Barriers and reinforcing factors to self-management behaviour in rheumatoid arthritis patients: A qualitative study

Development and psychometric evaluation of a self-management behaviours scale in rheumatoid arthritis patients (RA-SMBS)

BACKGROUND

Self-management behaviours can be crucial to improving disease symptoms and health outcomes in rheumatoid arthritis (RA) patients. Currently, the tools available for measuring self-management behaviours in RA patients are either generalized for patients with chronic diseases, which lack specificity or have poor reliability in the only specific scale-self-care behaviours scale (SCBS). The aim of this study was to develop a self-management behaviours scale for RA patients and evaluate its psychometric properties.

METHODS

The study included two steps: scale development and the psychometric evaluation. The items were developed from a literature review, in-depth individual interviews, nominal group technique, Delphi expert consultation, and a pilot test. For the psychometric evaluation, a sample of 561 patients with RA was recruited. Item analysis, content validity, exploratory and confirmatory factor analysis, convergent and discriminant validity, and internal consistency reliability were conducted to examine the psychometric properties of the RA-SMBS.

RESULTS

The final scale consists of 23 items with 4 dimensions, including medication management, exercise and joint protection, resource utilization and emotional management, and symptom management. The content validity index was 0.78. Exploratory factor analysis explained 61.89% of the total item variance. Confirmatory factor analysis indicated that the RA-SMBS fit well. Good internal consistency reliability was demonstrated (Cronbach's alpha = 0.908), and the test-retest reliability was found to be acceptable (ICC = 0.628, r = 0.780).

CONCLUSIONS

The scale has good content validity, construct validity, and internal consistency reliability. It can be used to assess the level of self-management behaviours in RA patients.

A mobile health + health coaching application for the management of chronic non-cancer pain in older adults: Results from a pilot randomized controlled study

Introduction

The rapid growth of mobile health (mHealth) devices holds substantial potential for improving care and care outcomes in aging adults with chronic non-cancer pain (CNCP), however, research evaluating these devices in older adults remains limited.

Objective

To ascertain the feasibility and preliminary efficacy of an mHealth intervention (Mymee) that combines symptom, diet, and behavior tracking via a smartphone application with data analytics to detect associations between symptoms and lifestyle factors along with weekly health coaching sessions to mitigate CNCP in adults 55 years of age and older.

Methods

Participants (N = 31) in this pilot study were recruited from one primary care practice in New York City and randomized to an intervention [app + up to 12 health coaching sessions (scheduled approximately once weekly) + usual care] or a control (app + usual care) arm. Feasibility measures included recruitment (proportion of eligible persons who enrolled) and retention rates (proportion of subjects completing a follow-up assessment) as well as adherence with the weekly coaching sessions and logging daily data on the app. Efficacy outcomes (e.g., pain intensity, self-efficacy, disability, anxiety) were assessed at baseline and follow-up (~16 weeks after baseline). Descriptive statistics were obtained and general linear mixed models used for primary analyses.

Results

Participants had a mean (standard deviation) age of 67.32 (9.17) and were mostly female (61%). Feasibility outcomes were mixed as evidenced by recruitment and retention rates of 74% and 65%, respectively. The mean number of weekly coaching sessions attended by intervention participants was 6.05 (SD = 5.35), while the average number of days logging data on the app was 44.82 (34.02). We found a consistent trend in favor of the intervention, where pain intensity, affect, and quality of life measures improved considerably more among intervention (vs. control) participants. Finally, the proportion of participants with GAD-7 scores at follow up decreased by 0.35 to 0, whereas controls did not change, a significant effect in favor of the intervention (p = 0.02).

Conclusions

This study supports the need for future research that seeks to enhance feasibility outcomes and confirm the efficacy of the Mymee intervention among aging adults with CNCP.

Impact of COVID-19 pandemic on patients with rheumatic diseases in Latin America

The objective of our study was to describe knowledge, attitudes and practices of Latin-American rheumatology patients regarding management and follow-up of their disease during COVID-19 pandemic. A cross-sectional observational study was conducted using a digital anonymous survey. Rheumatic patients ≥ 18 years from non-English-speaking PANLAR countries were included. Our survey included 3502 rheumatic patients living in more than 19 Latin-American countries. Median age of patients was 45.8(36-55) years and the majority (88.9%) was female. Most frequently self-reported disease was rheumatoid arthritis (48.4%). At least one anti-rheumatic treatment was suspended by 23.4% of patients. Fear of contracting SARS-Cov2 (27.7%) and economic issues (25%) were the most common reasons for drug discontinuation. Self-rated disease activity increased from 30 (7-50) to 45 (10-70) points during the pandemic. Communication with their rheumatologist during the pandemic was required by 55.6% of patients, mainly by telephone calls (50.2%) and social network messages (47.8%). An adequate knowledge about COVID-19 was observed in 43% of patients. Patients with rheumatic diseases in Latin America were negatively affected by the COVID-19 pandemic. An increase in self-rated disease activity, a reduction in medication adherence, and hurdles for medical follow-up were reported. Teleconsultation was perceived as a valid alternative to in-person visits during the pandemic.

Understanding peer mentorship in supporting self-management of hip and knee osteoarthritis: A qualitative study of mentees' perspectives

Background

Hip and knee osteoarthritis (OA) are common musculoskeletal conditions. Treatment is usually conservative, making self‐management a priority. We developed and trialled an OA peer mentorship intervention to support self‐management in older people. Our objectives were to gain understanding of the perceived challenges of living with OA and explore how a peer mentorship intervention can support tackling these challenges; and to explore mentees' experiences of receiving the intervention to understand how this affected their OA self‐management.

Methods

Qualitative semi‐structured interviews focussing on acceptability and feasibility of being in the study were conducted with mentees. Transcribed interviews were double coded and subject to framework analysis. To address the objectives of this paper, three main themes were subject to focused analysis: mentees' experiences of OA, experience of peer mentorship support and factors influencing self‐management.

Results

Seventeen mentees participated in an interview following completion of the peer support intervention. Themes emerging from focused analysis were the following: tackling the challenges of living with OA pre‐ and post‐intervention; and the interplay of the peer mentorship intervention and self‐management. Key elements of the latter theme are enabling factors provided by peer mentorship, and mentees' readiness to self‐manage.

Conclusion

To effectively support OA self‐management, peer mentorship interventions should include core educational components and focus on strategies that enhance key enablers of self‐management. Paying attention to the mentor–mentee relationship and timing of intervention engagement can maximise opportunities for older people to adjust and transition from supported to independent self‐management.

The role of support from significant others in the association between disease-related factors and sickness absence in early rheumatoid arthritis: a longitudinal study

Objective: The aim of this study was to analyse how support from significant others affects the associations between disease-related variables and sickness absence during the first 2 years after rheumatoid arthritis (RA) diagnosis.Method: Data from 274 people with RA (73% women) of working age (18-63 years) were retrieved from the Swedish early RA cohort TIRA-2. These data concerned disease-related variables (disease activity, activity limitations, pain intensity, and grip force), sickness absence, and perceived support from significant others. Associations of disease-related variables with sickness absence and how these associations were moderated by support from significant others were analysed using zero-inflated negative binomial regression.Results: During the 2 years after diagnosis, higher disease activity was significantly associated with increased odds of sickness absence, a connection strengthened by perceived support from family during the first year. More perceived support was also directly and significantly associated with increased odds of sickness absence during the first year.Conclusions: Support from significant others is related to sickness absence in RA, specifically during the first year after diagnosis. Although patients report high levels of support from significant others, this does not necessarily lead to more positive work outcomes. Therefore, it is important to consider other aspects of support that might influence work outcomes, e.g. type and quality of support. Future research should investigate these forms of support, and when significant others should be encouraged to support in the rehabilitation process to increase the chances of people with RA having a well-functioning and sustainable work life.

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self-managing rheumatoid arthritis

Background

As chronic illnesses, such as rheumatoid arthritis (RA), place an increased burden on health‐care systems, the ability of individuals to self‐manage these diseases is crucial.

Objective

To identify and synthesize the lived experience of self‐management described by adults living with RA.

Design

A systematic search of five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and ASSIA) was undertaken to identify relevant studies. Data were extracted and quality‐assessed using CASP guidelines. A meta‐synthesis was conducted based on Thomas and Harden's thematic synthesis approach.

Results

The search identified 8423 publications. After removing duplicates, 6527 records remained of which 32 studies met the inclusion criteria. Quality of studies was moderate to high, yet a considerable lack of reflection on researcher bias was evident. Our analysis identified 28 dimensions of self‐management RA across six domains: (a) cognitive‐emotional, (b) behavioural, (c) social, (d) environmental, (e) physical and (f) technological. Cognitive‐emotional experiences dominated the analysis. Renegotiating ‘the self’ (self‐concept, self‐esteem, self‐efficacy) was a key focus of self‐management among individuals with RA.

Conclusion

Our findings highlight the focus of ‘the self’ as a central concern in the self‐management of RA. Standardized self‐management programmes may primarily focus on disease management and daily functioning. However, we suggest that personal biographies and circumstances should move to the fore of self‐management support.

Registration

PROSPERO International Prospective Register of Systematic Reviews 2018: CRD42018100450.

Patient or Public Contribution

Patient and public involvement was not explicit in this review. However, three authors provided a patient perspective on the self‐management of arthritis and autoimmune disease.

Health status and self-management in patients with inflammatory arthritis-A five-year follow-up study after nurse-led patient education

Aim

The aim of this study was to investigate changes in patients' self-management and health status five years after nurse-led patient education.

Design

A longitudinal study.

Methods

We collected self-reported data on physical function, pain, tiredness, disease activity, psychological status, patient activation and self-efficacy from a sample of Norwegian-speaking adults with inflammatory arthritis that had participated in a randomised controlled study investigating the effects of nurse-led patient education. Changes and associations in patients' health status and self-management were analysed with paired sample t tests and multivariable linear regression analyses, respectively.

Results

Except from a small deterioration in patients' physical function, there were no changes in patients' health status 5 years after the nurse-led patient education. Patients' self-management skills were improved after 5 years. Self-efficacy was positively associated with female gender, patient activation, less tiredness and less psychological distress.

Self-management behaviors in adults with chronic hepatitis B: A structural equation model

BACKGROUND

Chronic hepatitis B is a serious and chronic health problem, requiring self-management to control the disease and related complications.

OBJECTIVES

To develop a structural model to identify how social support, self-efficacy and disease knowledge contribute to their self-management behaviors in adults with chronic hepatitis B.

DESIGN

A cross-sectional study.

SETTINGS

Hepatology units in two hospitals in Chongqing, China.

PARTICIPANTS

A total of 306 patients with chronic hepatitis B were recruited.

METHODS

Data were collected using Social Support Rating Scale, Self-Efficacy for Managing Chronic Disease, Hepatitis B Knowledge Questionnaire and Chronic Hepatitis B Self-Management Scale. Structural equation model was applied to analyze the data.

RESULTS

The final model showed good model fit. Social support directly influenced self-management behaviors (β = 0.19, p < 0.01), and indirectly influenced self-management behaviors (β = 0.20, p < 0.01) through self-efficacy. Self-efficacy directly influenced self-management behaviors (β = 0.37, p < 0.05). Disease knowledge indirectly influenced self-management behaviors (β = 0.12, p < 0.05) through self-efficacy.

CONCLUSIONS

Our findings indicated that social support, self-efficacy and disease knowledge directly or indirectly affected self-management behaviors in adults with chronic hepatitis B. This provides a theoretical basis for developing self-management interventions for patients with chronic hepatitis B, which may lead to health improvements in this population.