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Rohloff N, Götz T, Kortekamp SS, Heinze NR, Weber C, Schäfer SD. Influence of App-Based Self-Management on the Quality of Life of Women With Endometriosis. Cureus 2024; 16:e67655. [PMID: 39314601 PMCID: PMC11417970 DOI: 10.7759/cureus.67655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but are often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine the impact of the Endo-App (Endo Health GmbH, Chemnitz, Germany) on both disease-related quality of life and symptoms of endometriosis affecting it. METHODS In the present randomized, controlled pilot study, the impact of utilizing the Endo-App on the quality of life among a sample of 122 women affected by endometriosis is assessed. To measure the changes over a 12-week period, the study incorporates the validated Endometriosis Health Profile (EHP-5 and EHP-30) questionnaire from Oxford University, among other assessment tools. RESULTS The use of the Endo-App leads to significant changes in the following areas after 12 weeks compared to the control group: pain disability, pain self-efficacy, fatigue, depressive symptoms, and Endometriosis Health Profile scores. The EHP-5 score from T0 to T12 is reduced by -16.76 (p-value of the Mann-Whitney U test (pU) = 0.008), and the EHP-30 score by -15.48 (pU = 0.004). The results remain significant in sensitivity analyses. The effect size of Cohen's d was in the medium range. CONCLUSION In summary, the Endo-App improves both physical and psychological symptoms and the patient's self-efficacy. The Endo-App contributes to improving endometriosis care in Germany and enables women suffering from endometriosis to significantly increase their quality of life.
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Theißen T, Ullrich A, Oechsle K, Wikert J, Bokemeyer C, Schieferdecker A. "Being an informal caregiver - strengthening resources": mixed methods evaluation of a psychoeducational intervention supporting informal caregivers in palliative care. BMC Palliat Care 2024; 23:95. [PMID: 38600500 PMCID: PMC11007958 DOI: 10.1186/s12904-024-01428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Informal caregivers are key support for patients with progressive incurable diseases. However, their own needs often remain unmet. Therefore, we developed, manualised and implemented the intervention "Being an informal caregiver - strengthening resources" aiming to support and empower informal caregivers by addressing relevant information-related, physical, psychological and social needs. METHODS In this pilot study, we evaluated the acceptance and experiences with this psychoeducational intervention. The study was conducted over two years (2019-2021). Informal caregivers were recruited from the University Medical Centre Hamburg-Eppendorf and the metropolitan region of Hamburg, Germany. The intervention was aimed at adult persons who identified themselves as an informal caregiver to an adult patient with a progressive incurable cancer and non-cancer disease. For the evaluation we used a mixed methods approach, combining a longitudinal questionnaire survey (pre-intervention, after each module, 3-months follow-up) and semi-structured interviews post-intervention. Quantitative data were analysed using descriptive statistics and a paired t-Test, interviews were analysed based on the qualitative content analysis according to Mayring. Results were triangulated using a convergent triangulation design. RESULTS Of 31 informal caregivers who received the intervention, 25 returned the follow-up questionnaire and 20 informal caregivers were interviewed. Triangulated results showed a high satisfaction with the implementation of the intervention. Of a broad range of subjective benefits, gaining knowledge, self-awareness and self-efficacy were most apparent. Informal caregivers reported improved preparedness, awareness of own needs as well as confidence regarding handling own emotions and interacting with the ill person. However, implementing the learned skills into daily life can be challenging due to internal and external factors. Motivations and challenges for participating as well as potential for improvement were identified. CONCLUSIONS This pilot study showed an overall positive evaluation and several subjective benefits of the psychoeducational intervention "Being an informal caregiver - strengthening resources". Further research is needed to measure the efficacy of this intervention on informal caregivers' outcomes. Therefore, a multicentre randomized prospective study is planned.
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Affiliation(s)
- Tabea Theißen
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Julia Wikert
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Aneta Schieferdecker
- Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Lehmann H, Kraus T, Esser A, Krabbe J. Evaluation of a Workplace Active Rest Program in Office Workers With Comparison of a Prospective and Retrospective Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231220605. [PMID: 38146165 PMCID: PMC10752044 DOI: 10.1177/00469580231220605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023]
Abstract
Physical activity-related workplace interventions can be counterstrategies for physical inactivity due to office work. Newly introduced programs should be evaluated for success. This study aimed to evaluate the intervention of a workplace active rest program and to compare a prospective and retrospective design of evaluation. A Germany-wide multicenter evaluation of a 3-month workplace active rest program (30 min, once a week) was carried out at 14 locations with a longitudinal pre/post design by means of an anonymous questionnaire (npre = 405, npost = 369). The participants' program-related changes in targeted characteristics regarding posture, function, complaints and physical awareness were collected with a questionnaire in a prospective design and afterward retrospectively. The prospective evaluation showed a significant improvement in the target characteristic "postural muscles in the neck area". In the retrospective survey, all target characteristics improved significantly. There were no differences between locations. The workplace active rest program in this study had positive effects on the perception of postural neck muscle status regardless of prospective or retrospective approach. Selection of survey mode should depend on desired outcome and consecutive influencing factors. In this specific case, retrospective survey could give more indirect information about overall satisfaction with the program and job although being influenced by response bias. Recall bias should be relatively small for shorter time periods assessed. Future studies should account for corresponding bias and specifics of target characteristics regardless of the chosen approach to survey.
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Affiliation(s)
- Heidi Lehmann
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Social Accident Insurance Institution for the Energy, Textile, Electrical and Media Products Sectors (BG ETEM), Köln, Germany
| | - Thomas Kraus
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - André Esser
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Julia Krabbe
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Chen B, Shin S, Wu M, Liu Z. Visualizing the Knowledge Domain in Health Education: A Scientometric Analysis Based on CiteSpace. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6440. [PMID: 35682025 PMCID: PMC9180308 DOI: 10.3390/ijerph19116440] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to visualize the evidence in the global research on health education to better improve the nation's health literacy and to guide future research. METHOD We searched the Web of Science (Core Collection) electronic databases. The search strategies: topic: ("Health Education" OR "Education, Health" OR "Community Health Education" OR "Education, Community Health" OR "Health Education, Community") AND document: (Article) AND language:(English). Articles of evidence from January 2011 to December 2021 with those words in the title or abstract or keywords will be included in this review. We used the Citespace 5.6.R5 (64-bit) to investigate and determine the thematic patterns, and emerging trends of the knowledge domain, and presented a narrative account of the findings. RESULT We analyzed 10,273 eligible articles. It showed that BMC Public Health displays the most prolific journals. Author MARCO PAHOR is highlighted in health education. The University of Sydney has published the most studies about health education. The USA plays an important role in these studies. Specifically, the visualization shows several hotspots: disease prevalence surveys and a specific population of knowledge, attitude and practice surveys, health intervention, chronic and non-communicable management, youth-health action, sexual and reproductive health, and physical activity promotion. Furthermore, document co-citation analysis indicated that there are 10 main clusters, which means the research front in health education. Meanwhile, by the citation detected, COVID-19, has achieved universal health coverage in related studies, however, public health education and the health workforce might be more popular in the coming years. CONCLUSION Health education is an effective measure to shift the concept of public health and improve healthy living standards. The present study facilitates an extensive understanding of the basic knowledge and research frontiers that are pivotal for the developmental process of health education and allows scholars to visualize the identification modes and tendencies.
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Affiliation(s)
- Boyuan Chen
- Department of Physical Education, Henan University of Science and Technology, Luoyang 471023, China;
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou 450001, China; (M.W.); (Z.L.)
| | - Sohee Shin
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
| | - Ming Wu
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou 450001, China; (M.W.); (Z.L.)
| | - Zhihui Liu
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou 450001, China; (M.W.); (Z.L.)
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Jeyathevan G, Jaglal SB, Hitzig SL, Linassi G, Mills S, Noonan VK, Anzai K, Clarke T, Wolfe D, Bayley M, Aslam L, Farahani F, Alavinia SM, Omidvar M, Craven BC. Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S94-S117. [PMID: 34779736 PMCID: PMC8604486 DOI: 10.1080/10790268.2021.1961054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. METHODS Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. RESULTS The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. CONCLUSION The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual's self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.
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Affiliation(s)
- Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sandra Mills
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Karen Anzai
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | | | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada,School of Health Studies, Western University, London, Ontario, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lubna Aslam
- Spinal Cord Injury Ontario, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 206-H 520 Sutherland Drive, Toronto, ON, M4G3V9, Canada; Ph: 416-597-3422x6122.
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Depping MK, Uhlenbusch N, Härter M, Schramm C, Löwe B. Efficacy of a Brief, Peer-Delivered Self-management Intervention for Patients With Rare Chronic Diseases: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:607-615. [PMID: 33625502 PMCID: PMC7905693 DOI: 10.1001/jamapsychiatry.2020.4783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Patients coping with rare diseases need psychosocial support. OBJECTIVE To evaluate the efficacy of a brief, transdiagnostic, peer-delivered intervention for patients with rare diseases in addition to care as usual (CAU) compared with CAU only. DESIGN, SETTING, AND PARTICIPANTS In this 2-group randomized clinical trial conducted from October 5, 2017, to July 12, 2019, patients were recruited via specialized clinics and patient organizations across Germany and participated from home. The study included consecutive adult patients with neurofibromatosis type 1, Marfan syndrome, primary sclerosing cholangitis, and pulmonary arterial hypertension who have limited functionality because of the disease. Exclusion criteria were a life-threatening health status and ongoing psychotherapeutic treatment. Of 143 patients screened for eligibility with a semistructured telephone interview, 54 were excluded, and 89 were randomized: 45 patients were randomly allocated to the peer-delivered intervention group, and 44 to the control group; 87 patients (98%) completed the 6-month follow-up assessment. The analysis was performed using an intention-to-treat principle. Data cleansing and analysis were conducted between April 25, 2019, and February 13, 2020. INTERVENTIONS The 6-week intervention consisted of a self-help book and telephone-based peer counseling in addition to CAU. The control group received CAU alone. Peer counselors received training, structured consultation guidelines, and supervision. MAIN OUTCOMES AND MEASURES The primary outcome was acceptance of the disease as assessed using the Illness Cognition Questionnaire (ICQ; mean sum scores range from 0 to 18, with higher values representing more acceptance) 6 months after the intervention. Secondary outcomes included self-reported coping strategies (Health Education Impact Questionnaire), illness cognition (ICQ and Illness Perception Questionnaire), depression severity (Patient Health Questionnaire 9-item depression scale), anxiety severity (Generalized Anxiety Disorder Scale), quality of life (12-Item Short-Form Health Survey), and social support (Social Support Questionnaire). Outcomes were assessed before the intervention, after the intervention, and at a 6-month follow-up. RESULTS The mean (SD) age of the 89 participating patients was 46.3 (14.9) years; 59 (66%) were women. There were no group differences regarding baseline variables. All patients allocated to the intervention group completed the intervention. Six months after the intervention, but not directly after completing the program, the intervention group had significantly higher rates of acceptance (ICQ) of the disease (primary outcome) compared with the CAU group. Mean (SD) baseline ICQ scores were 9.61 (3.79) in the control group and 9.86 (3.40) in the intervention group. Mean (SE) ICQ scores at 6 months were 10.32 (0.42) for the control group and 11.79 (0.42) for the intervention group, with a significant mean difference of -1.47 (95% CI, -2.63 to -0.31; P = .01). Several secondary outcomes, including different coping strategies, social support, and mental quality of life, were significantly higher after the intervention compared with the control group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, a self-help and peer counseling intervention improved patients' acceptance of their rare chronic diseases. Self-management and peer support can efficiently address the unique care needs of patients with rare diseases. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN13738704.
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Affiliation(s)
- Miriam K. Depping
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,Hamburg Center for Translational Immunology, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Adams L, Feicke J, Eckert T, Spörhase U, Göhner W, Bitzer EM. [A Motivational-Volitional Program for Women after Breast Cancer Increases Physical Activity 12 Months Post Rehabilitation - Results of a Prospective Controlled Trial]. REHABILITATION 2021; 60:110-123. [PMID: 33858020 DOI: 10.1055/a-1361-4858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the effectiveness of a motivational-volitional program for women after breast cancer (MoVo-BnB) who engage less than 60 minutes per week in physical activity. METHODS This is a non-randomised, prospective bi-centered controlled trial in 2 in-patient medical rehabilitation centers. Data are assessed at 4 measurement points: at admission, discharge, 6 and 12 months post discharge. The control group (CG; n=266) has received the standard rehabilitation, and the intervention group (IG; n=279) attended additionally the group program (4 sessions lead by physiotherapeutic and health pedagogic personnel). The primary outcome is self-reported physical activity (BSA-F); secondary outcomes are health related quality of life (QLQ-C30), breast cancer specific quality of health (QLQ-BR23) and program acceptance. Analysis of change are performed by ANCOVA for each follow-up, adjusting for baseline values. RESULTS At 12 months follow up, the level of exercise in the intervention group is 22 min/week higher than in the control group (95% CI: 2,6 to 41.5; p=0.02). Further, 49.1% of the intervention group exercises for at least 60 min/week compared to 37.6% of the control group (p≤0.01). We have observed no significant differences between the groups for quality of life. The participants' evaluation of the intervention is positive and does not differ substantially between the 2 clinics (p=0.3). CONCLUSION Our findings demonstrate that a cognitive-behavioral program based on the motivation-volitional model can lead to long-term improvement in exercise behavior in breast cancer patients, who is initially minimally active. Physical activity should be encouraged after breast cancer diagnosis. The results suggest that practitioners working in cancer aftercare might like to consider using a motivational-volitional program for improving and maintaining physical activity behavior for physical sedentary target groups.
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Assessing health empowerment - Brazilian cross-cultural adaptation and validity testing of the health education impact questionnaire (heiQ) among people with chronic low back pain. Braz J Phys Ther 2021; 25:460-470. [PMID: 33583719 DOI: 10.1016/j.bjpt.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/01/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There is no patient reported outcome measure available in Brazilian Portuguese to comprehensively assess outcomes following administration of patient education programs for people with chronic conditions. OBJECTIVE To describe the cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the Health Education Impact Questionnaire (heiQ), a multidimensional questionnaire designed for the evaluation of patient education programs, which was tested in people with chronic low back pain (LBP). METHODS One hundred thirty-seven individuals with non-specific chronic LBP (age: 38.7 ± 13.2) were enrolled in the study. The translation was performed according to international standards. Intraclass correlation coefficient (ICC) was used to assess test-retest reliability, Cronbach's α to assess internal consistency, Pearson rank correlation to compare the heiQ scales with comparator scales, and confirmatory factor analysis (CFA) for structural validity. RESULTS The test-retest analysis yielded ICC values ranging from 0.75 to 0.91. Cronbach's alphas for the seven scales ranged from 0.70 to 0.89. Significant correlations between affective and general health constructs and the heiQ scales (72%) were observed. For the majority of the scales, the CFA fit statistics showed to be good to excellent. CONCLUSION Overall, the Brazilian Portuguese version of the heiQ showed acceptable reliability, internal consistency, construct validity, and structural validity in individuals with chronic LBP. The heiQ scales may serve as direct outcomes to assess education and self-management programs for the Brazilian Portuguese speaker population.
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Pozza A, Osborne RH, Elsworth GR, Gualtieri G, Ferretti F, Coluccia A. Evaluation of the Health Education Impact Questionnaire (heiQ), a Self-Management Skill Assessment Tool, in Italian Chronic Patients. Psychol Res Behav Manag 2020; 13:459-471. [PMID: 32547268 PMCID: PMC7246315 DOI: 10.2147/prbm.s245063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes). Methods Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed. Results A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches. Conclusion The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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Hüppe A, Langbrandtner J, Lill C, Raspe H. The Effectiveness of Actively Induced Medical Rehabilitation in Chronic Inflammatory Bowel Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:89-96. [PMID: 32102728 DOI: 10.3238/arztebl.2020.0089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The poor evidence base is a major problem for the German rehabilitation sector. This trial focused on testing the efficacy and benefit of inpatient medical rehabilitation compared to routine care in a single common entity, namely, chronic inflammatory bowel disease (IBD). METHODS This pragmatic, multicenter, randomized controlled trial with a parallel group design included gainfully employed patients with IBD who were covered by one of four statutory health insurance providers. Patients in the intervention group were actively advised regarding options for rehabilitation and given support in applying for it; patients in the control group continued with the care they had been receiving before participation in the trial. The primary endpoint was social participation, and there were various secondary endpoints, including disease activity and sick days taken off from work. All parameters were assessed by questionnaire at the beginning of the trial and twelve months later. This was trial no. DRKS00009912 in the German clinical trials registry. RESULTS In a complete case analysis, the intervention group (211 patients, of whom 112 underwent rehabilitation) did better than the control group (220 patients, of whom 15 underwent rehabilitation) in multiple respects. The reported limitation in social participation was reduced by 7.3 points in the intervention group and 2.9 points in the control group (p = 0.018; d = 0.23). Significant improvements were also seen in disease activity, vitality, health-related quality of life, and self-management, with effect sizes between 0.3 and 0.4. No benefit was seen in outcomes related to working capacity. Sensitivity analyses lent further support to the findings. CONCLUSION Rehabilitation research can be conducted with individually randomized, controlled trials. The findings of this trial indicate the absolute effectiveness of ied rehabilitation for IBD patients, as well as its additional benefit compared to routine care.
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Affiliation(s)
- Angelika Hüppe
- Institute of Social Medicine and Epidemiology, University of Lübeck; Center for Population Medicine and Health Services Research, University of Lübeck
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Does a Train-the-Trainer Approach for Enhancing Healthcare Professionals' Skills in Patient Education during Inpatient Medical Rehabilitation Improve Patient Outcomes? Rehabil Res Pract 2020; 2020:8316256. [PMID: 32274215 PMCID: PMC7132594 DOI: 10.1155/2020/8316256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
Abstract
This study is aimed at identifying the impact of a team-based train-the-trainer program (TTT-P) to enhance healthcare professional (HCP) skills in patient education during medical rehabilitation. Focusing on patient-reported outcomes, a prospective, sequential two-cohort study was conducted in the fields of psychosomatic and oncological rehabilitation. Two hundred fifteen patients were evaluated before (Cohort 1) and 196 post implementation of TTT-P (Cohort 2). Patients of both cohorts completed validated questionnaires on self-management (heiQ®), general self-efficacy (GSE scale), and quality of life (WHOQOL-Bref) at the beginning, at the end, and at the 6-month follow-up to analyze short- and intermediate-term effects. Analyses were conducted separately for the psychosomatic and oncological setting. Results showed that TTT-P had no impact on patient outcomes in both rehabilitation settings. Patients did report positive outcomes as a result of the whole inpatient rehabilitation programs, though effects at follow-up were mostly small to medium size. Concerning self-management competencies, cancer patients gained less benefit during rehabilitation than psychosomatic patients. In conclusion, TTT-P did not result in measurable improvements at the patient level, likely because of the limited nature of the intervention. However, these populations of rehabilitants took benefit from participating in a multimodal rehabilitation program, of which patient education is one part.
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Pozza A, Osborne RH, Elsworth GR, Ferretti F, Coluccia A. Italian validation of the health education impact questionnaire (heiQ) in people with chronic conditions. Health Qual Life Outcomes 2020; 18:89. [PMID: 32228608 PMCID: PMC7106648 DOI: 10.1186/s12955-020-01329-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The health education impact Questionnaire (heiQ) measures eight self-management skills in people with chronic conditions. It seems to be important to provide cross-cultural evidence on its properties in non-English healthcare contexts. The present study assessed the psychometric properties of the heiQ in Italian adults with chronic conditions. METHODS Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50.16% females) completed the heiQ and the Medical Outcomes Study-Short Form (SF-36). Confirmatory factor analyses, Composite Reliability Indices, and bivariate correlations were performed. RESULTS Structural validity based on 8 correlated factors with good fit was in line with previous research. Concurrent validity was confirmed, as shown by moderate associations between the scores on the Constructive attitudes and approaches, Self-monitoring and insight, Health directed activities, Social integration and support, and Emotional distress subscales and the scores on SF-36 Physical functioning, General health perceptions, Vitality, Social functioning, Perceived mental health and Role limitations due to physical and emotional problems subscales. CONCLUSIONS The Italian heiQ has strong properties and it can be used routinely also in the Italian healthcare services.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci, 16 53100, Siena, Italy
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia.,University of Copenhagen, Copenhagen, Denmark
| | | | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci, 16 53100, Siena, Italy.
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale Bracci, 16 53100, Siena, Italy
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Bayrhuber M, Anka N, Camp J, Glattacker M, Farin E, Rieg S. Prevention of post-splenectomy sepsis in patients with asplenia - a study protocol of a controlled trial. BMC Infect Dis 2020; 20:41. [PMID: 31937251 PMCID: PMC6961276 DOI: 10.1186/s12879-019-4752-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/30/2019] [Indexed: 12/03/2022] Open
Abstract
Background Patients with asplenia have a significantly increased lifelong risk of severe invasive infections, particular post-splenectomy sepsis (PSS). Clear preventive measures have been described in the literature, but previous studies found poor implementation of prevention recommendations. Aim of the study is to improve the adherence to guideline-based preventive measures and thereby reduce the incidence of PSS by a novel telephone-delivered intervention that involves both patients and their physicians. Methods A prospective controlled, two-armed historical control group design is used to evaluate the new intervention compared to usual care. The intervention for patients includes both educational aspects and, building on the Health Action Process Approach (HAPA), intervention components that promote motivation and planning of preventive measures. For physicians the intervention is primarily information-based. The primary outcome, the adherence to preventative measures, is indicated by a study-specific ‘Preventing PSS-score’ (PrePSS-score), which is assessed at baseline and at 6-months follow-up. Secondary outcomes include, amongst others, patient self-efficacy and action-planning, asplenia-specific health literacy, general self-management and asplenia-specific self-management. In a process-evaluating part of the study interview-data on patients’ and physicians’ evaluation of the intervention will be gathered. Discussion This trial will provide evidence about the effectiveness of the novel prevention intervention for asplenic patients. If demonstrated beneficial, the intervention manual will be made publicly available to enable implementation in practice. The experience gained within this trial may also be valuable for prevention strategies in patients with other diseases. Trial registration German Clinical Trials Register (DRKS): DRKS00015238; Trial registration date 07. December 2018.
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Affiliation(s)
- Marianne Bayrhuber
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Natascha Anka
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Center -Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erik Farin
- Section of Health Care Research and Rehabilitation Research, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center -Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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[Participation in self-help groups: impact on self-management and knowledge]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:10-16. [PMID: 30478487 DOI: 10.1007/s00103-018-2850-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Self-help groups (SHGs) are an inherent part of patient involvement and play an important role in the healthcare system. Until now, however, there has been a lack of systematic investigations and quantitative data about the individual impact of self-help for patients and relatives. OBJECTIVES This study presents the results of a comparison between members of SHGs and non-members. Thereby, the effects of self-help shall be described in terms of empowerment and self-management. The study is part of the project "Health-related Collective Self-Help in Germany" (Gesundheitsbezogene Selbsthilfe in Deutschland-SHILD) funded by the Federal Ministry of Health. MATERIALS AND METHODS The study was conducted with patients from five therapeutic areas (diabetes mellitus type 2, prostate cancer, multiple sclerosis, tinnitus, relatives of dementia patients). Participants administered a multidimensional questionnaire (paper-and-pencil or online). Of the 2870 participants in this analysis, 49% were active members of SHGs. RESULTS Statistical analysis showed some significant, but small differences between the two groups in five out of seven scales of the Health Education Impact Questionnaire (heiQ) in favour of the SHG members. Furthermore, SHG members performed better in specific knowledge tests. Members see the importance of their group especially in social inclusion, psychosocial relief, coping with the disease and new insights in dealing with the disease. CONCLUSIONS With respect to the study design we cannot rule out that differences might be based on personal characteristics influencing the decision to participate in a SHG or not. But as the results are controlled for confounders, the hypothesis that SHG participation has a positive impact on the outcomes rather than vice versa seems supported.
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COPD-Specific Self-Management Support Provided by Trained Educators in Everyday Practice is Associated with Improved Quality of Life, Health-Directed Behaviors, and Skill and Technique Acquisition: A Convergent Embedded Mixed-Methods Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 13:103-119. [PMID: 31502238 DOI: 10.1007/s40271-019-00386-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is a necessity to better document the effect of continuing education activities targeted at respiratory educators providing self-management support for patients with chronic obstructive pulmonary disease (COPD). We therefore sought to describe real-life COPD-specific self-management support delivered by respiratory educators who participated in a lecture-based continuing education activity and assess the outcomes of patients with COPD. METHODS We conducted a convergent embedded mixed-methods study. Respiratory educators attended a 7-h, lecture-based continuing education activity on self-management support held in Québec, Canada. Four months after the continuing education activity, in their professional practice, trained educators provided self-management support to patients with COPD. One month later, to describe the components of self-management support provided, individual telephone interviews were conducted with educators. Interviews were transcribed verbatim and were qualitatively analyzed. Before self-management support and 6 months afterwards, we assessed the following clinical outcomes of patients with COPD: (1) quality of life (St. George's Respiratory Questionnaire for COPD patients, Impact domain; score 0-100; minimal clinically important difference = - 4; telephone administered); (2a) whether patients had one or more unscheduled doctor visit, (2b) one or more emergency room visit, and (2c) one or more hospitalization in the 6 preceding months (Survey on Living with Chronic Diseases in Canada; telephone administered); and (3a) health-directed behaviors and (3b) skill and technique acquisition (Health Education Impact Questionnaire; score 1-4; self-administered at home). We used mixed models to estimate mean differences and prevalence ratios, with associated 95% confidence intervals. RESULTS Trained respiratory educators (nurse: n = 1; respiratory therapist: n = 3; ≥ 15 years of experience of care with patients with chronic disease) invited 75 patients with COPD to participate in the study. Fifty-four individuals with COPD (age, mean ± standard deviation: 68 ± 8 years; men: n = 31) were enrolled and received self-management support. Qualitative analyses revealed that self-management support consisted of one to two visits that included: (1) provision of information on COPD; (2) training in inhalation technique; and (3) smoking cessation advice. No educator reported implementing two or more follow-up visits because of a lack of time and human resources in their work setting. Among patients with COPD, improvements in quality of life were clinically important (adjusted mean difference = - 12.75; 95% confidence interval - 18.79 to - 6.71; p = 0.0001). Health-resource utilization was not different over time (all p values > 0.05). Improvements in health-directed behaviors and skill and technique acquisition were statistically significant (health-directed behaviors: adjusted mean difference = 0.50; 95% confidence interval 0.23-0.77; p = 0.0005; skill and technique acquisition: adjusted mean difference = 0.12; 95% confidence interval 0.01-0.23; p = 0.0293). CONCLUSIONS Following a 7-h, lecture-based continuing education activity on COPD-specific self-management support, respiratory educators with significant experience of care provided self-management support that included provision of information, inhalation technique training, and smoking cessation advice. This resulted in enhanced patient quality of life, health-directed behaviors, and skill and technique acquisition. To decrease health resource utilization, the training could employ active learning methods. More time and resources could also be devoted to implementing regular follow-up visits. CLINICAL TRIALS REGISTRATION NO NCT02870998.
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Question prompts to empower cancer patients: results of a randomized controlled trial. Support Care Cancer 2019; 28:2571-2579. [DOI: 10.1007/s00520-019-05036-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/08/2019] [Indexed: 12/31/2022]
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Quality of life and fear of disease progression are associated with aspects of health literacy in men with prostate cancer from Germany. Support Care Cancer 2019; 28:2283-2292. [PMID: 31473840 DOI: 10.1007/s00520-019-05052-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Our research aimed to identify whether specific aspects of health literacy (HL) are associated with quality of life (QOL) and fear of progression (FOP) in men with prostate cancer (PC). METHODS We conducted a cross-sectional study. Regarding HL, we surveyed communication skills, guideline awareness, and knowledge in several domains: PC, health care system, own physical condition, dealing with health problems. Research questions were addressed using regression models for QOL and FOP including sociodemographic and disease-related variables as additional predictors. RESULTS One thousand five hundred seventy-seven men completed the questionnaire. Better QOL was statistically significant associated with communication skills (OR 2.24; CI 1.57-3.21), knowledge of dealing with health problems (OR 2.54; CI 1.74-3.72), and knowledge of own physical condition (OR 0.63; CI 0.42-0.95). FOP decreased with increasing communication skills (β - 0.09; CI - 0.15 to - 0.04), knowledge of health care system (β - 0.07; CI - 0.12 to - 0.02), and knowledge of dealing with health problems (β - 0.21; CI - 0.27 to - 0.15). It increased with guideline awareness (β 0.07; CI 0.02-0.11), PC knowledge (β 0.11; CI 0.06-0.16), and knowledge about own physical condition (β 0.11; CI 0.05-0.17). CONCLUSIONS The findings lead to the hypothesis that some aspects of HL may have a positive and some a negative influence on men with PC. Men should not be overwhelmed by a recommendation for self-observation or by promotion of PC knowledge. Interventions are needed that provide knowledge for managing health problems. Communication in health care should be tailored to men's needs.
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Kusma B, Pietsch A, Riepenhof H, Haß S, Kuhn D, Fischer K, Nienhaus A. The Back College for nurses - an evaluation of intermediate effects. J Occup Med Toxicol 2019; 14:19. [PMID: 31249605 PMCID: PMC6584993 DOI: 10.1186/s12995-019-0239-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/10/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Nursing staff and care workers run an increased risk of work related musculoskeletal disorders such as low back pain. The Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) offers its insured persons the opportunity to participate in a three-week Back College with the aim of preventing them having to abandon their profession due to back problems. The aim of the study was to record the effectiveness and sustainability of the Back College on an intermediate basis (6 months). METHODS As part of a single-group pre-post measurement on three survey dates - at the start (T0) and end (T1) of rehabilitation and 6 months later (T2) - in 2013 all participants in the Back College at three locations were surveyed using a standard questionnaire. Wilcoxon signed-rank tests were performed to evaluate statistically significant changes. RESULTS For measurement dates T0 to T2 we had 570 complete datasets (response rate 70.81%). There was a significant decrease in reported back pain and the general state of health and quality of life index improved. Participants' emotional strain decreased and they showed an improved understanding of illness as well as of having acquired knowledge-based abilities and skills for dealing with the disease. After training, they recorded back-friendly behaviour in everyday life and opportunities to relieve strain on the spinal column were utilised at work more often. Participants' subjective assessment of their ability to work (Work Ability Index) improved. CONCLUSION The present study proved the intermediate effectiveness of the Back College curriculum. Whether these effects remain stable in the long term will be tested on the subsequent measurement date (T3, after 24 months).
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Affiliation(s)
- Bianca Kusma
- Institution for Statutory Accident Insurance in the Health and Welfare Services, Pappelallee 35/37, 22089 Hamburg, Germany
| | - Aki Pietsch
- BG Hospital Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany
| | - Helge Riepenhof
- BG Hospital Hamburg, Bergedorfer Straße 10, 21033 Hamburg, Germany
| | - Sören Haß
- BG Nordsee Reha-Klinik, Wohldweg 7, 25826 St. Peter-Ording, Germany
| | - Daniel Kuhn
- BG Hospital Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - Klaus Fischer
- BG Hospital Bergmannstrost Halle, Merseburger Straße 165, 06112 Halle (Saale), Germany
| | - Albert Nienhaus
- Institution for Statutory Accident Insurance in the Health and Welfare Services, Pappelallee 35/37, 22089 Hamburg, Germany
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), Martinistrasse 52, 20246 Hamburg, Germany
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Self-management and health related quality of life in persons with chronic obstructive pulmonary disease. Qual Life Res 2019; 28:2889-2899. [DOI: 10.1007/s11136-019-02231-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2019] [Indexed: 12/20/2022]
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Schuler M, Murauer K, Stangl S, Grau A, Gabriel K, Podger L, Heuschmann PU, Faller H. Pre-post changes in main outcomes of medical rehabilitation in Germany: protocol of a systematic review and meta-analysis of individual participant and aggregated data. BMJ Open 2019; 9:e023826. [PMID: 31154291 PMCID: PMC6549744 DOI: 10.1136/bmjopen-2018-023826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Multidisciplinary, complex rehabilitation interventions are an important part of the treatment of chronic diseases. However, little is known about the effectiveness of routine rehabilitation interventions within the German healthcare system. Due to the nature of the social insurance system in Germany, randomised controlled trials examining the effects of rehabilitation interventions are challenging to implement and scarcely accessible. Consequently, alternative pre-post designs can be employed to assess pre-post effects of medical rehabilitation programmes. We present a protocol of systematic review and meta-analysis methods to assess the pre-post effects of rehabilitation interventions in Germany. METHODS AND ANALYSIS The respective study will be conducted within the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic literature review will be conducted to identify studies reporting the pre-post effects (start of intervention vs end of intervention or later) in German healthcare. Studies investigating the following disease groups will be included: orthopaedics, rheumatology, oncology, pulmonology, cardiology, endocrinology, gastroenterology and psychosomatics. The primary outcomes of interest are physical/mental quality of life, physical functioning and social participation for all disease groups as well as pain (orthopaedic and rheumatologic patients only), blood pressure (cardiac patients only), asthma control (patients with asthma only), dyspnoea (patients with chronic obstructive pulmonary disease only) and depression/anxiety (psychosomatic patients only). We will invite the principal investigators of the identified studies to provide additional individual patient data. We aim to perform the meta-analyses using individual patient data as well as aggregate data. We will examine the effects of both study-level and patient-level moderators by using a meta-regression method. ETHICS AND DISSEMINATION Only studies that have received institutional approval from an ethics committee and present anonymised individual patient data will be included in the meta-analysis. The results will be presented in a peer-reviewed publication and at research conferences. A declaration of no objection by the ethics committee of the University of Würzburg is available (number 20180411 01). TRIAL REGISTRATION NUMBER CRD42018080316.
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Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Kathrin Murauer
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Stephanie Stangl
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Anna Grau
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Katharina Gabriel
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | | | - Peter U Heuschmann
- Institute for Clinical Epidemiology and Biometry (ICE-B), Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
- Comprehensive Heart Failure Center Würzburg, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-Universität Würzburg, Würzburg, Bayern, Germany
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Musekamp G, Gerlich C, Ehlebracht-Kï Nig I, Dorn M, Hï Fter A, Tomiak C, Schlittenhardt D, Faller H, Reusch A. Evaluation of a self-management patient education programme for fibromyalgia-results of a cluster-RCT in inpatient rehabilitation. HEALTH EDUCATION RESEARCH 2019; 34:209-222. [PMID: 30689860 DOI: 10.1093/her/cyy055] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/01/2019] [Indexed: 06/09/2023]
Abstract
The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.
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Affiliation(s)
- G Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-University of W�rzburg, W�rzburg, Germany
| | - C Gerlich
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-University of W�rzburg, W�rzburg, Germany
| | | | - M Dorn
- Rehabilitation Centre Bad Eilsen, Bad Eilsen, Germany
| | - A Hï Fter
- Rehabilitation Centre Bad Aibling, Clinic Wendelstein, Bad Aibling, Germany
| | - C Tomiak
- Rehabilitation Centre Bad Aibling, Clinic Wendelstein, Bad Aibling, Germany
| | - D Schlittenhardt
- Rehabilitation Clinic Bad S�ckingen GmbH, Bad S�ckingen, Germany
| | - H Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-University of W�rzburg, W�rzburg, Germany
| | - A Reusch
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Julius-Maximilians-University of W�rzburg, W�rzburg, Germany
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Wilke A, Gediga G, Goergens A, Hansen A, Hübner A, John SM, Nordheider K, Rocholl M, Weddeling S, Wulfhorst B, Nashan D. Interdisciplinary and multiprofessional outpatient secondary individual prevention of work-related skin diseases in the metalworking industry: 1-year follow-up of a patient cohort. BMC DERMATOLOGY 2018; 18:12. [PMID: 30541516 PMCID: PMC6292163 DOI: 10.1186/s12895-018-0080-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 11/30/2018] [Indexed: 11/10/2022]
Abstract
Background In Germany, work-related skin diseases are predominant within the spectrum of reported occupational diseases. Metal workers are among the high-risk professions. Offering effective prevention programs to affected patients is of utmost importance to avoid deterioration of the disease and job loss. We conducted a 1-year follow-up in patients who participated in a multidisciplinary, complex outpatient prevention program representing a standard procedure of patient care by the respective statutory accident insurance. Methods The multi-component prevention program consists of multiprofessional individual patient counseling, a structured skin protection seminar in a group, as well as workplace visits and on-site counseling in terms of appropriate skin protection (e.g. gloves). An observational study with a 1-year follow-up and four measurements (T1-T4, longitudinal pre/post-test design) including dermatological examinations and standardized written questionnaires was conducted between 2013 and 2016 to assess changes over time regarding job loss and disease severity. Results Data from 94 patients (87 male, mean age: 45.4 years) were included in the analysis. One year after the skin protection seminar (T4), 83 patients (88.3%) remained in their original professional metalworking activity and four patients (4.3%) had given up their profession because of their skin disease. At baseline (T1), irritant contact dermatitis of the hands was the most frequent diagnosis (80.7%). Methods for self-reported disease severity showed good correlation with the clinical gold standard at T1 and T2 (dermatological examination with the Osnabrück Hand Eczema Severity Index / OHSI), and a significant decrease of the self-reported disease severity was found over time from T1 to T4 (p < 0.001). Further results indicate an improved self-perceived disease control and an overall satisfaction with the prevention program. Conclusions The results of this observational study demonstrate that the comprehensive prevention program positively influences the course of work-related skin diseases, increases the possibility to continue working in a “high-risk” profession and improves the disease management of metal workers. In the long term, the prevention program may lead to cost savings by preventing high therapy costs or professional retraining. Electronic supplementary material The online version of this article (10.1186/s12895-018-0080-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Wilke
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany. .,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.
| | - Günther Gediga
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Andreas Goergens
- German Social Accident Insurance Institution for the woodworking and metalworking industries, district administration in Dortmund, Semerteichstraße 98, 44263, Dortmund, Germany
| | - Andreas Hansen
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Anja Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Swen Malte John
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Marc Rocholl
- Institute for Health Research and Education, Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany
| | - Sabine Weddeling
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Britta Wulfhorst
- Faculty of Human Sciences/Department of Educational Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Germany
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Wilke A, Brans R, Nordheider K, Braumann A, Hübner A, Sonsmann FK, John SM, Wulfhorst B. Skin Protection Seminars to Prevent Occupational Skin Diseases: Results of a Prospective Longitudinal Study in Apprentices of High-risk Professions. Saf Health Work 2018; 9:398-407. [PMID: 30559987 PMCID: PMC6284163 DOI: 10.1016/j.shaw.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Occupational skin diseases (OSDs) are frequent in professions with exposure to skin hazards. Thus, a health educational intervention for apprentices of high-risk professions was conducted. It was the aim of this study to gain insight into possible effects of this intervention. METHODS A one-time skin protection seminar was conducted in 140 apprentices of health-related and non-health-related professions [trained cohort (TC)]. In addition, 134 apprentices of the same occupations were monitored [untrained cohort (UTC)]. The OSD-specific knowledge and the skin condition of the hands were assessed at baseline (T0), after the seminar (T1), and after 6 (T2) and 12 months (T3). RESULTS The OSD-specific knowledge increased in all cohorts from T0 to T3, but we found a significantly higher knowledge in the TC at T2 (p < 0.001, t = 3.6, df = 196, 95% confidence interval = 0.9, 3.3) and T3 (p < 0.001, t = 3.8, df = 196, 95% confidence interval = 1.0, 3.2) compared to the UTC. Our results indicated a better skin condition of the hands in the TC of the health-related professions but not in the non-health-related professions. CONCLUSION The study indicates that an educational intervention may positively influence the disease-specific knowledge and the prevalence of OSD in apprentices. However, definite conclusions cannot be drawn because of the heterogeneous study cohorts and the study design. Future research should aim at tailoring primary prevention to specific target groups, e.g., in view of the duration and frequency of skin protection education, different professions, and gender-specific prevention approaches.
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Affiliation(s)
- Annika Wilke
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Richard Brans
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Kathrin Nordheider
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Antje Braumann
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Hamburg, Germany
| | - Anja Hübner
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Flora K. Sonsmann
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Britta Wulfhorst
- Faculty of Human Sciences/Department of Educational Sciences, MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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Ko D, Bratzke LC, Muehrer RJ, Brown RL. Self-management in liver transplantation. Appl Nurs Res 2018; 45:30-38. [PMID: 30683248 DOI: 10.1016/j.apnr.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-management is crucial for liver transplant (LT) recipients to maintain transplants and optimize health outcomes. However, previous literature has been primarily limited to examining medication adherence; there is a knowledge gap regarding self-management in the LT population. AIM The aims of this study were to 1) comprehensively describe self-management behaviors and activities in LT recipients, 2) explore levels of overall self-management, and 3) explore the relationships of self-efficacy, cognition, and health information seeking behavior with self-management. METHODS Adult LT recipients (n = 113) who had a functioning transplant for at least 6 months participated in this cross-sectional, descriptive study. Participants were asked to identify self-management behaviors and rate their performance of those behaviors, including symptom management and medication adherence. They also completed a cognitive assessment and questionnaires measuring self-efficacy and health information seeking behavior. Descriptive statistics, latent profile analysis, and probit model for path analysis were used for the data analysis. RESULTS LT recipients acknowledged engaging in various self-management behaviors including symptom management, physical activity, maintenance of positive attitudes, and communication with healthcare providers. Three levels of self-management (i.e., low, medium, and high) were found; a high level of self-management was related to self-efficacy and health information seeking behavior. CONCLUSIONS The findings indicate that self-management may be improved with interventions aimed at increasing self-efficacy and health information seeking behavior. Findings from this study will inform future interventions, to improve self-management and subsequent health outcomes in this population. Future longitudinal studies are necessary to confirm the causality of the identified relationships.
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Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI 53705, United States of America.
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Room 5127, Madison, WI 53705, United States of America.
| | - Rebecca J Muehrer
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI 53705, United States of America
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Room 4187, Madison, WI 53705, United States of America.
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25
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Sindlinger K, Meng K, Dorn M, Faller H, Schuler M. Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations. Psychol Health 2018; 34:200-215. [PMID: 30358411 DOI: 10.1080/08870446.2018.1523406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined. DESIGN AND MAIN OUTCOME MEASURES This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation. METHODS To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models. RESULTS On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF. CONCLUSION IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.
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Affiliation(s)
- K Sindlinger
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - K Meng
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - M Dorn
- b Rehabilitation Center Bad Eilsen , Bad Eilsen , Germany
| | - H Faller
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
| | - M Schuler
- a Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences , University of Würzburg , Würzburg , Germany
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26
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Haack M, Kofahl C, Kramer S, Seidel G, von dem Knesebeck O, Dierks ML. Participation in a prostate cancer support group and health literacy. Psychooncology 2018; 27:2473-2481. [PMID: 30092120 DOI: 10.1002/pon.4854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/13/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND To cope with prostate cancer (PC) and its consequences and to be certain about therapeutic alternatives, some patients seek mutual help in prostate cancer support groups (PCSGs), where they share information and find social support. Our study was intended to assess whether group participation is associated with health literacy (HL). METHODS We compared PCSG members (n = 441) with PC patients without support group experiences (n = 135) in a cross-sectional design. For this purpose, HL was operationalized through PC-specific knowledge, noncancer-specific knowledge about health care, guideline awareness, and skills needed to apply health information to meet own needs. Binary logistic regression models were calculated. Socio-demographic data and disease-related characteristics were used as control variables. RESULTS Knowledge about PC (OR, 2.2; CI, 1.3-3.7), the fact of having heard of guidelines (OR, 3.7; CI, 2.1-6.8) and having read one (OR, 5.1; CI, 2.8-9.4), and competencies regarding health service navigation (OR, 1.8; CI, 1.0-3.1) are associated with PCSG membership. No statistically significant associations could be found between PCSG membership and further skills questioned, as well as between membership and knowledge about noncancer-specific health care. CONCLUSION PCSG membership is associated with HL in some areas only. In particular, the groups seem to provide an important platform for information exchange in the field of PC. The potentially conflicting results on PC knowledge and the application skills may arise from the different forms of measurement-knowledge was tested; skills were self-assessed.
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Affiliation(s)
- Marius Haack
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kramer
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Gabriele Seidel
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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Meng K, Reusch A, Musekamp G, Seekatz B, Zietz B, Steimann G, Altstidl R, Haug G, Worringen U, Faller H. Self-management education for rehabilitation inpatients: A cluster-randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2018; 101:1630-1638. [PMID: 29627267 DOI: 10.1016/j.pec.2018.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/06/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate generic self-management modules (SelMa) as an adjunct to disease-specific educational programs during inpatient medical rehabilitation. METHODS A bi-center cluster-randomized controlled trial with 698 patients with coronary artery disease, metabolic syndrome, or inflammatory bowel disease was conducted. We compared two versions of SelMa, a group with 3 h or a lecture with 1 h, respectively, in addition to disease-related patient education, to usual care (only disease-related education). SelMa aims at providing skills that may help implementing health behavior. The primary outcomes were goal setting and behavior planning at discharge and goal attainment and health behavior at 6- and 12-months follow-up. Secondary outcomes included motivation, knowledge and self-management competences. RESULTS At discharge, SelMa group, but not SelMa lecture, proved superior to usual care regarding goal setting (p = 0.007, d = 0.26), but not behavior planning (p = 0.37, d = 0.09). Significant effects were also observed on several secondary outcomes. At later follow-up, however, no effects on primary outcomes emerged. Participants' satisfaction was higher in the group than the lecture format. CONCLUSIONS These short modules did not succeed in improving self-management skills in the long-term. PRACTICE IMPLICATIONS A self-management group may foster self-management skills in short term. Interventions should be developed to increase sustainability of effects.
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Affiliation(s)
- Karin Meng
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Andrea Reusch
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Gunda Musekamp
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Bettina Seekatz
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | | | | | - Robert Altstidl
- Rehabilitation Center Bayerisch Gmain, Bayerisch Gmain, Germany
| | - Günter Haug
- Rehabilitation Center Bayerisch Gmain, Bayerisch Gmain, Germany
| | | | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Langbrandtner J, Hüppe A, Jessen P, Büning J, Nikolaus S, Raspe H, Bokemeyer B. Quality of care in inflammatory bowel disease: results of a prospective controlled cohort study in Germany (NET IBD). Clin Exp Gastroenterol 2017; 10:215-227. [PMID: 28919797 PMCID: PMC5590680 DOI: 10.2147/ceg.s135346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background/aims Patients with inflammatory bowel disease (IBD) need comprehensive, interdisciplinary and cross-sectoral health care. In Germany, evidence-based care pathways have been developed to improve the quality of care of IBD patients. We aimed to evaluate the effects of the implementation of some of these recommendations on patient-related outcomes. Methods In a region of North Germany, outpatients with IBD were recruited by gastroenterologists (intervention group). Three activities based on the recommendations of the IBD pathways were implemented, namely, 1) patient participation in a questionnaire-based assessment of 22 somatic and psychosocial problems combined with individualized care recommendations (patient activation procedure); 2) patient invitation to participate in a 2-day patient education program and 3) invitation to their gastroenterologists to participate in periodic interdisciplinary case conferences. For the control group, IBD patients receiving standard care at gastroenterology practices outside the specified region were recruited by their doctors. At baseline, 6- and 12-month follow-up, study patients were invited to complete questionnaires. Generic health-related quality of life, social participation and self-management skills were the main outcomes. Results At baseline, 349 patients were included in the study (intervention group: 189; control group: 160); 142 patients from the former and 140 from the latter group returned completed questionnaires at the 12-month follow-up. Over time, improvement in health-related quality of life and social participation was similar in both groups. Participants of the intervention group demonstrated improved self-management skills and more often followed steroid-free medication regimens. Conclusion In a real-world clinical context, patient activation procedure combined with patient education and case conferences was less effective than expected. The observed beneficial effects, however, encourage the evaluation of more intensive and addressee-centered activities.
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Affiliation(s)
- Jana Langbrandtner
- Institute of Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Angelika Hüppe
- Institute of Social Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Petra Jessen
- Gastroenterology Practice Altenholz-Kiel, Erdbeerfeld, Altenholz
| | - Jürgen Büning
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee, Luebeck
| | - Susanna Nikolaus
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstraße, Kiel
| | - Heiner Raspe
- Center for Population Medicine and Health Services Research, University of Luebeck, Ratzeburger Allee, Luebeck
| | - Bernd Bokemeyer
- Gastroenterology Practice Minden, Uferstraße, Minden, Germany
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Laursen DH, Christensen KB, Christensen U, Frølich A. Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). BMC Res Notes 2017; 10:213. [PMID: 28619041 PMCID: PMC5471707 DOI: 10.1186/s13104-017-2536-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a progressive chronic illness that will affect more than 500 million people worldwide by 2030. It is a significant cause of morbidity and mortality. Finding the right care management for diabetes patients is necessary to effectively address the growing population of affected individuals and escalating costs. Patient education is one option for improving patient self-management. However, there are large discrepancies in the outcomes of such programs and long-term data are lacking. We assessed the short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). METHODS We conducted a observational cohort study of 83 type 2 diabetes patients participating in patient education programs in Denmark. The seven-scale HeiQ was completed by telephone interview at baseline and 2 weeks (76 participants, 93%) and 12 months (66, 80%) after the patient education ended. Changes over time were assessed using mean values and standard deviation at each time point and Cohen effect sizes. RESULTS Patients reported improvements 2 weeks after the program ended in 4 of 7 constructs: skills and technique acquisition (ES = 0.59), self-monitoring and insight (ES = 0.52), constructive attitudes and approaches (ES = 0.43) and social integration and support (ES = 0.27). After 12 months, patients reported improvements in 3 of 7 constructs: skills and technique acquisition (ES = 0.66), constructive attitudes and approaches (ES = 0.43), and emotional wellbeing (ES = 0.44). Skills and technique showed the largest short- and long-term effect size. No significant changes were found in health-related activity or positive and active engagement in life over time. CONCLUSION After 12 months, diabetes patients who participated in patient education demonstrated increased self-management skills, improved acceptance of their chronic illness and decreased negative emotional response to their disease. Applying HeiQ as an outcome measure yielded new knowledge as to what patients with diabetes can obtain by participating in a patient education.
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Affiliation(s)
- Ditte Hjorth Laursen
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark.
| | - Karl Bang Christensen
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Ulla Christensen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Anne Frølich
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark
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Bäuerle K, Feicke J, Scherer W, Spörhase U, Bitzer EM. Evaluation of a standardized patient education program for inpatient asthma rehabilitation: Impact on patient-reported health outcomes up to one year. PATIENT EDUCATION AND COUNSELING 2017; 100:957-965. [PMID: 27993435 DOI: 10.1016/j.pec.2016.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To modify and evaluate a patient education program for adult asthma patients in consideration of quality criteria for teaching. METHODS This was a prospective single-center controlled trial in an inpatient rehabilitation center. The control group (n=215) received the usual lecture-based education program, and the intervention group (n=209) the modified patient education program. Data were assessed at admission, discharge, 6 and 12 months post discharge. The primary outcome was asthma control, the secondary outcomes were asthma knowledge, quality of life, and program acceptance. Analysis of change was performed by ANCOVA for each follow-up, adjusting for baseline values. RESULTS Statistically significant increases in all health outcomes and in asthma control were maintained in both groups at 12 months: CG: +1.9 (95%-CI 1.3-2.6) IG: +1.6 (95%-CI 0.8-2.3). We observed no significant differences between the programs for asthma control and quality of life. Regarding practical asthma knowledge, after 12 months, a group*time interaction emerged with a small effect size (P=0.06, η2=0.01). CONCLUSION The modified program was not superior to traditional patient education concerning asthma control. It permanently increased self-management knowledge. PRACTICAL IMPLICATIONS Structured and behavioral patient education fosters patient's disease management ability. Possible ways of improving asthma control need to be explored.
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Affiliation(s)
- Kathrin Bäuerle
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany.
| | - Janine Feicke
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | | | - Ulrike Spörhase
- Department of Biology and its Didactics, University of Education, Freiburg, Germany
| | - Eva-Maria Bitzer
- Department of Everyday Culture, Exercise and Health, University of Education, Freiburg, Germany
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31
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Berding A, Witte C, Gottschald M, Kaltz B, Weiland R, Gerlich C, Reusch A, Kruis W, Faller H. Beneficial Effects of Education on Emotional Distress, Self-Management, and Coping in Patients with Inflammatory Bowel Disease: A Prospective Randomized Controlled Study. Inflamm Intest Dis 2017; 1:182-190. [PMID: 29922675 DOI: 10.1159/000452989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) suffer from various physical as well as psychological impairments, and patient education may help improve their well-being. Therefore, we developed a manualized education program for IBD patients addressing medical and psychological issues. This study aimed to evaluate it in a large controlled trial. METHODS A total of 181 IBD outpatients participated in a prospective, randomized, waitlist-controlled trial; assessments were made before as well as 2 weeks and 3 months after intervention. Analysis of covariance was used to assess intervention effects on disease-related worries and concerns (primary outcome), fear of progression, coping with anxiety, health competencies, health-related quality of life (HRQoL), perceived disease activity, symptoms of depression and anxiety, disease-related knowledge, and coping strategies. Participants' satisfaction with the program was also evaluated. RESULTS At 2 weeks and 3 months after intervention, we found significant large effects of our education program on skill and technique acquisition, knowledge, and coping with IBD. Moreover, we found significant medium effects on disease-related worries and concerns, fear of progression, coping with anxiety, constructive attitudes and approaches, as well as coping with disease-related negative emotions. The number of coping strategies used was significantly higher at 3 months. We did not find any effects on perceived disease activity, HRQoL, positive and active engagement in life, or symptoms of anxiety and depression. The program was rated very favorably by the attendees. CONCLUSION Our education program contributed to improvements in psychological distress, self-management skills, and coping and was appreciated by its attendees.
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Affiliation(s)
- Anja Berding
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany.,Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christine Witte
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | | | - Birgit Kaltz
- German Crohn's and Colitis Association (DCCV e.V.), Berlin, Germany
| | - Romy Weiland
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Christian Gerlich
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Andrea Reusch
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Wolfgang Kruis
- Department of Internal Medicine, Protestant Hospital Kalk, Cologne, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
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Abstract
Zusammenfassung
Chronisch Kranke benötigen Kompetenzen, die sie dazu befähigen, möglichst selbstbestimmt mit ihrer Erkrankung umzugehen (Selbstmanagement). Solche Kompetenzen können durch Patientenschulungen vermittelt werden (Empowerment). Kontrollierte Studien konnten Effekte innovativer, interaktiver Schulungsprogramme auf Gesundheitskompetenz und Selbstmanagement-Outcomes nachweisen. Außerdem zeigte sich, dass Verbesserungen der Gesundheitskompetenz Verbesserungen der Lebensqualität mit sich bringen.
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Affiliation(s)
- Hermann Faller
- Universität Würzburg, Abteilung für Medizinische Psychologie, Medizinische Soziologie und Rehabilitationswissenschaften , Klinikstraße 3, 97070 Würzburg , Germany
| | - Karin Meng
- Universität Würzburg, Abteilung für Medizinische Psychologie, Medizinische Soziologie und Rehabilitationswissenschaften , Würzburg , Germany
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Schultz K, Seidl H, Jelusic D, Wagner R, Wittmann M, Faller H, Nowak D, Schuler M. Effectiveness of pulmonary rehabilitation for patients with asthma: study protocol of a randomized controlled trial (EPRA). BMC Pulm Med 2017; 17:49. [PMID: 28274210 PMCID: PMC5343403 DOI: 10.1186/s12890-017-0389-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/28/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Asthma patients are enrolled in multimodal pulmonary rehabilitation (PR) programs. However, available data for the effectiveness of PR in asthma are sparse. Therefore, the primary aim of this randomized control trial (RCT) is to evaluate short-term (end of rehabilitation) and intermediate-term effectiveness (3 months after rehabilitation) of PR for patients with asthma regarding asthma control (primary outcome) and other outcomes. Secondly, moderator effects of gender, age, baseline asthma control, quality of life, and anxiety will be examined. Thirdly, a longitudinal follow-up study will explore the course of the outcomes over one year and the annual costs. METHODS The EPRA study is a single-center randomized controlled waiting-list trial in the Bad Reichenhall Clinic. Inclusion criteria include a referral diagnosis for uncontrolled asthma, no cognitive impairment and no very severe co-morbidities that indicate significantly greater illness morbidity than asthma alone. In the intervention group (IG), participants will start PR within 4 weeks after randomization; participants of the control group (CG) will start PR 20 weeks after randomization. Data will be assessed at randomization (T0), after 4 weeks (T1; IG: begin of PR), 7 weeks (T2; IG: end of PR), and 20 weeks (T3, CG: begin of PR). The primary outcome is asthma control at T2/T3. Secondary outcomes are health-related quality of life, functional exercise capacity, dyspnea, anxiety, depression, subjective self-management skills, illness perceptions, sick leave and subjective work ability. Outcomes will be analyzed with analysis of covariance, including baseline values of the respective outcomes as covariates. Healthcare costs will be analyzed with a gamma model with a log-link. A longitudinal follow-up study will generate additional data at 3/6/9/12 months after PR for both IG and CG. Latent change models will be used to analyze the course of the primary and secondary outcomes. Annual cost differences before and after rehabilitation will be compared by paired t-test. DISCUSSION This RCT will determine the effectiveness of a complex inpatient PR for asthma patients concerning asthma control. Furthermore, important medical and economic information regarding the effectiveness of PR as part of the long-term management of patients with uncontrolled asthma will be generated. TRIAL REGISTRATION German Clinical Trials Register ( DRKS00007740 , May 15, 2015). Protocol version: 1.0 (December, 23, 2016).
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Affiliation(s)
- Konrad Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Hildegard Seidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Danijel Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Rupert Wagner
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences Section, University of Würzburg, Würzburg, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU University of München, member DZL, German Centre for lung Research, Munich, Germany
| | - Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences Section, University of Würzburg, Würzburg, Germany
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Nolte S, Osborne RH, Dwinger S, Elsworth GR, Conrad ML, Rose M, Härter M, Dirmaier J, Zill JM. German translation, cultural adaptation, and validation of the Health Literacy Questionnaire (HLQ). PLoS One 2017; 12:e0172340. [PMID: 28234987 PMCID: PMC5325258 DOI: 10.1371/journal.pone.0172340] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022] Open
Abstract
The Health Literacy Questionnaire (HLQ), developed in Australia in 2012 using a 'validity-driven' approach, has been rapidly adopted and is being applied in many countries and languages. It is a multidimensional measure comprising nine distinct domains that may be used for surveys, needs assessment, evaluation and outcomes assessment as well as for informing service improvement and the development of interventions. The aim of this paper is to describe the German translation of the HLQ and to present the results of the validation of the culturally adapted version. The HLQ comprises 44 items, which were translated and culturally adapted to the German context. This study uses data collected from a sample of 1,058 persons with chronic conditions. Statistical analyses include descriptive and confirmatory factor analyses. In one-factor congeneric models, all scales demonstrated good fit after few model adjustments. In a single, highly restrictive nine-factor model (no cross-loadings, no correlated errors) replication of the original English-language version was achieved with fit indices and psychometric properties similar to the original HLQ. Reliability for all scales was excellent, with a Cronbach's Alpha of at least 0.77. High to very high correlations between some HLQ factors were observed, suggesting that higher order factors may be present. Our rigorous development and validation protocol, as well as strict adaptation processes, have generated a remarkable reproduction of the HLQ in German. The results of this validation provide evidence that the HLQ is robust and can be recommended for use in German-speaking populations. TRIAL REGISTRATION German Clinical Trial Registration (DRKS): DRKS00000584. Registered 23 March 2011.
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Affiliation(s)
- Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Richard H. Osborne
- Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Sarah Dwinger
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerald R. Elsworth
- Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Melanie L. Conrad
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jördis M. Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Musekamp G, Schuler M, Seekatz B, Bengel J, Faller H, Meng K. Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education. BMC Cardiovasc Disord 2017; 17:51. [PMID: 28196523 PMCID: PMC5309929 DOI: 10.1186/s12872-017-0486-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 01/27/2017] [Indexed: 01/07/2023] Open
Abstract
Background Heart failure (HF) patient education aims to foster patients’ self-management skills. These are assumed to bring about, in turn, improvements in distal outcomes such as quality of life. The purpose of this study was to test the hypothesis that change in self-reported self-management skills observed after participation in self-management education predicts changes in physical and mental quality of life and depressive symptoms up to one year thereafter. Methods The sample comprised 342 patients with chronic heart failure, treated in inpatient rehabilitation clinics, who received a heart failure self-management education program. Latent change modelling was used to analyze relationships between both short-term (during inpatient rehabilitation) and intermediate-term (after six months) changes in self-reported self-management skills and both intermediate-term and long-term (after twelve months) changes in physical and mental quality of life and depressive symptoms. Results Short-term changes in self-reported self-management skills predicted intermediate-term changes in mental quality of life and long-term changes in physical quality of life. Intermediate-term changes in self-reported self-management skills predicted long-term changes in all outcomes. Conclusions These findings support the assumption that improvements in self-management skills may foster improvements in distal outcomes.
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Affiliation(s)
- Gunda Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany.
| | - Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany
| | - Bettina Seekatz
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany
| | - Jürgen Bengel
- Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstraße 41, D-79085, Freiburg, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany
| | - Karin Meng
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany
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Ammerlaan JW, van Os-Medendorp H, Sont JK, Elsworth GR, Osborne RH. Validation of the dutch version of the health education impact questionnaire (HEIQ) and comparison of the Dutch translation with the English, German and French HEIQ. Health Qual Life Outcomes 2017; 15:28. [PMID: 28143551 PMCID: PMC5282770 DOI: 10.1186/s12955-017-0601-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 01/19/2017] [Indexed: 11/11/2022] Open
Abstract
Background The Health Education Impact Questionnaire (heiQ) evaluates the effectiveness of health education and self-management programs provided to people dealing with a wide range of conditions. Aim of this study was to translate, culturally adapt and validate the Dutch translation of the heiQ and to compare the results with the English, German and French translations. Methods A systematic translation process was undertaken. Psychometric properties were studied among patients with arthritis, atopic dermatitis, food allergy and asthma (n = 286). Factorial validity using confirmatory factor analysis, item difficulty (D), item remainder correlation and composite reliability were conducted. Stability was tested using the intra-class correlation coefficient (ICC). Results Items were well understood and only minor language adjustments were required. Confirmatory fit indices were >0.95 and item difficulty was D ≥ 0.65 for all items in scales showing acceptable fit indices, except for the reversed Emotional distress scale. Composite reliability ranged between 0.67 and 0.85. Test-retest reliability (n = 93) ICC varied between 0.61 and 0.84. Comparisons with other translations showed comparable fit indices. A lower ICC on Self-monitoring and insight scale was observed. Conclusions The Dutch translation of the heiQ was found to be well understood and user friendly by patients with Rheumatoid Arthritis, Atopic Dermatitis, Food allergy and asthma and to have robust psychometric properties for evaluating the impact of health education and self-management programs. Given the wide applications of the heiQ and the comparability of the Dutch results with the English, German and French version, the heiQ is a practical and useful questionnaire to evaluate the impact of self-management support programs in different countries and populations with different diseases.
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Affiliation(s)
- Judy W Ammerlaan
- Department Rheumatology and Clinical Immunology, University Medical Center Utrecht, HPN D02.244, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Harmieke van Os-Medendorp
- Department Dermatology and Allergology, University Medical Center Utrecht, HPN D02.244, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jacob K Sont
- Leiden University Medical Center, Department of Medical Decision Making, J10-86, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Gerald R Elsworth
- Health Systems Improvement Unit, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
| | - Richard H Osborne
- Health Systems Improvement Unit, School of Health and Social Development, Deakin University, Geelong, 3220, Australia
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Reusch A, Weiland R, Gerlich C, Dreger K, Derra C, Mainos D, Tuschhoff T, Berding A, Witte C, Kaltz B, Faller H. Self-management education for rehabilitation inpatients suffering from inflammatory bowel disease: a cluster-randomized controlled trial. HEALTH EDUCATION RESEARCH 2016; 31:782-791. [PMID: 27651394 DOI: 10.1093/her/cyw042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
Although inflammatory bowel disease (IBD) affects patients' psychological well-being, previous educational programs have failed to demonstrate effects on psychosocial outcomes and quality of life. Therefore, we developed a group-based psychoeducational program that combined provision of both medical information and psychological self-management skills, delivered in an interactive manner, and evaluated it in a large, cluster-randomized trial. We assigned 540 rehabilitation inpatients suffering from IBD (mean age 43 years, 66% female) to either the new intervention or a control group comprising the same overall intensity and the same medical information, but only general psychosocial information. The primary outcome was patient-reported IBD-related concerns. Secondary outcomes included disease knowledge, coping, self-management skills, fear of progression, anxiety, depression and quality of life. Assessments took place at baseline, end of rehabilitation and after 3 and 12 months.The psychoeducational self-management program did not prove superior to the control group regarding primary and secondary outcomes. However, positive changes over time occurred in both groups regarding most outcomes. The superior effectiveness of the newly developed psychoeducational program could not be demonstrated. Since the intervention and control groups may have been too similar, this trial may have been too conservative to produce between-group effects.
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Affiliation(s)
- A Reusch
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - R Weiland
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - C Gerlich
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
| | - K Dreger
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - C Derra
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - D Mainos
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - T Tuschhoff
- Rehabilitation Centre Bad Mergentheim, Clinic Taubertal, Bad Mergentheim, 97980, Germany
| | - A Berding
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - C Witte
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - B Kaltz
- German Crohn's and Colitis Association (Deutsche Morbus Crohn/Colitis ulcerosa Vereinigung, DCCV e.V.), Berlin, 10179, Germany
| | - H Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, Würzburg, D 97070, Germany
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Wahl AK, Osborne RH, Langeland E, Wentzel-Larsen T, Mengshoel AM, Ribu L, Peersen K, Elsworth GR, Nolte S. Making robust decisions about the impact of health education programs: Psychometric evaluation of the Health Education Impact Questionnaire (heiQ) in diverse patient groups in Norway. PATIENT EDUCATION AND COUNSELING 2016; 99:1733-8. [PMID: 27211224 DOI: 10.1016/j.pec.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/04/2016] [Accepted: 05/01/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To undertake a rigorous psychometric evaluation of the widely used eight-scale heiQ version 2.0 (evaluating immediate effects of self-management interventions) in diverse patient groups in Norway. METHODS Cross-sectional survey data were collected from 1019 Norwegians. Data were extracted from studies among people with musculoskeletal disorders (n=516), psoriasis (n=254), heart disease (n=97), and Type 2 diabetes (n=152). To investigate the factorial validity of the Norwegian heiQ, confirmatory factor analyses (CFA) were carried out using Mplus. RESULTS One-factor model fit, without modifications, was acceptable for the Emotional distress scale. Only one correlated residual was required to be fitted in each of the other scales to achieve satisfactory model fit. The postulated highly restricted full eight-factor model (no cross-loadings, no correlated residuals) showed good fit to the data. Internal consistency was acceptable for most scales (0.72-0.90) but low for Self-monitoring and insight. CONCLUSION This study of the Norwegian heiQ replicates the factor structure of the original Australian heiQ, using robust and highly restricted CFA procedures, demonstrating a clean independent clusters model structure. PRACTICE IMPLICATIONS Researchers, program implementers and policymakers could use the Norwegian heiQ with confidence to generate reliable information on program outcomes and support quality improvement activities.
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Affiliation(s)
- Astrid K Wahl
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Richard H Osborne
- Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia.
| | - Eva Langeland
- Faculty of Health and Social Sciences, Bergen University College, Norway.
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
| | - Anne Marit Mengshoel
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Lis Ribu
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Nursing, Oslo, Norway.
| | | | - Gerald R Elsworth
- Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia.
| | - Sandra Nolte
- Deakin Univerity, Health Systems Improvement Unit, School of Health and Social Development, Geelong, VIC, Australia; Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Musekamp G, Bengel J, Schuler M, Faller H. Improved self-management skills predict improvements in quality of life and depression in patients with chronic disorders. PATIENT EDUCATION AND COUNSELING 2016; 99:1355-1361. [PMID: 27050107 DOI: 10.1016/j.pec.2016.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Self-management programs aim to improve patients' skills to manage their chronic condition in everyday life. Improvement in self-management is assumed to bring about improvements in more distal outcomes, such as quality of life. This study aimed to test the hypothesis that changes in self-reported self-management skills observed after participation in self-management programs predict changes in both quality of life and depressive symptoms three months later. METHODS Using latent change modeling, the relationship between changes in latent variables over three time points (start and end of rehabilitation, after three months) was analysed. The sample comprised 580 patients with different chronic conditions treated in inpatient rehabilitation clinics. The influence of additional predictor variables (age, sex, perceived social support) and type of disorder as a moderator variable was also tested. RESULTS Changes in self-reported self-management skills after rehabilitation predicted changes in both quality of life and depressive symptoms at the end of rehabilitation and the 3 months follow-up. These relationships remained significant after the inclusion of other predictor variables and were similar across disorders. CONCLUSION The findings provide support for the hypothesis that improvements in proximal outcomes of self-management programs may foster improvements in distal outcomes. Further studies should investigate treatment mechanisms.
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Affiliation(s)
- Gunda Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Jürgen Bengel
- Institute of Psychology, Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.
| | - Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany.
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Reusch A, Musekamp G, Küffner R, Dorn M, Braun J, Ehlebracht-König I. Wirksamkeitsprüfung rheumatologischer Schulungen. Z Rheumatol 2016; 76:613-621. [DOI: 10.1007/s00393-016-0120-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meng K, Musekamp G, Schuler M, Seekatz B, Glatz J, Karger G, Kiwus U, Knoglinger E, Schubmann R, Westphal R, Faller H. The impact of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation. PATIENT EDUCATION AND COUNSELING 2016; 99:1190-1197. [PMID: 26898600 DOI: 10.1016/j.pec.2016.02.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/27/2016] [Accepted: 02/13/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate a patient-centred self-management educational group program for patients with chronic systolic heart failure as compared to usual care education during inpatient cardiac rehabilitation. METHODS A multicentre cluster randomized controlled trial of 475 patients was conducted. In the intervention condition, patients received the new self-management educational group program whereas in the control condition, patients received a short lecture-based educational program (usual care). The primary outcome was patients' self-reported self-management competence. Secondary outcomes included self-management health behaviour, health-related quality of life, and treatment satisfaction. Patients completed self-reported outcome measures at admission, discharge, and after 6 and 12 months. RESULTS There was a significant small between-group intervention effect on certain dimension of patients' self-management competence (self-monitoring and insight) in short term (p<0.05). Furthermore, significant small effects were observed for treatment satisfaction at discharge as well as symptom monitoring after 6 months (p<0.05) and by trend on symptom monitoring and physical activity after 12 months. CONCLUSIONS The patient-centred self-management program might be more effective in certain self-management outcomes than a usual care education in both short-term and long-term periods. PRACTICE IMPLICATIONS Therefore, such programs may be considered for dissemination within cardiac rehabilitation.
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Affiliation(s)
- Karin Meng
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Wuerzburg, Würzburg, Germany.
| | - Gunda Musekamp
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Wuerzburg, Würzburg, Germany
| | - Michael Schuler
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Wuerzburg, Würzburg, Germany
| | - Bettina Seekatz
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Wuerzburg, Würzburg, Germany
| | | | - Gabriele Karger
- Rehabilitation Hospital Heidelberg-Königstuhl, Heidelberg, Germany
| | - Ulrich Kiwus
- Rehabilitation Center Bad Nauheim-Rehabilitation Hospital Wetterau, Bad Nauheim, Germany
| | - Ernst Knoglinger
- Rehabilitation Hospital Kirchberg-Klinik, Bad Lauterberg, Germany
| | | | - Ronja Westphal
- Segeberger Kliniken GmbH, Rehabilitation Hospital, Bad Segeberg, Germany
| | - Hermann Faller
- Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, University of Wuerzburg, Würzburg, Germany
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Achstetter LI, Schultz K, Faller H, Schuler M. Leventhal's common-sense model and asthma control: Do illness representations predict success of an asthma rehabilitation? J Health Psychol 2016; 24:327-336. [PMID: 27257266 DOI: 10.1177/1359105316651332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigates whether illness representations predict changes in asthma control or vice versa. Illness perceptions and asthma control were assessed in N = 113 asthma patients at the begin/end of an inpatient rehabilitation. Bivariate cross-lagged panel analyses showed that the illness representation dimensions Personal control, Consequences, Coherence, and Emotional representation predicted the change in asthma control, but asthma control did not predict illness representations. In multiple regression analyses with covariates, Personal control still predicted the change in asthma control. Illness beliefs assessed at the beginning of an intervention might help to identify patients with lower probability of treatment success.
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Abstract
Due to the chronic course, rheumatic diseases may be associated with both long-lasting pain and movement limitations. Those afflicted by these disorders thus face continuous challenges regarding both adapting to their illness as well as changing their lifestyle habits, for example increasing the physical activity levels. However, patient education may provide patients with the competencies they need to cope with their illness and modify their behavior. Therefore, patient education programs are core elements of rehabilitation in rheumatology. The German Society for Rheumatology has performed pioneering work concerning conceptualization and evaluation of standardized educational programs. In this article some more recent developments and up to date standards for contents and didactics of self-management programs are presented. Empowerment may be considered the overriding aim of these programs, i.e. enabling patients to make informed decisions in situations where their health is involved. Patient-centered didactic methods as used in state of the art concepts mirror the empowerment approach. To foster sustainability of lifestyle changes, detailed planning of behavioral modifications is recommended, thus increasing the chance of transferring changes adopted during rehabilitation into everyday living. Such methods have been proven to be effective and are employed in the updated education concept for patients with fibromyalgia syndrome, which is described here as an example. The Centre for Patient Education offers support in updating and evaluating patient education concepts.
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Affiliation(s)
- H Faller
- Abteilung für Medizinische Psychologie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Klinikstr. 3, 97070, Würzburg, Deutschland,
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Musekamp G, Gerlich C, Ehlebracht-König I, Faller H, Reusch A. Evaluation of a self-management patient education program for patients with fibromyalgia syndrome: study protocol of a cluster randomized controlled trial. BMC Musculoskelet Disord 2016; 17:55. [PMID: 26842871 PMCID: PMC4738802 DOI: 10.1186/s12891-016-0903-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is a complex chronic condition that makes high demands on patients' self-management skills. Thus, patient education is considered an important component of multimodal therapy, although evidence regarding its effectiveness is scarce. The main objective of this study is to assess the effectiveness of an advanced self-management patient education program for patients with FMS as compared to usual care in the context of inpatient rehabilitation. METHODS/DESIGN We conducted a multicenter cluster randomized controlled trial in 3 rehabilitation clinics. Clusters are groups of patients with FMS consecutively recruited within one week after admission. Patients of the intervention group receive the advanced multidisciplinary self-management patient education program (considering new knowledge on FMS, with a focus on transfer into everyday life), whereas patients in the control group receive standard patient education programs including information on FMS and coping with pain. A total of 566 patients are assessed at admission, at discharge and after 6 and 12 months, using patient reported questionnaires. Primary outcomes are patients' disease- and treatment-specific knowledge at discharge and self-management skills after 6 months. Secondary outcomes include satisfaction, attitudes and coping competences, health-promoting behavior, psychological distress, health impairment and participation. Treatment effects between groups are evaluated using multilevel regression analysis adjusting for baseline values. DISCUSSION The study evaluates the effectiveness of a self-management patient education program for patients with FMS in the context of inpatient rehabilitation in a cluster randomized trial. Study results will show whether self-management patient education is beneficial for this group of patients. TRIAL REGISTRATION German Clinical Trials Register, DRKS00008782 , Registered 8 July 2015.
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Affiliation(s)
- Gunda Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany.
| | - Christian Gerlich
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany.
| | | | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany.
| | - Andrea Reusch
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, Klinikstr. 3, D-97070, Würzburg, Germany.
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Schuler M, Faller H, Wittmann M, Schultz K. Asthma Control Test and Asthma Control Questionnaire: factorial validity, reliability and correspondence in assessing status and change in asthma control. J Asthma 2016; 53:438-45. [PMID: 26539757 DOI: 10.3109/02770903.2015.1101134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined the factor structures and reliabilities of the Asthma Control Test (ACT) and the Asthma Control Questionnaire (ACQ-7; ACQ-6) and the correspondence between them in assessing both level and change in asthma control. METHODS Lung function and questionnaire data for ACT and ACQ were assessed in 113 asthma patients at the beginning (T1) and the end (T2) of inpatient rehabilitation. Confirmatory factor analyses, composite reliability coefficients, Pearson correlations, Cohen's Kappa and positive/negative agreements were computed. RESULTS Unidimensional factor structure was confirmed for ACT. For ACQ configural invariance (i.e. same factor structure) over time could not be established. Furthermore, in ACQ-7, FEV1 showed no relation to the latent factor. Reliability estimates were 0.86-0.88 (ACT), 0.88-0.92(ACQ-6) and 0.81-0.86 (ACQ-7). Pearson correlations between ACT and ACQ were between 0.75 and 0.90 and tended to be higher at T2. If the aim is to identify patients with either not well-controlled asthma or change in asthma control, concordance was at least moderate (Kappa = 0.52-0.72). Correspondence tended to be lower in identifying patients with well-controlled asthma (Kappa = 0.30-0.79). In some circumstances, ACQ-6 showed higher agreement with ACT than did ACQ-7. CONCLUSIONS ACT is a unidimensional measure, but factor structure of ACQ remains unclear. Correspondence between ACT and ACQ depends on the aim of the assessment. Including FEV1 in the assessment of asthma control level even lowers reliability of ACQ and concordance with ACT. Our results support GINA (2014) in conceptualizing FEV1 as a risk factor for poor asthma outcome instead of an indicator of level of asthma control.
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Affiliation(s)
- Michael Schuler
- a Department of Medical Psychology and Psychotherapy , Medical Sociology and Rehabilitation Sciences, University of Würzburg , Würzburg , Germany and
| | - Hermann Faller
- a Department of Medical Psychology and Psychotherapy , Medical Sociology and Rehabilitation Sciences, University of Würzburg , Würzburg , Germany and
| | - Michael Wittmann
- b Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics , Bad Reichenhall , Germany
| | - Konrad Schultz
- b Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics , Bad Reichenhall , Germany
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Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes 2015; 13:64. [PMID: 26306793 PMCID: PMC4549914 DOI: 10.1186/s12955-015-0254-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/30/2015] [Indexed: 01/05/2023] Open
Abstract
Background The Health Education Impact Questionnaire (heiQ) allows for the evaluation of the effects of education interventions provided to patients with chronic diseases. This study describes the process for the cross-cultural adaptation and validation of the heiQ into French (heiQ-Fv). Methods We undertook a systematic translation process followed by a validation study based on the secondary analysis of cross-sectional data from a longitudinal study. Participants in the validation study were adult patients from primary care clinics in Quebec, Canada, with one or more of the following diseases: diabetes, asthma, chronic obstructive pulmonary disease, cardiovascular disease; or one or more risk factors for these diseases. Main outcomes of the study were the French version of the heiQ-Fv and the validation analyses that included internal consistency, test-retest reliability, confirmatory factor analysis (CFA) and concomitant validity. Results The validation analysis was conducted on results from 332 participants. Cronbach’s alphas (internal consistency) for seven domains of the heiQ-Fv varied from 0.80 to 0.89; one domain scored 0.69. The test-retest analysis (n = 50) yielded intra-class correlation coefficients from 0.66 to 0.86. The CFA of the eight heiQ domains with the hypothesis of no correlation between the domains yielded a model that did not exhibit acceptable fit values. A model with the hypothesis of all domains correlated exhibited acceptable fit values (scaled chi-square = 1210.15, degrees of freedom = 712, p < 0.001; CFI = 0.98; RMSEA = 0.06; SRMR = 0.065). Results show a moderate correlation (concomitant validity) between five domains of the heiQ-Fv and the Self-Efficacy for Managing Chronic Diseases. We also found a moderate to strong correlation between the Emotional Wellbeing domain of the heiQ and the Kessler Psychological Distress Scale (K6) (r = 0.61; 95 % CI: 0.52 –0.69, p < 0.01). Conclusions The heiQ was translated into French using a rigorous translation process; the French-language version showed good psychometric properties. Health professionals and researchers in primary care settings may use the heiQ-FV to evaluate the impact of educational programs on patients with chronic diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0254-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Bélanger
- Registered nurse and graduate student, Department of health sciences, Université du Québec à Chicoutimi (UQAC), Quebec, Canada.
| | - Catherine Hudon
- Family physician and professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Martin Fortin
- Family physician and professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - José Amirall
- Adjunct professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Tarek Bouhali
- Adjunct professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Maud-Christine Chouinard
- Registered nurse and professor, Department of health sciences, Université du Québec à Chicoutimi (UQAC), Québec, Canada.
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Elsworth GR, Nolte S, Osborne RH. Factor structure and measurement invariance of the Health Education Impact Questionnaire: Does the subjectivity of the response perspective threaten the contextual validity of inferences? SAGE Open Med 2015; 3:2050312115585041. [PMID: 26770785 PMCID: PMC4679238 DOI: 10.1177/2050312115585041] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 03/26/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE On-going evidence is required to support the validity of inferences about change and group differences in the evaluation of health programs, particularly when self-report scales requiring substantial subjectivity in response generation are used as outcome measures. Following this reasoning, the aim of this study was to replicate the factor structure and investigate the measurement invariance of the latest version of the Health Education Impact Questionnaire, a widely used health program evaluation measure. METHODS An archived dataset of responses to the most recent version of the English-language Health Education Impact Questionnaire that uses four rather than six response options (N = 3221) was analysed using exploratory structural equation modelling and confirmatory factor analysis appropriate for ordered categorical data. Metric and scalar invariance were studied following recent recommendations in the literature to apply fully invariant unconditional models with minimum constraints necessary for model identification. RESULTS The original eight-factor structure was replicated and all but one of the scales (Self Monitoring and Insight) was found to consist of unifactorial items with reliability of ⩾0.8 and satisfactory discriminant validity. Configural, metric and scalar invariance were established across pre-test to post-test and population sub-groups (sex, age, education, ethnic background). CONCLUSION The results support the high level of interest in the Health Education Impact Questionnaire, particularly for use as a pre-test/post-test measure in experimental studies, other pre-post evaluation designs and system-level monitoring and evaluation.
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Affiliation(s)
- Gerald R Elsworth
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, VIC, Australia
| | - Sandra Nolte
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, VIC, Australia; Medical Clinic, Department of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, Deakin University, Melbourne, VIC, Australia
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Schuler M, Spanier K, Lukasczik M, Schwarze M, Musekamp G, Osborne RH, Faller H, Pohrt U. Individual prevention courses for occupational skin diseases: changes in and relationships between proximal and distal outcomes. Contact Dermatitis 2015; 72:371-80. [PMID: 25845413 DOI: 10.1111/cod.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/08/2015] [Accepted: 01/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND To treat people with occupational contact dermatitis, the German Accident Prevention and Insurance Association in the Health and Welfare Services offers 2-day individual prevention (IP) seminars. OBJECTIVES We investigated whether there are short-term and medium-term changes in proximal (e.g. behaviour) and distal (e.g. symptoms) outcomes after an IP seminar, whether changes in proximal outcomes are associated with changes in distal outcomes, and whether subgroups can be identified that benefit in particular. PATIENTS/MATERIALS/METHODS In a prospective study, 502 participants of 85 IP courses completed the health education impact questionnaire (heiQ™) and skin symptom questionnaire (Skindex-29) at the start of the course, immediately thereafter, and after 6 months. Change was assessed according to standardized effect size. Regression techniques were used to analyse associations between proximal and distal outcomes. RESULTS After 6 months, participants showed improved self-management skills and preventive behaviour, and less fear of job loss, disease-related symptoms, and emotional distress. Significant associations between proximal and distal outcomes were found. Participants who felt more limited by their skin disease showed greater effects. CONCLUSIONS The results are consistent with the assumption that IP courses provide a range of benefits for people with occupational contact dermatitis. Changes in distal outcomes may be influenced by changes in proximal outcomes.
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Affiliation(s)
- Michael Schuler
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, D-97072, Würzburg, Germany
| | - Katja Spanier
- Institute of Social Medicine and Epidemiology, University of Lübeck, D-23538, Lübeck, Germany
| | - Matthias Lukasczik
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, D-97072, Würzburg, Germany
| | - Monika Schwarze
- Department of Rehabilitation Medicine, Medical School Hannover, D-30625, Hannover, Germany
| | - Gunda Musekamp
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, D-97072, Würzburg, Germany
| | - Richard H Osborne
- Population Health Strategic Research Centre, School of Health & Social Development, Deakin University, 3125, Melbourne, Australia
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, University of Würzburg, D-97072, Würzburg, Germany
| | - Ute Pohrt
- Accident Prevention and Insurance Association in the Health and Welfare Services (Berufsgenossenschaft für Gesundheit und Wohlfahrtspflege), D-10777, Berlin, Germany
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Cross-cultural adaptation of the Health Education Impact Questionnaire: experimental study showed expert committee, not back-translation, added value. J Clin Epidemiol 2015; 68:360-9. [DOI: 10.1016/j.jclinepi.2013.07.013] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 07/14/2013] [Accepted: 07/19/2013] [Indexed: 12/29/2022]
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Weymann N, Dirmaier J, von Wolff A, Kriston L, Härter M. Effectiveness of a Web-based tailored interactive health communication application for patients with type 2 diabetes or chronic low back pain: randomized controlled trial. J Med Internet Res 2015; 17:e53. [PMID: 25736340 PMCID: PMC4376097 DOI: 10.2196/jmir.3904] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness. Objective The main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients’ knowledge and empowerment. Methods We performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t0), directly after the first visit (t1), and at 3-month follow-up (t2). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes. Results A total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t1 (P=.02) and more emotional well-being (subscale of empowerment) at t2 (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale. Conclusions The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. Trial Registration International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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