***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Peer support is based on the belief that people who have faced , endured , and overcome adversity can offer useful support , encouragement , hope , and perhaps mentorship to others facing similar situations . While this belief is well accepted for many conditions , such as addiction , trauma , or cancer , stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system . Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management , opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement . This article defines  peer support as a form of mental health care and review s data from 4 r and omized controlled trials , which demonstrated few differences between the outcomes of conventional care when provided by peers versus non-peers . We then consider what , if any , unique contributions can be made by virtue of a person 's history of serious mental illness and recovery and review beginning efforts to identify and evaluate these potential valued-added components of care . We conclude by suggesting that  peer support  is still early in its development as a form of mental health service provision and encourage further exploration and evaluation of this promising , if yet unproven , practice OBJECTIVE To evaluate the feasibility of a telehealth psychoeducation intervention for persons with schizophrenia and their family members . STUDY DESIGN R and omized controlled trial . PARTICIPANTS 30 persons with schizophrenia and 21 family members or other informal support persons . INTERVENTIONS Web-based psychoeducation program that provided online group therapy and education . MAIN OUTCOME MEASURES Measures for persons with schizophrenia included perceived stress and perceived social support ; for family members , they included disease-related distress and perceived social support . RESULTS At 3 months , participants with schizophrenia in the intervention group reported lower perceived stress ( p = .04 ) and showed a trend for a higher perceived level of social support ( p = .06 ) . CONCLUSIONS The findings demonstrate the feasibility and impact of providing telehealth-based psychosocial treatments , including online therapy groups , to persons with schizophrenia and their families Background Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making . Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes . Objective This study reports the outcome of a r and omized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders . Methods The study was carried out in a Dutch mental health institution . Patients were recruited from 2 outpatient teams for patients with psychosis ( N=250 ) . Patients in the intervention condition ( n=124 ) were provided an account to access a Web-based information and decision tool aim ed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization . Patients were given the opportunity to use the Web-based tool either on their own ( at their home computer or at a computer of the service ) or with the support of an assistant . Patients in the control group received care as usual ( n=126 ) . Half of the patients in the sample were patients experiencing a first episode of psychosis ; the other half were patients with a chronic psychosis . Primary outcome was patient-perceived involvement in medical decision making , measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness ( COMRADE ) . Process evaluation consisted of question naire-based surveys , open interviews , and research er observation . Results In all , 73 patients completed the follow-up measurement and were included in the final analysis ( response rate 29.2 % ) . More than one-third ( 48/124 , 38.7 % ) of the patients who were provided access to the Web-based decision aid used it , and most used its full functionality . No differences were found between the intervention and control conditions on perceived involvement in medical decision making ( COMRADE satisfaction with communication : F1,68=0.422 , P=.52 ; COMRADE confidence in decision : F1,67=0.086 , P=.77 ) . In addition , results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams . Conclusions The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them . This holds for both first-episode patients and long-term care patients , although the latter group might need more assistance . However , results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making . This may be because of weak implementation of the study protocol and a low response rate . Trial Registration Dutch Trial Register ( NTR ) trial number : 10340 ; http://www.trialregister.nl/trialreg/admin/ rcts earch.asp?Term=10340 ( Archived by WebCite at http://www.webcitation.org/6Jj5umAeS ) Background Persons with serious mental illness ( SMI ) are disproportionately burdened by premature mortality . This disparity is exacerbated by poor continuity of care with the health system . The Veterans Health Administration ( VA ) developed Re-Engage , an effective population -based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services . However , such programs often encounter barriers getting implemented into routine care . Adaptive design s are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention . This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a st and ard implementation strategy ( Replicating Effective Programs , or REP ) with REP enhanced with External Facilitation ( enhanced REP ) to promote the uptake of Re-Engage . Methods / Design This study employs a four-phase , two-arm , longitudinal , clustered r and omized trial design . VA sites ( n = 158 ) across the United States with a design ated Re-Engage provider , at least one Veteran with SMI lost to care , and who received st and ard REP during a six-month run-in phase . Subsequently , 88 sites with inadequate uptake were stratified at the cluster level by geographic region ( n = 4 ) and VA regional service network ( n = 20 ) and r and omized to REP  ( n = 49 ) vs.  enhanced REP  ( n = 39 ) in phase two . The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry . The intervention was at the site and network level and consisted of st and ard REP versus REP enhanced by external phone facilitation consults . At 12 months ,  enhanced REP sites returned to st and ard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three . Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services . Discussion Adaptive implementation design s consisting of a sequence of decision rules that are tailored based on a site ’s uptake of an effective program may produce more relevant , rapid , and generalizable results by more quickly validating or rejecting new implementation strategies , thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies . Trial registration Current Controlled TrialsIS RCT N21059161 OBJECTIVE This study examined the use of a uniquely design ed Web site and home computers to deliver online multifamily psychoeducational therapy to persons with schizophrenia and their informal supports ( family and friends ) . Web site usage and outcome benefits are reported . METHODS Thirty-one persons with schizophrenia or schizoaffective disorder and 24 support persons were r and omly assigned to the online intervention ( telehealth ) or treatment as usual ( usual care ) condition . At three , six , and 12 months , interviewer-administered assessment s were conducted with participants . Intention-to-treat analyses compared persons with schizophrenia in the two study conditions on severity of positive symptoms and knowledge of schizophrenia . Support persons in the two study conditions were compared on knowledge of schizophrenia . Each participant 's usage of the Web site was logged . RESULTS Persons with schizophrenia in the telehealth condition had a large and significant reduction in positive symptoms ( p=.042 , d=-.88 ) and a large and significant increase in knowledge of schizophrenia compared with their counterparts in the usual care condition . Support persons in the telehealth condition showed a large and significant increase in knowledge about prognosis compared with those in the usual care condition ( p=.036 , d=1.94 ) . Persons with schizophrenia used the Web site to a much greater extent ( pages viewed and time spent ) than support persons . CONCLUSIONS These findings suggest that online delivery of psychotherapeutic treatment and educational re sources to consumers ' homes has considerable potential to improve consumer well-being and offers several advantages over st and ard clinic-based delivery models Despite the prevalence of Internet support groups for individuals with mental illnesses little is known about the potential benefits , or harm , of participating in such groups . Therefore , this r and omized controlled trial sought to determine the impact of unmoderated , unstructured Internet peer support , similar to what is naturally occurring on the Internet , on the well-being of individuals with psychiatric disabilities . Three hundred individuals resident in the USA diagnosed with a Schizophrenia Spectrum or an Affective Disorder were r and omized into one of three conditions : experimental Internet peer support via a listserv , experimental Internet peer support via a bulletin board , or a control condition . Three measurement time points , baseline , 4- and 12 months post-baseline , assessed well-being by examining measures of recovery , quality of life , empowerment , social support , and distress . Time × group interactions in the repeated measures ANOVA showed no differences between conditions on the main outcomes . Post-hoc repeated measures ANOVAs found that those individuals who participated more in Internet peer support reported higher levels of distress than those with less or no participation ( p = 0.03 ) . Those who reported more positive experiences with the Internet peer support group also reported higher levels of psychological distress than those reporting less positive experiences ( p = 0.01 ) . Study results therefore do not support the hypothesis that participation in an unmoderated , unstructured Internet listserv or bulletin board peer support group for individuals with psychiatric disabilities enhances well-being . Counterintuitive findings demonstrating those who report more positive experiences also experienced higher levels of distress are discussed but we also point to the need for additional research . Future research should explore the various structures , formats , and interventions of Internet support , as well as the content and quality of interactions . Knowledge generated from such research can help to inform policies and guidelines for safely navigating online re sources and supports to gain maximum benefit 
    Output:
    
Findings suggest the effects of social media interventions are largely unknown .