The educational needs of people with systemic sclerosis: a cross-sectional study using the Dutch version of the Educational Needs Assessment Tool (D-ENAT)

Which Educational Topics and Smartphone App Functions Are Prioritized by US Patients With Rheumatic and Musculoskeletal Diseases? A Mixed-Methods Study

OBJECTIVE

We sought to identify (1) what types of information US adults with rheumatic and musculoskeletal diseases (RMD) perceive as most important to know about their disease, and (2) what functions they would use in an RMD-specific smartphone app.

METHODS

Nominal groups with patients with RMD were conducted using online tools to generate a list of needed educational topics. Based on nominal group results, a survey with final educational items was administered online, along with questions about desired functions of a smartphone app for RMD and wearable use, to patients within a large community rheumatology practice-based research network and the PatientSpot registry. Chi-square tests and multivariate regression models were used to determine differences in priorities between groups of respondents with rheumatic inflammatory conditions (RICs) and osteoarthritis (OA), and possible associations.

RESULTS

At least 80% of respondents considered finding a rheumatologist, understanding tests and medications, and quickly recognizing and communicating symptoms to doctors as extremely important educational topics. The highest-ranked topic for both RIC and OA groups was "knowing when the medication is not working." The app functions that most respondents considered useful were viewing laboratory results, recording symptoms to share with their rheumatology provider, and recording symptoms (eg, pain, fatigue) or disease flares for health tracking over time. Approximately one-third of respondents owned and regularly used a wearable activity tracker.

CONCLUSION

People with RMD prioritized information about laboratory test results, medications, and disease and symptom monitoring, which can be used to create educational and digital tools that support patients during their disease journey.

Educational needs in patients with knee osteoarthritis using the SpENAT questionnaire

INTRODUCTION

Knee osteoarthritis (KOA) is a major public health issue because it causes pain and functional limitation in patients. Engagement with self-management may, however, minimize the impact of KOA on the health of patients suffering this illness. To be fully engaged with self-management activities, knowledge about KOA is a prerequisite. There is data on people's understanding of KOA and their needs for information about KOA. The Educational Needs Assessment Tool-Spanish version (SpENAT) is a self-reported questionnaire that assesses educational needs (Ned) in order to provide information adapted and focused on patients with knee KOA. It comprises 39 questions grouped into seven domains: Pain, Movement, Feelings, Osteoarthritis, Medical treatment, Non-medical treatment, Help.

OBJECTIVES

To estimate the Ned in patients with knee KOA using the SpENAT.

MATERIAL AND METHOD

An observational, descriptive, and cross-sectional study was carried out in 215 patients with a diagnosis of knee KOA according to the criteria of the American College of Rheumatology who attended the service's protocolized consultation of knee conditions of rheumatology at the "Hermanos Ameijeiras" Surgical Clinical Hospital during the study period between January 2017 and August 2020. Demographic data, educational level and characteristics of the disease were recorded. All patients completed the SpENAT and were questioned about the sources they turn to obtain information on their disease.

RESULTS

Women over 50 years of age and overweight with a diagnosis of OA predominated. Major Ned were observed in the domains of movement, help, pain, feeling, KOA. Patients over 50 years of age, female, normal weight, and active workers showed greater interest in the movement domain. The most used source of information was the rheumatologist (91.60%).

CONCLUSION

The Ned in patients with knee KOA are high, and are higher in the domains of movement, pain, help and feeling. The rheumatologist is the main source of information for patients with KOA, it seems wise to design a targeted strategy to educate people about KOA to provide, support and prepare them for self-management.

Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool

Objectives

Knowledge and health literacy enable patients to monitor symptoms and disease impact. Educational needs have previously been explored in rheumatology, but scarcely for patients with ANCA-associated vasculitis (AAV). The aim of the study was to assess the educational needs among patients with AAV using the educational needs assessment tool (ENAT).

Methods

This was a cross-sectional observational study including adults with AAV. Educational needs were captured by ENAT. Total ENAT (0–117 points, with higher numbers indicating higher educational need) and the seven domains (managing pain, movement, feelings, disease process, treatment, self-management and support systems) were explored regarding sex, age, education, diagnosis, disease duration and disease activity. To compare domains, a percentage response (0–100%) was calculated.

Results

One hundred and seventy-eight individuals (50% men; 34% with disease duration ≤2 years) were included. The total ENAT mean was 66.5 (s.d. 26.6; 57%), with domains as follows: disease process, 78%; self-management, 69%; treatments, 64%; feelings, 56%; managing pain, 48%; support systems, 47%; and movement, 41%. Higher educational needs were found among women in the domains movement, feelings and disease process and in total ENAT (all P < 0.04) compared with men. Higher educational needs were also seen in patients with disease duration ≤2 years regarding disease process, self-management and support systems and in total ENAT compared with patients with longer disease duration (all P < 0.03).

Conclusion

This study revealed great educational needs among AAV patients. Some groups expressed higher needs (women and those with shorter disease duration). Increased education for patients with AAV might lead to improved self-care and treatment adherence.

Promoting parental education of infants hospitalized in a children's hospital in Tabriz, Iran: a best practice implementation project

INTRODUCTION

Parents of infants admitted to hospital have high information needs. A good educational program will improve the outcomes and communication needs of these parents. Results from some studies have shown that patient education in Iran is inappropriate and should be improved.

OBJECTIVES

The aim of this evidence implementation project was to evaluate the current practice and implement the best practice related to promoting patient education in a children's hospital in Tabriz, Iran.

METHODS

A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Eight audit criteria that represent the best practice recommendations for patient education were used. A baseline audit was conducted followed by implementing multiple strategies, and the project was finalized with a follow-up audit to determine a change in practice.

RESULTS

Significant improvements in the follow-up audit in comparison with the baseline audit were as follows: evaluation of patient learning has been undertaken to determine met and unmet needs (from 65 to 77%); patients' learning needs, readiness to learn, and their learning style have been assessed before the implementation of an educational initiative (from 55 to 66%); and educational resources in different formats (e.g., written handouts, brochures, and links to online materials) are available in the ward (from 33 to 77%). Strategies that were implemented to achieve change in practice included conducting workshops and conferences, determining a trained nurse as responsible for educating parents, training in discharge time, the presentation of educational films daily, conducting group training, and installing related posters in the department and patient's room. The other five criteria were less compliant with best practice in the follow-up audit rather than the baseline audit; however, all of them except one (Criterion 3) were still up to 75% compliant, which is considered excellent by the audit team.

CONCLUSION

The follow-up audit results indicated an improvement in providing parental education. It can be concluded that these interventions can facilitate the implementation of evidence into clinical practice.

Validation of the Italian Version of the Educational Needs Assessment Tool in Rheumatoid Arthritis Patients and Factors Associated with Educational Needs

The educational needs assessment tool (ENAT) is a seven-domain questionnaire assessing the educational needs (EN) of patients with rheumatoid arthritis (RA). The aim of this study was to validate the Italian version of the ENAT and to identify factors associated with EN in people with RA. The original English ENAT version was translated into Italian according to Beaton’s method and subjected to Rasch analysis for validity testing. Socio-demographic and clinical variables were tested for associations with the ENAT domain scores using a multivariable linear regression model. The ENAT translated well into Italian and retained its construct validity. Some adjustments were needed when pooling the Italian and English datasets. The overall score of the ENAT had a high median: 82.8 (interquartile range (IQR): 57.5 to 100) i.e., 72.4% of the maximum score. The highest score was observed in the domain “Arthritis process” and the lowest was in “Support systems”. Only gender was independently associated with EN (females having higher EN than males). The Italian ENAT is feasible for the use in the clinical setting and may help the health care practitioners to tailor educational interventions for RA patients. The characteristics of the patients, particularly female gender, may be associated with higher EN.

Experiences of physical activity and exercise in individuals with systemic sclerosis: A qualitative study

INTRODUCTION

Exercise is emerging as an important part of the treatment in systemic sclerosis-patients with no-mild lung involvement. However, it has not been studied how patients experience physical activity and exercises. We thus explored and described experiences of physical activity/exercises in systemic sclerosis-individuals.

METHOD

Sixteen systemic sclerosis-patients were purposefully recruited to represent variation in gender, age, and lung disease. Semi-structured individual interviews were performed, transcribed and analyzed with qualitative content analysis.

RESULTS

Three themes (categories) emerged: 1) Essential for life and health (An effective treatment, Reduces fear of deterioration, and Feeling healthy and satisfied with oneself); 2) Disease-related hinders and other barriers (Disease consequences, Risk of worsening, and Non-disease related barriers); and 3) Self-care and/or support (Self-confidence in physical activity/exercise, and, Education and support from healthcare and other).

CONCLUSIONS

Physical activity/exercises were experienced as essential for life and health and as an effective treatment. It reduced fear of deterioration and made the participants feel healthy and satisfied with oneself. However, participants also experienced disease-related barriers like shortness of breath and pain, and they expressed a risk of worsening. Participants felt confidence in their physical activity/exercises and expressed that education and support from healthcare could be facilitating. Our findings add new knowledge about how systemic sclerosis-patients perceive physical activity/exercise and can contribute to the development of patient education and PA/exercise programs.

How do patients with systemic sclerosis experience currently provided healthcare and how should we measure its quality?

Objectives

To gain insight into SSc patients’ perspective on quality of care and to survey their preferred quality indicators.

Methods

An online questionnaire about healthcare setting, perceived quality of care (CQ index) and quality indicators, was sent to 2093 patients from 13 Dutch hospitals.

Results

Six hundred and fifty patients (mean age 59 years, 75% women, 32% limited cutaneous SSc, 20% diffuse cutaneous SSc) completed the questionnaire. Mean time to diagnosis was 4.3 years (s.d. 6.9) and was longer in women compared with men (4.8 (s.d. 7.3) vs 2.5 (s.d. 5.0) years). Treatment took place in a SSc expert centre for 58%, regional centre for 29% or in both for 39% of patients. Thirteen percent of patients was not aware of whether their hospital was specialized in SSc. The perceived quality of care was rated with a mean score of 3.2 (s.d. 0.5) (range 1.0–4.0). There were no relevant differences between expert and regional centres. The three prioritized process indicators were: good patient-physician interaction (80%), structural multidisciplinary collaboration (46%) and receiving treatment according to SSc guidelines (44%). Absence of disease progression (66%), organ involvement (33%) and digital ulcers (27%) were the three highest rated outcome indicators.

Conclusion

The perceived quality of care evaluated in our study was fair to good. No differences between expert and regional centres were observed. Our prioritized process and outcome indicators can be added to indicators suggested by SSc experts in earlier studies and can be used to evaluate the quality of care in SSc.

Developing a rare disease chronic care model: Management of systemic sclerosis (MANOSS) study protocol

AIM

The aim of the management of systemic sclerosis (MANOSS) study described in this protocol is to develop a chronic care model, based on a contextual analysis and stakeholder involvement, for patients living with the rare disease systemic sclerosis (SSc) in Switzerland.

DESIGN

Applying an implementation science approach, this study starts with an explanatory sequential mixed method study for contextual analysis, followed by broad stakeholder involvement for model development and a Delphi study to reach consensus.

METHODS

First, a quantitative cross-sectional survey with patients and healthcare professionals (HPs) will be conducted to identify current practice patterns of chronic illness management and technology readiness. Second, qualitative interviews with patients, family members and HPs will be performed to gain a deeper understanding of care needs identified in the quantitative survey. Third, a model of care will be co-created with input from patients, HPs and other experts. The eHealth enhanced Chronic Care Model will serve as a guiding framework. The new model and corresponding outcome parameters will be refined using a Delphi-study approach to reach consensus on a testable model of care for persons living with SSc. The protocol has received research ethics committee approval in September 2018 by the Swiss Ethics Committee.

DISCUSSION

The MANOSS study's participatory approach is essential for contextual fit of the model for patients with SSc in this setting. Subsequent feasibility testing and implementation are planned to evaluate the model's value in relation to health disparities faced by this patient population.

IMPACT

Patients living with this rare disease lack access to coordinated, specialized care and self-management support from qualified HPs. Reengineering of current care, with consideration for technological opportunities, is warranted to meet patients' and families' needs.

Pain, fatigue and functional disability are associated with higher educational needs in systemic sclerosis: a cross-sectional study

In the process of the planned and systematic education of patients/families, it is extremely important to identify patients' health problems as well as their needs and expectations. The objective of this study was to determine the relationship between functional disability, health problems and perceived educational needs in people with systemic sclerosis (SSc). This was a cross-sectional analytic study conducted in six rheumatology centers in Poland. Functional disability was measured using HAQ-DI, and the magnitude of other health problems (pain, fatigue, intestinal problems, breathing problems, Raynaud's phenomenon, finger ulcerations) was measured using 0-100 mm visual analogue scales. The educational needs were measured using the Polish version of the Educational Needs Assessment Tool (Pol-ENAT). Spearman's correlation coefficient (r_s) was used to report associations. The sample comprised 140 patients, 125 (89.28%) were women. They had a mean (SD) age of 54 (14.23) and disease duration of 11 (10.27) years. The median (IQR) HAQ-DI was 1.12 (0.62-1.62) and mean ENAT score was 71.54 (SD 27.72). Patients needed to know more about the disease process, self-help measures and managing pain. All health problems had significant correlations with the overall educational needs, pain, functional disability and fatigue having the highest r_s = 0.359, p < 0.0001; r_s = 0.314, p < 0.001 and r_s = 0.270, p = 0.001, respectively. Health problems in people with SSc are associated with considerable educational needs; therefore, health professionals should take this into account when planning patient education. Group interventions should consider providing patient education related to disease process as a minimum.

The educational needs of patients with undifferentiated spondyloarthritis: Validation of the ENAT questionnaire and needs assessment

OBJECTIVES

The aim of the present study was to validate the Swedish version of the educational needs assessment tool (SwENAT) in undifferentiated spondyloarthritis (USpA) and use it to study the educational needs of patients with USpA.

METHODS

This was a cross-sectional study, recruiting a random sample of patients with USpA from a hospital register in Sweden. Educational needs data were collected, together with disease activity and function indices (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Bath Ankylosing Spondylitis Functional Index [BASFI]). Rasch analysis was utilized to evaluate the construct validity, internal consistency and unidimensionality of the SwENAT before studying differences in educational needs between patient subgroups (gender, age and disease severity).

RESULTS

Complete responses were obtained from 77 patients (48 women), with a mean age (standard deviation [SD]) of 50 (12) years, a disease duration of 16 (11) years, a BASDAI score of 4.9 (1.9) and a BASFI score of 3.1 (2.3). The SwENAT satisfied the requirements of the Rasch model (χ² = 11.488; p = 0.119), including strict unidimensionality. Overall, the mean (SD) SwENAT score was 86 (32). Women reported higher needs than men in the domains of pain (mean [SD] 13.1 [6.8] versus 10.1 [6.0]; p = 0.05); movement (mean [SD] 13.0 [5.5] versus 9.9 [5.7]; p = 0.02) and self-help (mean [SD] 17.0 [5.8] versus 14.1 [5.0]; p = 0.03). Higher disease activity (BASDAI >4) was associated with higher educational needs (mean [SD] 92.6 [31.9] versus 73.7 [29.4]; p = 0.02).

CONCLUSIONS

These data suggest that the SwENAT is valid in USpA. Women and patients with higher disease activity are more likely to have high levels of educational needs, so special attention and strategies to target patient education are warranted.

Cross-cultural validation of the educational needs assessment tool into Chinese for use in severe knee osteoarthritis

BACKGROUND

Patient education is an integral part of the management of osteoarthritis. The educational needs assessment tool (ENAT) was developed in the UK to help direct needs-based patient education in rheumatic diseases.

AIM

The aim of the study was to adapt and validate the ENAT into Chinese, for use in severe knee osteoarthritis (KOA).

METHODS

This cross-cultural validation study took two phases: 1) adaptation of the ENAT into Chinese (CENAT) and 2) validation of the CENAT. The Construct validity was determined using factor analysis and criterion-related validity by comparing data from CENAT with data from different self-efficacy scales: patient-physician interactions scale (PEPPI-10), self-efficacy for rehabilitation outcome scale (SER), and the self-efficacy for exercise scale (SEE).

RESULTS

The sample comprised 196 patients, with mean age 63.6±8.7 years, disease duration was11.5 years, and 57.1% were female. The CENAT was found to have high internal consistency. The CENAT had weak correlations with the Chinese versions of PEPPI r=0.40, SER r=0.40, and SEE r=0.39. There were no correlations with age r=-0.03 or disease duration r=-0.11.

CONCLUSION

The ENAT translated well into Chinese and has evidence of validity in KOA. Future studies will further inform its usefulness in clinics, community, and online settings.