The aim of this thesis was to investigate in a (RCT) the effect of support group intervention in women with primary breast cancer in the short term, and with a long-term follow-up. Women with primary breast cancer were randomized between April 2002 and November 2007 and stratified according to adjuvant treatment with chemotherapy. Of 382 eligible patients, 191+191 patients were randomized to intervention and control groups respectively. Control patients were subjected to standard follow-up procedures. Patients in the intervention group received support intervention at the Foundation of Lustgården Mälardalen during one week followed by four days of follow-up two months later. Patients in intervention and control groups filled in questionnaires at baseline, after 2, 6 and 12 months and in the long-term follow-up after a mean of 6.5 years. In paper I, we studied the effect of the intervention on anxiety and depression measured by the HAD scale and we could show that a significantly lower proportion of women in the intervention group had high anxiety scores compared with women in the control group after 12 months; however, the proportion of women with high depression scores were unaffected. In paper II, we studied the effect of the intervention on fatigue and health-related quality of life (HRQoL) measured by the Norwegian version of the fatigue questionnaire (FQ) and EORTC-QLQ 30 and BR 23.We could not demonstrate any significant effect of the intervention. In paper III, we studied the effect of the intervention on sick-leave, healthcare utilization and the effect of the intervention in economic terms. We used a specially formulated questionnaire. There was a trend towards longer sick leave and more health-care utilization in the intervention group. The difference in total costs was statistically significantly higher in the intervention group after 12 months (p= 0.0036). In paper IV, we studied the long-term effects of the support intervention on anxiety, depression, fatigue and HRQoL. We could show a significant effect of the intervention on cognitive function, body image, future perspective and fatigue, the largest effect was seen among women who received chemotherapy; however, no effects on anxiety and depression were demonstrated.

The transition from primary to secondary school is regarded as one of the most difficult in children’s educational careers and the negative academic, social and emotional effects of an unsuccessful transition have been widely documented, with many practitioners identifying the transition to secondary school as a key intervention point (Galton, Morrison and Pell, 2000, Turnbull, 2006). Shy and socially withdrawn children are particularly vulnerable at this time. Pyramid Clubs, a short-term selective and preventative therapeutic group intervention offer a promising model of support, but a robust evidence-base is currently lacking (Munoz, Mrazek, and Haggerty, 1999; Shepherd and Roker, 2005). This study evaluated the use of a Pyramid Club to provide a ‘bridge’ of support before, during and following nine children’s transition to secondary school. The study was conducted from a critical realist stance and quantitative and qualitative methodology were adopted within an embedded single-case study design. The study had two aims; to evaluate the effectiveness of the club; and to explore the process, in order to understand the club’s mechanism of effect. Pre-and post-intervention teacher report data were collected in conjunction with club leader, club member and parents’ perspectives, obtained though focus groups and individual interviews. The researcher also observed each club meeting. Data were analysed using descriptive statistics and thematic analysis. The findings indicate the club offers an effective method of support. The children enjoyed the club experience and a range of social-emotional gains were reported. The findings were used to propose a theoretical framework based on the concept of resilience, to explain how Pyramid Clubs can be successfully used to support vulnerable children’s transition to secondary school. Core elements, which were considered to be essential components of the intervention, were identified to aid future implementation and evaluation of Transition Pyramid Clubs.

The aim of this study was to evaluate a 24-week support group intervention programme which was designed to enhance adaptive behaviour of latent-phase children affected by maternal HIV/Aids. The meta-theoretical paradigms underlying the study were pragmatism and realism. The study was embedded in a concurrent nested (QUALquan) mixed-method design. The quantitative approach in the main study followed a quasi-experimental research design whereas the qualitative approach in this study, contributing to the largest part of the analysis in the study, followed a nested multiple case study design. The theory-driven outcome programme evaluation model applied in this study was the integrative process/outcome evaluation approach. The participants (n=139) were purposefully selected from among previously identified HIV-positive women (n=220) with children between the ages of 6 and 10 years at clinics in the Tshwane region, South Africa. Data were collected over a period of five years in multiple waves of intervention implementation. Prolonged, in-depth engagement by the researcher with participants was prioritized. The data collection strategies comprised of mother-and-child psychological questionnaires, group process notes, careworker focus groups, quality assurance questionnaires and field notes. The data were quantitatively analysed by means of a paired-sample t-test for within-group comparisons and descriptive statistics were furthermore applied. The qualitative text and narration obtained through the interviews, documents and focus groups were coded and analysed for themes. The themes of the emergent concepts were re-coded to establish improved defined categories. The different data sampling strategies assisted the researcher in triangulating the data for increased evaluation reliability. The PhD-study was conducted within a broader longitudinal study on resilience in South African mothers and children affected by HIV/Aids – the Promoting Resilience in Young Children Study. The findings of the Child Support Group Evaluation Study (e.g. PhD) showed that the content, methods and processes employed in the group-based sessions were effective and culturally sensitive. The intervention sessions enhanced the children’s coping skills, internalised and externalised behaviour and daily living, communication and socialisation skills. The group provided a buffer for the children and supported them in coping with their mothers’ illness. The children displayed normative values through their religious coping styles, their quest for and display of respect and their unambiguous assertion of right and wrong. A specific finding of this study was that the children created a sphere or space in which to order their thoughts, behaviours and emotions within the intervention. This provided them with parameters in their adverse circumstances to display adaptive behaviour or resilience which they could use to function adequately. The study suggests that the use of support groups should be incorporated into intervention programmes dealing with latent-phase children affected by HIV/Aids. / Thesis (PhD)--University of Pretoria, 2013. / gm2014 / Educational Psychology / unrestricted