Evidence based practice in New Zealand: An evaluation of the effectiveness of a GSH programme.

Ms Maria SampsonDr Heather McDowellDr Jan GearyMs Lynne Blake

Outline

Background Why GSH? What is the evidence for GSH

Brief overview of the project What it is not! Participants Measures Research questions

Key Findings Implications

Why GSH?

Ability to reach more clients Earlier intervention Cost effective Group benefits

Social support Reduction of shame

Evidence based practiceMaintain gains

What is the evidence for GSH? Thiels et al., 1998, 2003 (Germany)

Ghaderi and Scott, 2003, 2006 (Sweden)

Bailer et al., 2004 (Austria)

Banasiak et al., 2005 (Australia)

Walsh et al., 2004 (USA)

Now to our NZ study!

How was this study different?

Mixed age groups

Support person

Investigated motivation

What it is not!

Not a RCT

Large sample size

Did not use the EDE to assess features of the ED

No medium or long term follow up

Overview of the project 39 Participants (BN and EDNOS)

All women between 13-39 years of age

Majority identified as New Zealand European

77% of the women had co-morbid diagnoses

All participants were asked to attend with a support person

Overview of the project cont.

All participants attended one of five consecutively run GSH groups Initially a 8 x 90 min session programme,

supported by a take-home manual. Based on Fairburn’s (1995) GSH model

Extended to a 10 week programme, preceded by three weeks of psycho-education and three follow-up sessions

GSH facilitated by two clinical psychologists

28 completed the programme

How did we measure change?

Key symptoms were assessed pre- and post-treatment by the SEED (Bauer Winn, Schmidt & Kordy,2005)

Motivation to change was assessed by an adapted version of the ‘To change or Not to Change’ Questionnaire (Rollnick, Morgan& Heather, 1996).

What were we hoping to find out?

Main aim: To evaluate the effectiveness of the programme

And answer some key questions

What were we hoping to find out? Some of our Key Questions:

Is there a reduction in BN and EDNOS symptoms at the end of the programme?

And is there a difference depending on age?

Will the presence of a support person impact on the BN and EDNOS symptoms?

Will motivation change as a result of completing the GSH programme?

Can we detect any difference between those who completed the programme vs. non-completers?

Changes in SEED scores

Overall the BN score reduced from 2.22 1.57 p= .0001

For participants 19 and over 2.30 1.72 p=.001

For participants 18 and under 2.05 1.25 p=.0001

Effects of having a support person

BN index on the SEED with support person 2.21 1.59 p=.0001

Motivation scores with a support person 19.08 22.82 p=.0001

Differences in motivation

Overall, the total sample made improvements in their motivation

Age discrepancies in Q1(How motivated are you to change?)

No significant improvement in either sub-group for Q3 (How ready are you to change?)

Completers vs. Non-Completers

Mean durationCompleters 64.07 months vs. Non-

Completers 82.36 months (p=0.04)

Support person 82% Completers vs. 46% Non-completers

(p=0.02)

Medication 57% Completers vs. 82% Non-Completers

(p=0.02)

Group Evaluation

87% found the format of the GSH suited their needs

Qualitative feedback Like to talk more about effects on siblings and

family and triggers More dietary advice More time for group discussions More one-to-one help GSH has given me the confidence to change GSH has given me a more positive outlook on life

Practical Implications Significant improvements from GSH!

Consider who GSH is most useful for (age, duration, meds etc)

Impact of the support person and mixed age groups.

Possibilities for future GSH research in NZ

Larger sample

Medium and long term follow up

RCT

Qualitative work

Acknowledgements

My supervisor Dr Heather McDowell

Dr Jan Geary and Lynne Blake from EDS in Auckland

Family and friends

On that note..