. 14 intervention sites

Stenov; 2019; Denmark x x 14 Observations of training and group

delivery and workshops pre- and posttraining. Action research

Stephen; 2011; Canada x x 6 Focus groups and panel discussion.

Torenholt; 2015; Denmark x x x x x 432 432 replies to questionnaires.

Interviews: n = 18; observations: n = 19 sessions

Tveiten; 2016; Norway x x 23 Elements from action research applied.

One of the participants was a member of the research group. Patients were also included: n = 4

Turner; 2014; Australia x x 15 Patients (peers) also included: n = 25

Varming; 2018; Denmark x x x x 65 Replies to questionnaires: n = 65;

interviews: n = 11; observations: n = 7 sessions

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3.2.Characteristicsoftheincludedstudies 3.2.1.Publicationyearandcountryoforigin

The studies were published between 2002 and 2019. Four studieswerepublisheduntil2009,ﬁvein2010–2014and18 in 2015–2019.SixstudiesoriginatedfromtheUK,sixfromUSA,four from Ireland, four fromDenmark and two from Australia. The otherswereallfromdifferentcountries.

3.2.2.Designandsamplesizes

Ofthe27studies,tenusedqualitativemethods[28–37],eight quantitativemethods[38–45]andninemixedmethods[46–54].

CharacteristicsofeachstudyarepresentedinTable1.Amongthose using qualitative methods,11 applied interviews[29,30,32–34, 46,48,50–52,54],threehadfocusgroups[28,37,49],onecombined individualinterviewsandfocusgroups[31],oneusedfocusgroups andpaneldiscussions[36]andoneincludedaworkshop[35]and twoincludedwrittenresponses[32,47].Sevenincludedqualitative data from observations of PE following training [29,32,35,46, 50–52].Ofthestudiesusingquantitativemethods,nineusedself- report questionnaires before and after the training [38,42,44, 46–49,53,54]andsixstudiesonlyaftertraining[39–41,50–52].Six studies used observation to gather quantitative data following training [42,43,45,48,51,54] and two also included observation before training [39,40]. Three studies compared outcomes between two [45,54] or three intervention groups [38]. Two includedactivecontrolconditionsandoneawaitinglistcondition.

Onestudyappliedrandomization[54].Twostudiesreportedon subsamples of other included studies [34,43]. Two training interventions were explored in more than one study [30,39,40,54]. Four studies includedmore than 40 participants [41,47,51,52].

3.2.3.Methodologicalquality

Allthequalitativestudieswerefoundtobeofhighmethodo- logicalquality.Thequantitativestudiesweremostlyofhighquality butafewomittedrelevantinformation.Thequalityofthemixed methodsstudieswasvaried;severalwereunclearaboutmethod- ological aspects related to the qualitative and/or quantitative approach.QualityassessmentresultsareprovidedinAppendixA inSupplementarymaterial.

3.3.Traininginterventioncharacteristics

3.3.1.Theoreticalbackground,componentsandmethods

Training characteristicsare summarizedinTable2.Reported theoretical or conceptual frameworks were modeling and ob- servedlearning [38,39], learning-by-teaching[39], collaborative learning[48],constructivism[54],adultlearningprinciples[44], motivationalstrategiesplusthestages-of-changemodel[41],and The Health Education Juggler education model [29,35]. Some informationontheprocessofdevelopingthetrainingwasincluded in 18 studies[28,32,35–37,39–41,44–46,48–54], e.g. information on choiceof content,pilottesting and persons involvedin the development. One study included a patient representative in trainingdevelopmentanddelivery[37].

The training involved different methods with lectures and group discussions most commonly mentioned. Sixteen studies reported experiential learning with role-play [31–33,37–39, 41–43,47–49,51–54]andthreeexperientiallearningwithpatients undersupervision[31,36,38].Thirteenstudiesreportedtrainingin applicationofdifferentformsofeducationaltoolssuchasdialogue or reﬂection prompts [29,32,34,35,39,40,42,46,49,51–54]. Five studies used educational tools as a key feature of the training [29,39,40,51,52].Also, twelvestudiesspeciﬁeda componenton group facilitation [31–33,35,37–40,44–46,53]. In eleven studies

thetrainingmaterialincludedmanualsorprotocols[31,32,34,38, 38,39,40,42,43,50,52,54]. Four studies explored e-learning [30,34,48,54].

Training interventions had different aims. Most trainings provided someinformation onPEframework suchascognitive behavioralapproach,psychoeducation,empowerment,self-deter- mination theory or person-centeredness. Most interventions includedcomponentsaboutconditions,self-managementand/or goal setting and behavior change. Four studies [32,34,37,54]

explored interventions aiming to improve HCPs’ skills in both group-basedandindividualPE.

3.3.2.Trainingdurationandfollow-up

Traininglastedbetweenthreehoursandfivedays,withtwo days being most common. Excluding follow-up time, seven interventionslasted fromthree hours toone day(eighthours) [29,35,36,39,40,45,51,52], nine lasted one to two days [28,33,34,38,41–44,49,50,54], two lasted two to three days [47,53], one lasted four days [31] and three lasted five days [32,37,46]. Five studies involved self-paced interventions [30,34,38,48,54].Sixinterventionsincludedfollow-uplastingsix weeks[52],tenweeks[36],fivemonths[38,47],sixmonths[45]or 18months[28].

3.3.3.Targetgroupandsetting

The studies included different HCP populations. Thirteen comprisedinterprofessionaltraining,ofwhichtwoalsoincluded peoplewithchronicillness experience[37,44].Amongst single- profession interventions, six involved physiotherapists [30,34,42,43,48,54]andtwoconcernednurses[38,49].HCPswere recruitedfromvarioussettings,mostlyoutpatientsettings.Three studies targeted inpatient psychiatric settings [38,45,49]. The HCPsweregenerallyexperiencedprofessionals.However,14ofthe studies did not specify prior group-based training or work experience. Among studies providing such information, nine reportedlittleornoexperience.Onlytwostudiesreportedhigh levelofpriorexperienceortrainingingroup-basedPE[36,48].

NinestudiesfocusedonfacilitatingHCPs’skillsinPEforadults, oneforadolescentsandchildren[50]andanotherforbothadults andadolescents[45].Targetagegroupwasnot speciﬁedin the otherstudies.Mosttrainingaimedatimprovingcompetenciesin PE for people with a speciﬁc condition. Six programs were designed forpeoplewithchronicpain and/orrheumaticillness [31,34,42,43,48,54], three targeted people with diabetes [28,35,50] and two were for peoplewith cancer [32,36]. Four trainingsinvolvedgenericPE[29,37,51,52].

3.4.Trainingimpactandoutcomemeasures 3.4.1.Reactionstotraining

The results of the studies are presented in Table 3. Fifteen studiesreportedonreactionstothetrainingwithstudy-speciﬁc measuresorinterviews[30,31,33,35–37,41,42,44,46–48,50,52,54].

AllreportedsomepositivereactionsbytheHCPs.Highsatisfaction with the training in general was reported in eight studies [33,36,42,44,46,48,50,54]. In several studies, HCPs emphasized the importance of practicing skills and feedback [31,33,36,48].

Experientiallearningwasdescribedasnecessaryandexcitingyet simultaneously uncomfortable and even “daunting” [31]. The ﬂexibilityand long-termaccessibilityof e-learningtrainingwas appreciated[30,34]butthelackofinteractivityandskillpractice wasperceivedasachallenge[30,54].Theonestudycomparinge- learningwithworkshoptrainingfoundhighsatisfactionwithboth trainingformatsbuthigheramongworkshopparticipants[54].In anotherstudy theHCPs appreciated theopportunity toreﬂect, learn and share experiences with colleagues and patient

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Table2

Summaryoftraininginterventioncharacteristics.

Firstauthor;year Trainingintervention(aim,backgroundandkeycontent,training methods,duration,trainers)

HCPprofession;setting Patientpopulation;typeofPE program

Abdel-All;2018[46] Aim:Increaseknowledgeandskillsinidentifyingandsupporting controlofhypertension

Background&content:Condition,healthylifestyle,goalsettingand behaviorchange,measurementskills,groupfacilitation

Trainingmethods:Lectures,groupdiscussions,experientiallearning (includingrole-play),tools(useofpictoriallyandtextbasedﬂipcharts) Duration:5days

Trainers:Researchteam

Accreditedsocialhealth workers;communitysettingin ruralIndia(trialsetting)

Peoplewithhypertension;

educationsupportgroups(6 sessionsovera3-month period)

Adolfsson;2004[28] Aim:ImproveabilitytoapplyempowermentapproachingroupPE Background&content:Empowermentapproach,motivationand learningprinciples,problemsolving,goalsettingandbehaviorchange Trainingmethods:Lectures,experientiallearning(video-taped individualcounseling)

Duration:2daysand3half-dayfollow-upmeetings(6monthsapart) Trainers:Empowermenteducatorandsupervisor

Physiciansandnurses;family practiceinprimarycare

Peoplewithdiabetes;

empowermentgroup education(3–5sessionsand1 follow-upsession)

Andersen;2014[29] Trainingaim:Promoteparticipatoryandpatient-centeredPEby applying4differenteducatorrolespresentedintheeducationmodel

“TheHealthEducationJuggler”:theembracer(takescareofthegroup), facilitator(generatesdialogueandparticipation),translator (communicatesprofessionalknowledge)andinitiator(motivatesaction inpatients)

Background&content:Reﬂectionsonchallengesrelatedtoeducation rolesinownpractice,themodel,traininginuseofatoolkitof24tools (e.g.cardswithpicture/statementswiththepurposeofkick-starting dialogueandenhancingparticipation)

Trainingmethods:Lectures,reﬂections,discussions Duration:1day

Trainers:Notclearlyreported

HCPswithvariouseducational background;communityand hospitalsettings

Peoplewithlongtermhealth challenges;group-basedPE (numberofsessionsnot speciﬁed)

Brooks;2012[39] Aim:Improveskillsinusingamultimediatoolkit(RoadMAPToolkit) Background&content:Condition(substanceabuse)andrelapse prevention,presentationofatoolkit,groupfacilitation.

TheRoadMAPToolkitconsistsofvideovignettes,posters,worksheets andteachingaids(guide/manual).Itisdesignedtoincreaseuseof evidence-basedrelapsepreventioncontentingroups.Itservesasbotha modeofinformationtransfertopatientsandteachingtoolforHCPs Trainingmethods:Lectures,toolkit(practicinguseoftoolkit),manual andhandbook,presentationofuseoftoolkitinonesession, Duration:3h(followedby2weekstofamiliarizewiththetoolkit) Trainers:Authors

Counselors;community settings

Peopleinoutpatientrelapse preventionprogram;group- basedrelapseprevention(6 modulesspeciﬁed)

Brooks;2013[40] Aim:Promotecompetenciesinprovidinggroup-basedrelapse preventionprogramusingamultimediatoolkit(RoadMAPToolkit– trainingandtoolkitasin[39])

Counselorsinsubstanceabuse relapseprevention;community settings

Peoplewithhistoryof substanceabuse;group-based relapseprevention(6modules speciﬁed)

Burlingame;2002[45] Aim:Increasegroupskills

Background&content:Psychoeducation,groupfacilitation Trainingmethods:Lectures,discussions,observations(modeling), experientiallearning(assistinganexperiencedHCPindeliveryin practice),experientiallearning(role-play),supervisionwithpeersand trainer

Duration:1-dayworkshop,practiceandweeklyfollow-up/supervision for6months

Trainers:Expertongrouptreatment,psychologists

Socialworkers,nursesand psychiatrictechnicians;

inpatientpsychiatriccare

Adolescentsandadultswith persistentmentalillness;

psychoeducationalgroupsand activitiesofdailylivingskills groups(andalso

psychotherapy)(numberof sessionsnotspeciﬁed)

Burlingame;2007[38] Aim:Increaseknowledgeandskillsinsymptommanagementandin leadingpsycho-educationalgroups

Interventions:

InterventionA:Self-instrumental(manualonly) InterventionB:Workshop(includingmanual)

InterventionC:Workshop(includingmanual)andweeklyclinical supervision(includedbeingobservedconducting3groupsessions) Background&content:Self-management,groupfacilitation Trainingmethods:

InterventionA:Self-instructional,manual

InterventionB:SameasininterventionAandlectures,experiential learning(role-play),discussions

InterventionC:SameasininterventionBandobservations,supervision Duration:

InterventionA:Suggestedstudyingtime12h InterventionB:12h

InterventionC:For5months

Trainers:HCPswithextensiveexperienceinpsychiatricnursingandin trainingHCPsinleadinggroups

Nurses;Inpatientpsychiatric care

Peoplewithsevereand persistentmentalillness;

psychoeducationalsymptom managementgrouptreatment (12sessions)

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Table2(Continued)

Christou;2019[30] Aim:Supportimplementationofagroup-basedcognitivebehavioral interventionBackSkillsTraining(BeST)

Background&content:Cognitivebehavioralapproach.

BasedonBeSTprogram(contentpublishedelsewhere,sameasin [34,54]

Trainingmethods:e-learning(writteninformation,videos,links, knowledgetests)

Duration:10h

Trainers:ContentbasedonBeST,notdevelopedbytheauthors

Physiotherapists,primarycare setting

Peoplewithlowerbackpain;

group-basedbackskills training(6sessions)

Cooper;2019[47] Aim:Promotedeliveryofproblem-solvingtraining

Background&content:Problem-solvingtrainingbasedoncognitive behavioralapproachwithemphasisonmilitarycultureandtailoring feedbacktouniqueaspectsofthispopulation

Trainingmethods:Lectures,clinicaldemonstrations,experiential learning,follow-up(weeklygroupphonecallswithanexperienced HCP)

Duration:2.5days+5-monthfollow-up Trainers:Problem-solvingtherapyexperts

Clinicalandnon-clinical providersofmentalhealth services;healthservicefor membersoftheDepartmentof Defense

Peopleexperiencingdistress;

group-basedpsychoeducation withproblem-solvingtraining (4sessions)

Dures;2019[31] Aim:Skillsindeliveringagroup-basedprogram

Background&content:Cognitivebehavioralapproach,groupfacilitation Trainingmethods:Lectures,manual,experientiallearning(role-playand deliveryofprogramtopatientsinapracticerununderobservation/

supervision) Duration:4days

Trainers:Aclinicalpsychologistandaspecialistoccupationaltherapist

Rheumatologynursesand occupationaltherapists;

rheumatologyhospitalsettings (clinicaltrialsetting)

Peoplewithrheumatoid arthritis;group-based cognitivebehavioral interventiontoreducefatigue (6sessionsand1follow-up session)

Hammond;2005[41] Aim:Developskillsindeliveringagroup-basedprogram(“Lookingafter yourjointsprogramme”)andtoreducebarrierstochangingpractice Background&content:Theoreticalbasisandresearchevidenceforthe PEprogram,self-management,behavioralapproach,stages-of-change model,practicalitiesofprogramdelivery

Trainingmethods:Experientiallearning(role-play),reﬂections (motivationalstrategiesusedtopromoteHCPs'readinesstochange), discussions(ofpotentialbarriers,initialactionplansandsupport networks)

Duration:2days Trainers:Firstauthor

Occupationaltherapists;

specialistrheumatologysetting (mainly)

Peoplewithrheumatoid arthritis;group-based behavioraljointprotection education(10h,numberof sessionsnotspeciﬁed

Hurley;2019[48] Aim:Improvecompetenciesindeliveryofagroup-basedprogram (“Self-managementofosteoarthritisandlowbackpainthroughactivity andskills”;SOLAS)

Background&content:Overviewofprogram,educationcontentforeach week,self-determinationtheory-basedcommunicaitonstrategies, exercisesandtheirmodeofdelivery,practicalitiesofprogramdelivery.

Basedonaface-to-facetrainingprogram(see[42])

Trainingmethods:e-learning(basedonacollaborativelearning environmentandgamiﬁcationprinciples)withlectures,peerrole modeling,self-reﬂections(includingknowledgeassessments), experientiallearningwithfeedback

Duration:HCPswereencouragedtocompletethetrainingovera4-week period

Trainers:Trainerswithinthee-learningprogramnotclearlyreported

Physiotherapists;primarycare setting

Peoplewithosteoarthritisor lowbackpain;group-based self-managementprogram (6sessions)

Keogh;2018[42] Aim:Improvecompetenciesindeliveryofagroup-basedprogram (SOLAS)

Background&content:TraininginthecontentanddeliveryofSOLAS, trainingin9self-determinationtheorybasedcommunicationstrategies (e.g.offermeaningfulrationaleforthebehavior,provideopportunity forinputandchoicetopatients;usesupportandencouragementrather thanpressurizingbehavior;collaborativegoalsetting,actionplanning andproblemsolving;providepositive,information-richfeedback) Trainingmethods:Lectures,discussions,reﬂections,experiential learningwithrole-play,protocol

Duration:2days Trainers:Notreported

Physicaltherapists;primary care(clinicaltrialsetting)

Peoplewithosteoarthritisor lowbackpain;group-based self-managementintervention (6sessions)

Keogh;2018[43] Aim:Improvecompetenciesindeliveryofagroup-basedprogram (SOLAS).Speciﬁedfurtherthanin[42]astrainingineducational contentdeliveryof17behavioralchangetechniquesanduseof communicationstylebasedonself-determinationtheory

Physicaltherapists;primary care(clinicaltrialsetting)

Peoplewithosteoarthritisor lowbackpain;group-based self-managementintervention (6sessions)

Matsuda;2015[49] Aim:Increasecompetenciesinprovidingpsychoeducation

Background&content:Fundamentalsofpsychoeducation,knowledgeof illnessandtreatment,nursingtheory,communicationskills,skills requiredtoprovidepsychoeducation(positivefeedback,reframing, copingquestions,dryrun,modelling)

Trainingmethods:Lectures,textbook,audiovisualaids(DVDwith simulatedpractice),experientiallearningwithrole-play Duration:2days

Nurses;psychiatrichospitals Peoplewithschizophrenia;

group-basedpsychoeducation (4sessions)

(8)

Table2(Continued)

Parahoo;2017[32] Aim:CompetenceinprovidinggroupPE

Background&content:Interventionprotocol,conditionandtreatment, groupfacilitation

Trainingmethods:Lectures,problem-solving,discussions,experiential learningwithrole-play,protocol,educationaltools(informationsheets totriggergroupdiscussion)

Duration:5days

Trainers:ExpertwhoworkedonasimilarprojectintheUS

Counsellors(professional backgroundnotspeciﬁed);

nationalcancercharity(clinical trialsetting)

Menwithprostatecancerand theirpartners;psychosocial intervention(3groupsessions and2individualtelephone sessions)

Peters;2019[33] Aim:Promotecompetenciesinprogramdelivery

Background&content:Self-management,behaviorchange,group facilitation

Trainingmethods:Lectures,experientiallearning(role-play) Duration:2days

Trainers:Ahealthprofessionalwhohadbeeninvolvedindevelopment oftheprogram

Occupationaltherapistsand physiotherapists;community healthservices

Personswithmultiple sclerosis;group-basedfatigue self-managementprogram (6-weekprogram)

Richmond;2016[54] Aim:DisseminationofBackSkillsTrainingprogram(BeST)materials andprovidetraininginacognitivebehavioralapproach

Background&content:Cognitivebehavioralapproach,manualabout howtodeliveragroup-basedprogram(contentnotdescribedindetail butreferredtopreviouswork)

Trainingmethods:

InterventionAandB:Manual,sessionnarratives,cribsheets,patient workbook,additionalinformationsources

InterventionA(e-learning):Self-directedreading,reﬂectivepractice, skillrehearsal,multiple-choicequestions,formativetestswith feedback,interactiveexcercises,discussionforum,multimedia InterventionB(workshop):Lectures,videos,experientiallearningwith role-play,discussions,websitewhereadditionalpaperworkcouldbe downloaded

Duration:

InterventionA:10h(online)within6weeks InterventionB:2days

Physiotherapists;National HealthServicedepartments

Peoplewithnon-speciﬁclow backpain;group-basedback skillstrainingprogram(6group sessionsand1individual session)

Richmond;2018[34] SameasinterventionAin[54] SameasinterventionAin[54] SameasinterventionAin[54]

Sanchez;2017[53] Aim:Developknowledgeandskillsinfacilitatingthegroups Background&content:Condition,self-management,groupfacilitation Trainingmethods:Lectures,videos,groupdiscussions,experiential learningwithrole-play

Duration:24h(>6weeks)

Trainers:Audiologygraduatestudentssupervisedbyaudiologyfaculty

Communityhealthworkers (nonclinical);federally qualiﬁedhealthcenterinan underservedareainaUS- Mexicobordercity

Peoplewithhearingloss;

group-basedself-management support;(numberofsessions notspeciﬁed)

Sawtell;2015[50] Background&content:Basedonmotivationalinterviewingand solution-focusedbrieftherapy

Trainingmethods:Manual,othermethodsnotdescribedinthis publication

Duration:2days

Trainers:Adiabetesspecialistnurseandapsychologist(whodeveloped theprogram)

HCPs(mainlypediatricdiabetes specialistnursesand dietitians);pediatricdiabetes clinics(clinicaltrialsetting)

Childrenandadolescentswith diabetesandtheirfamilies;the ChildandAdolescent StructuredCompetencies ApproachtoDiabetes Education(CASCADE) (4sessions) Stenov;2019[35] Aim:Developnewapproachestowardsaddressingbiopsychosocial

issuesandfacilitatinggroupprocesses

Background&content:Themodel"HealthEducationJuggler", motivationalinterviewingingroups,person-centeredcommunication, readinessassessment,goalsettingandproblemsolving,emotional- behavioralstrategies,groupfacilitation

Thetermworkshopwasusedtoemphasizeuser-drivenand collaborativeresearchapproach

Trainingmethods:Lectures,reﬂections,discussions,casescenarios, dialoguetools,videos

Duration:Two3hworkshops Trainers:Theresearchgroup

Nurses,physiotherapists, dieticians,occupational therapist;hospitaland municipalities

Peoplewithdiabetes;group- basedperson-centeredself- managementeducation (numberofsessionsnot speciﬁed)

Stephen;2011[36] Aim:Skillsinfacilitatingonlinesupportgroups

Background&content:TherapeuticmodelofTheWellnessCommunity (aUSnon-proﬁtorganization)aimingtoencouragepatientstobecome empoweredtomakeactivechoiceintheirrecovery

Trainingmethods:Lectures,experientiallearning(co-facilitation;i.e.

deliveryofsupportgroupwithanexpert),supervision(weeklyonline peermeetings)

Duration:35h(>10weeks)

Trainers:TrainerfromTheWellnessCommunity

Psychosocialoncology counsellors;cancercenters

Peoplewithcancer;online supportgroups(numberof sessionsnotspeciﬁed)

Torenholt;2015[51] Aim:Useofeducationtoolkit

Background&content:Introductionofatoolkitincluding24tools categorizedintofourthemes:1)Reﬂectionandexperience;2) Motivationandgoals;3)Knowledgeandlearning;4)Bodyandsenses.

Thetoolkitincludeddescriptionsofeachtool,practicalinformationand advisoryinstructionsforuse.Thetoolsappliedthreeelementsas mechanismsofaction:useofphotos;useofpatientquotesandpatient statements;anduseofgameelements

Nurses,physiotherapists, dieticians,occupational therapists,other;municipality (92%);hospital(6%)andpatient organization(2%)

Peoplewithchronicillness;

group-basedself-management education(numberofsessions notspeciﬁed)

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