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Sadiq S, Hamre KES, Kumar S, Bazur-Leidy S, Désir L, Désir MM, Gilbert MC, Beau de Rochars VM, Telfort MA, Noland GS, Byrd E. A pilot study to address the mental health of persons living with lymphatic filariasis in Léogâne, Haiti: Implementing a chronic disease self-management program using a stepped-wedge cluster design. Int Health 2024; 16:i68-i77. [PMID: 38547350 PMCID: PMC10977951 DOI: 10.1093/inthealth/ihae006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 01/09/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) inflict significant comorbid disability on the most vulnerable communities; yet interventions targeting the mental health of affected communities are lacking. A pilot study to assess the effectiveness of a chronic disease self-management program (CDSMP) was introduced to lymphatic filariasis peer support groups in Léogâne, Haiti. METHODS Using a closed-cohort stepped-wedge cluster trial design, Hope Clubs were assigned into Arm 1 (n=118 members) and Arm 2 (n=92). Household surveys, measuring self-rated health, depression, disease self-efficacy, perceived social support, and quality of life, were conducted at baseline (before CDSMP); midpoint (after Arm 1/before Arm 2 completed CDSMP); and endpoint (after CDSMP). Non-Hope Club member patients (n=74) were evaluated at baseline for comparison. RESULTS Fifty percent of Hope Club members (Arm 1: 48.3%, Arm 2: 52.2%) screened positive for depression at baseline, compared with 36.5% of non-Hope Club members. No statistically significant differences were found in outcome measures between intervention observation periods. At endpoint, depressive illness reduced to 28.7% (Arm 1) and 27.6% (Arm 2). CONCLUSIONS The intervention was feasible to integrate into Hope Clubs, showed overall positive effects and reduced depressive symptoms. More studies are needed to evaluate the efficacy of implementing CDSMP in the NTD context. CONTEXTE Les maladies tropicales négligées (MTN) infligent d'importantes incapacités comorbides aux communautés les plus vulnérables; pourtant, les interventions ciblant la santé mentale des communautés affectées font défaut. Une étude pilote visant à évaluer l'efficacité d'un programme d'autogestion des maladies chroniques (CDSMP) a été introduite dans des groupes de soutien par les pairs pour la filariose lymphatique à Léogâne, en Haïti. MÉTHODES Dans le cadre d'un essai en grappe à cohorte fermée, les clubs Hope ont été répartis entre le bras 1 (n=118 membres) et le bras 2 (n=92). Des enquêtes auprès des ménages, mesurant l'auto-évaluation de la santé, la dépression, l'auto-efficacité face à la maladie, le soutien social perçu et la qualité de vie, ont été menées au départ (avant le CDSMP), à mi-parcours (après que le bras 1 / avant que le bras 2 ait terminé le CDSMP) et à la fin (après le CDSMP). Les patients non membres du Hope Club (n=74) ont été évalués au début de l'étude à des fins de comparaison. RÉSULTATS Cinquante pourcent des membres du Hope Club (bras 1 : 48,3%, bras 2 : 52,2%) ont été dépistés positifs pour la dépression au début de l'étude, contre 36,5% des non-membres du Hope Club. Aucune différence statistiquement significative n'a été constatée dans les mesures des résultats entre les périodes d'observation de l'intervention. À la fin de l'étude, la maladie dépressive était réduite à 28,7% (bras 1) et 27,6% (bras 2). CONCLUSIONS L'intervention a pu être intégrée dans les clubs Hope, elle a montré des effets globalement positifs et a permis de réduire les symptômes dépressifs. D'autres études sont nécessaires pour évaluer l'efficacité de la mise en œuvre du CDSMP dans le contexte des MTD. ANTECEDENTES Las enfermedades tropicales desatendidas (ETDs) infligen una importante discapacidad comórbida a las comunidades más vulnerables; sin embargo, faltan intervenciones dirigidas a la salud mental de las comunidades afectadas. Se introdujo un estudio piloto para evaluar la eficacia de un programa de autogestión de enfermedades crónicas (CDSMP, por sus siglas en inglés) en grupos de apoyo entre pares de filariasis linfática en Léogâne, Haití. MÉTODOS Utilizando un diseño de ensayo por conglomerados de cohortes cerradas escalonadas, los Clubes Esperanza fueron asignados al Grupo 1 (n=118 miembros) y al Grupo 2 (n=92). Se realizaron encuestas en los hogares para medir la autoevaluación de la salud, la depresión, la autoeficacia frente a la enfermedad, el apoyo social percibido y la calidad de vida en la línea de base (antes del CDSMP), en el punto medio (después de que el Grupo 1/antes de que el Grupo 2 completara el CDSMP) y en el punto final (después del CDSMP). Los pacientes que no pertenecían al Club Esperanza (n=74) fueron evaluados al inicio del estudio a modo de comparación. RESULTADOS El 50% de los miembros del Club Esperanza (Grupo 1: 48,3%, Grupo 2: 52,2%) dieron positivo en depresión al inicio del estudio, en comparación con el 36,5% de los no miembros del Club Esperanza. No se encontraron diferencias estadísticamente significativas en las medidas de resultado entre los periodos de observación de la intervención. Al final, la enfermedad depresiva se redujo al 28,7% (Grupo 1) y al 27,6% (Grupo 2). CONCLUSIONES La intervención fue factible de integrar en los Clubes Esperanza, mostróefectos positivos generales y redujo los síntomas depresivos. Se necesitan más estudios para evaluar la eficacia de la aplicación del CDSMP en el contexto de las ETD.
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Affiliation(s)
- Shanze Sadiq
- Mental Health Program, The Carter Center, Atlanta, GA, 30307, USA
| | - Karen E S Hamre
- Hispaniola Initiative, The Carter Center, Atlanta, GA, 30307, USA
| | - Samhita Kumar
- Mental Health Program, The Carter Center, Atlanta, GA, 30307, USA
| | | | - Luccène Désir
- Hispaniola Initiative, The Carter Center, Atlanta, GA, 30307, USA
| | - M Martha Désir
- Notre Dame Haiti Program, University of Notre Dame, Port-au-Prince, Haiti
| | - Murielle C Gilbert
- National Program to Eliminate Lymphatic Filariasis, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - V Madsen Beau de Rochars
- Hispaniola Initiative, The Carter Center, Atlanta, GA, 30307, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, 32610, USA
| | - Marc-Aurèle Telfort
- National Program to Eliminate Lymphatic Filariasis, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Gregory S Noland
- Hispaniola Initiative, The Carter Center, Atlanta, GA, 30307, USA
| | - Eve Byrd
- Mental Health Program, The Carter Center, Atlanta, GA, 30307, USA
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Walter O, Hazan-Liran B. Personal Well-being and Recovery in Peer Support Specialists Working at Psychiatric Hospitals. Am J Health Behav 2023; 47:539-548. [PMID: 37596751 DOI: 10.5993/ajhb.47.3.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Objectives: Personal well-being is a major part of recovery for the many people who experience mental illness. Peer support specialists are mental health professionals who have themselves experienced mental illness and use their recovery experiences to facilitate the healing of others. In this study, we explored how peer specialists view their subjective well-being in their work with others and how they perceive their profession. Methods: Seven peer specialists working in a psychiatric hospital participated in individual interviews. We asked them about their personal experiences, their subjective well-being, and their perceptions of the peer specialist profession. We analyzed the interviews thematically. Results: The peer specialists' responses emphasized the link between mental health recovery and subjective well-being. Our findings also indicated the importance of positive relationships and community belonging as fundamental to subjective well-being, and consequently, to recovery. Conclusions: The insights that peer support specialists have acquired and the tools they have mastered in their own recovery process highlight the valuable experience-based knowledge and skills they can provide to others. Future studies may investigate how the experience of their own well-being and recovery directly influences their work with others.
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Affiliation(s)
- Ofra Walter
- Department of Education, Tel Hai Academic College, Kiryat Shmona, Israel
| | - Batel Hazan-Liran
- Department of Education, Tel Hai Academic College, Kiryat Shmona, Israel
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Matthews EB, Rahman R, Schiefelbein F, Galis D, Clark C, Patel R. Identifying key roles and responsibilities of peer workers in behavioral health services: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107858. [PMID: 37348313 DOI: 10.1016/j.pec.2023.107858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/18/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The roles and responsibilities of peer workers (PWs) are not well articulated. This scoping review aims to systematically identify and describe the roles of PWs in outpatient, community based mental health and substance use services, and compare their roles and responsibilities across these service settings METHODS: The scoping review was a priori developed and implemented according to the Joanna Briggs Institute methodology, which includes stating the review objectives, conducting a three-step search method, and charting the results. RESULTS Forty-four peer reviewed manuscripts were included in the review. PWs were used more often in mental health (n = 27) than substance use (n = 10) programs. Peers adopted a wide range of skills. Across program contexts, peers were frequently used as a source of informal support or mentorship and care coordination. Mental health programs often used peers to deliver manualized interventions, while substance use programs more frequently leveraged PWs to facilitate service linkage and engagement. CONCLUSION Roles of peers differed between substance use and mental health programs, reflecting significant diversity in how peers are being integrated into the behavioral health workforce. PRACTICE IMPLICATIONS Peer certification programs must balance consistency with the wide range of skills required of this workforce.
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Affiliation(s)
- Elizabeth B Matthews
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA.
| | - Rahbel Rahman
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Faith Schiefelbein
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Danielle Galis
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Carson Clark
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
| | - Rupal Patel
- Fordham University, Graduate School of Social Service, 113W. 60th st., New York, NY 10023, USA
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Gauthier-Beaupré A, Kuziemsky C, Battistini BJ, Jutai JW. Evolution of public health policy on healthcare self-management: the case of Ontario, Canada. BMC Health Serv Res 2023; 23:248. [PMID: 36918904 PMCID: PMC10011770 DOI: 10.1186/s12913-023-09191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/16/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND As people live longer, they are at increased risk for chronic diseases and disability. Self-management is a strategy to improve health outcomes and quality of life of those who engage in it. This study sought to gain a better understanding of the factors, including digital technology, that affect public health policy on self-management through an analysis of government policy in the most populous and multicultural province in Canada: Ontario. The overarching question guiding the study was: What factors have influenced the development of healthcare self-management policies over time? METHODS Archival research methods, combining document review and evaluation, were used to collect data from policy documents published in Ontario. The documents were analyzed using the READ approach, evaluated using a data extraction table, and synthesized into themes using the model for health policy analysis. RESULTS Between January 1, 1985, and May 5, 2022, 72 policy documents on self-management of health were retrieved from databases, archives, and grey literature. Their contents largely focussed on self-management of general chronic conditions, while 47% (n = 18/72) mention diabetes, and 3% (n = 2/72) focussed solely on older adults. Digital technologies were mentioned and were viewed as tools to support self-management in the context of healthcare delivery and enhancing healthcare infrastructure (i.e., telehealth or software in healthcare settings). The actors involved in the policy document creation included mostly Ontario government agencies and departments, and sometimes expert organizations, community groups and engaged stakeholders. The results suggest that several factors including pressures on the healthcare system, hybrid top-down and bottom-up policymaking, and political context have influenced the nature and implementation timing of self-management policy in Ontario. CONCLUSIONS The policy documents on self-management of health reveal a positive evolution of the content discussed over time. The changes were shaped by an evolving context, both from a health and political perspective, within a dynamic system of interactions between actors. This research helps understand the factors that have shaped changes and suggests that a critical evidence-based approach on public health policy is needed in understanding processes involved in the development of healthcare self-management policies from the perspective of a democratic governing system.
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Affiliation(s)
| | - Craig Kuziemsky
- Office of Research Services and School of Business, MacEwan University, Edmonton, Alberta, Canada
| | - Bruno J Battistini
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey W Jutai
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Shi J, Ferretti L, McCallion P. Attending with family members, completion rate and benefits accrued from chronic disease self-management program. Chronic Illn 2022; 18:784-795. [PMID: 34282954 DOI: 10.1177/17423953211032263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Chronic Disease Self-Management Program (CDSMP) has been demonstrated effective in addressing the self-management of chronic conditions among older adults. With a higher attrition rate, this study investigated whether attending with family members influenced completion of and benefits accrued from the CDSMP. METHODS The baseline data were collected from CDSMP participants in New York State (n = 4184), and the follow-up data were collected from completers (attended 4+ sessions) (n = 293). Multi-level logistic regression was employed to predict the association between family accompany and program completion. Paired sample t-test was used to compare the differences in benefits from CDSMP after six months. RESULTS Attending with family members was associated with a higher likelihood of completing the CDSMP (OR = 1.626, p < .05). All completers reported small but significant improvements in self-rated health at six months (p < .001), and the changes were greater for those with family members. Males, caregivers, those aged 65 to 84 years old, with college or above education, were more accompanied by family members. Workshops in senior centers, libraries, or educational institutions attracted more family companions. DISCUSSION Engaging family members may increase CDSMP participants' motivation to complete the program. CDSMP providers should encourage participants to attend with their family members.
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Affiliation(s)
- Junrong Shi
- Department of Social Work, College of Health, Education, and Professional Studies, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Lisa Ferretti
- School of Social Work, Temple University, Philadelphia PA, USA
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Eschbach CL, Contreras DA, Kennedy LE. Three Cooperative Extension initiatives funded to address Michigan's opioid crisis. Front Public Health 2022; 10:921919. [PMID: 36203707 PMCID: PMC9530269 DOI: 10.3389/fpubh.2022.921919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/31/2022] [Indexed: 01/22/2023] Open
Abstract
People living with opioid use disorder and those experiencing other types of substance misuse are part of a public health crisis in the United States. Rates of opioid misuse, overdose, and opioid-related deaths within different subpopulations show where prevention efforts must focus. Through concerted efforts, aligned with common goals, a statewide community-based educational organization (Michigan State University Extension) has demonstrated ability to acquire multi-year funding from varied sources of state and federal funds that has produced robust support for statewide projects and collaborations. Researchers, educators, public health program managers, and other practitioners can benefit from learning how three funded initiatives in one state resulted in improved awareness and access for individuals and healthcare organizations. By sharing our implementation of health educational programs and presentations, other states' can adopt these evidence-based strategies for similar outreach. Cooperative Extension in Michigan delivers program series and one-time education to the public on the self-management of chronic conditions and pain, mindfulness for stress reduction, anger management, and opioid misuse prevention, treatment, and recovery. These evidence- and research-based health programs implemented by Extension staff teach participants common aspects of prevention such as self-management care, communication skills, self-efficacy, and goal setting or personal health action plans. Education aims to reduce dependency on opioids, prevent opioid misuse and share non-pharmacological solutions to pain management for those living with chronic conditions or at risk for developing dependence. The funded initiatives targeted rural residents, older adults, health care providers, and people living with chronic pain who may have access to prescription opioids. In addition to direct education, projects supported local communities with the development of coalitions, including the training of community partners to become program facilitators thereby increasing community capacity for prevention programs, and through the creation of patient referrals from healthcare settings to community-based education. In rural areas, Cooperative Extension plays a crucial role in connecting community resources to address healthy aging, and chronic disease or chronic pain self-management education. Community partners engaged in public health education and promotion, and healthcare providers alike may not be aware that Cooperative Extension plays a vital role in providing community-based health education.
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Talking about Health: A Topic Analysis of Narratives from Individuals with Schizophrenia and Other Serious Mental Illnesses. Behav Sci (Basel) 2022; 12:bs12080286. [PMID: 36004857 PMCID: PMC9405157 DOI: 10.3390/bs12080286] [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: 06/14/2022] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with schizophrenia have higher mortality and shorter lifespans. There are a multitude of factors which create these conditions, but one aspect is worse physical health, particularly cardiovascular and metabolic health. Many interventions to improve the health of individuals with schizophrenia have been created, but on the whole, there has been limited effectiveness in improving quality of life or lifespan. One potential new avenue for inquiry involves a more patient-centric perspective; understanding aspects of physical health most important, and potentially most amenable to change, for individuals based on their life narratives. This study used topic modeling, a type of Natural Language Processing (NLP) on unstructured speech samples from individuals (n = 366) with serious mental illness, primarily schizophrenia, in order to extract topics. Speech samples were drawn from three studies collected over a decade in two geographically distinct regions of the United States. Several health-related topics emerged, primarily centered around food, living situation, and lifestyle (e.g., routine, hobbies). The implications of these findings for how individuals with serious mental illness and schizophrenia think about their health, and what may be most effective for future health promotion policies and interventions, are discussed.
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Pullyblank K, Brunner W, Scribani M, Krupa N, Ory MG, Smith ML. Recruitment and engagement in disease self-management programs: Special concerns for rural residents reporting depression and/or anxiety. Prev Med Rep 2022; 26:101761. [PMID: 35299592 PMCID: PMC8921301 DOI: 10.1016/j.pmedr.2022.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/07/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Poorer health outcomes are correlated with depression/anxiety in a rural population. Electronic modes of recruitment engage those reporting depression/anxiety into CDSME. CDSME increases patient activation regardless of history of depression/anxiety.
Chronic disease self-management education (CDSME) programs benefit individuals with chronic diseases, including mental health conditions, by improving health-related outcomes and increasing engagement with the health care system. Recruiting individuals with a history of mental health conditions to participate in CDSME is challenging, particularly in rural, underserved areas. Hence, it is important to understand factors associated with the presence of mental health conditions, and impacts of CDSME on patient engagement. This project identifies individual and program-level characteristics, as well as recruitment characteristics, associated with reporting a history of depression and/or anxiety. It also assesses factors related to program engagement and the relationship between completing CDSME and patient activation. Data were collected during CDSME workshops offered in 2019 in a rural region of New York. Of the 421 enrollees who completed survey instruments, 162 reported a history of depression and/or anxiety. Univariate analyses indicated that those reporting a history of depression and/or anxiety were younger, female, in poorer health, had more comorbidities, were Medicaid beneficiaries, and had lower patient activation scores. They also heard about and signed up for the workshop through the internet at higher rates than those not reporting a history of depression and/or anxiety. Multivariable logistic regression modeling indicated age, self-rated health, and number of comorbidities were independent predictors of reporting a history of depression and/or anxiety. Among CDSME completers, patient activation significantly improved regardless of history of depression and/or anxiety. Engaging individuals with mental health conditions in CDSME requires a multimodal recruitment strategy incorporating electronic marketing and registration.
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Affiliation(s)
- Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA.,Decker College of Nursing and Health Sciences, Binghamton University, PO Box 6000, Binghamton, NY 13902, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Melissa Scribani
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Nicole Krupa
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
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Roberge P, Houle J, Provost JR, Coulombe S, Beaudin A, Bower P, Lemyre FC, Drapeau M, Drouin MS, Hudon C, Provencher MD, Vasiliadis HM. A pragmatic randomized controlled trial of a group self-management support program versus treatment-as-usual for anxiety disorders: study protocol. BMC Psychiatry 2022; 22:135. [PMID: 35189848 PMCID: PMC8862538 DOI: 10.1186/s12888-021-03675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The integration of a personal recovery-oriented practice in mental health services is an emerging principle in policy planning. Self-management support (SMS) is an intervention promoting recovery that aims at educating patients on the nature of their mental disorder, improving their strategies to manage their day-to-day symptoms, fostering self-efficacy and empowerment, preventing relapse, and promoting well-being. While SMS is well established for chronic physical conditions, there is a lack of evidence to support the implementation of structured SMS programs for common mental disorders, and particularly for anxiety disorders. This study aims to examine the effectiveness of a group-based self-management support program for anxiety disorders as an add-on to treatment-as-usual in community-based care settings. METHODS/DESIGN We will conduct a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months. TREATMENT AND CONTROL GROUPS: a) group self-management support (10 weekly 2.5-h group web-based sessions with 10-15 patients with two trained facilitators); b) treatment-as-usual. Participants will include adults meeting DSM-5 criteria for Panic Disorder, Agoraphobia, Social Anxiety Disorder, and/or Generalized Anxiety Disorder. The primary outcome measure will be the Beck Anxiety Inventory; secondary outcome measures will comprise self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation. STATISTICAL ANALYSIS Data will be analysed based on intention-to-treat with a mixed effects regression model accounting for between and within-subject variations in the effects of the intervention. DISCUSSION This study will contribute to the limited knowledge base regarding the effectiveness of structured group self-management support for anxiety disorders. It is expected that changes in patients' self-management behaviour will lead to better anxiety management and, consequently, to improved patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov: NCT05124639 . Prospectively registered 18 November 2021.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
| | - Janie Houle
- Department of Psychology, Faculty of Social Sciences, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal (Quebec), H3C 3P8 Canada
| | - Jean-Rémy Provost
- Relief, 418, rue Sherbrooke Est, bur. 300, Montréal (Québec), H2L 1J6 Canada
| | - Simon Coulombe
- Département des Relations Industrielles, Université Laval, Pavillon J.-A.-DeSève, 1025, avenue des Sciences-Humaines, Québec, G1V 0A6 Canada
- VITAM – Centre de recherche en santé durable, Québec, Canada
| | - Annie Beaudin
- Relief, 418, rue Sherbrooke Est, bur. 300, Montréal (Québec), H2L 1J6 Canada
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, The University of Manchester, Manchester, M13 9PL UK
| | - Félix Camirand Lemyre
- Department of Mathematics, Faculty of Sciences, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 2500, boul. de l’Université, Sherbrooke (Quebec), J1K 2R1 Canada
| | - Martin Drapeau
- Departments of counselling psychology and psychiatry, McGill University, 3700 McTavish, Montreal, Quebec, H3A 1Y2 UK
| | - Marc-Simon Drouin
- Department of Psychology, Faculty of Social Sciences, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal (Quebec), H3C 3P8 Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
| | - Martin D. Provencher
- VITAM – Centre de recherche en santé durable, Québec, Canada
- School of Psychology, Faculty of Social Sciences, Université Laval, 2325, rue des Bibliothèques, Québec, G1V 0A6 Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
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Combination of self-management theory with PRECEDE–PROCEED model to promote life quality in patients with hypertension. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kelly EL, Hong B, Duan L, Pancake L, Cohen H, Brekke JS. Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention. Psychiatr Serv 2021; 72:1145-1150. [PMID: 33887952 DOI: 10.1176/appi.ps.201900615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on service use during that trial. METHODS Medicaid data on use of general medical services (emergency room, outpatient, and inpatient) for 6 months were compared for 144 individuals with serious mental illnesses-Bridge participants (N=72) and a waitlist control group (N=72). An intent-to-treat approach was used, with regression models controlling for general medical services in the 6 months before baseline. RESULTS Zero-inflated negative binomial analyses, controlling for service use 6 months before baseline, found that the intervention group used the emergency room significantly less frequently, compared with the control group (adjusted mean±SD number of visits, 0.72±0.19 versus 1.59±0.42). No between-group differences were found in use of general medical inpatient or outpatient services. CONCLUSIONS The Bridge was effective in decreasing emergency room use among individuals with serious mental illnesses.
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Affiliation(s)
- Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Benjamin Hong
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Lei Duan
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Laura Pancake
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Heather Cohen
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - John S Brekke
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
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Dopke CA, McBride A, Babington P, Jonathan GK, Michaels T, Ryan C, Duffecy J, Mohr DC, Goulding EH. Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder. JMIR Form Res 2021; 5:e25810. [PMID: 33759798 PMCID: PMC8075075 DOI: 10.2196/25810] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/14/2020] [Accepted: 01/17/2021] [Indexed: 12/13/2022] Open
Abstract
Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.
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Affiliation(s)
- Cynthia A Dopke
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Alyssa McBride
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Pamela Babington
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Geneva K Jonathan
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tania Michaels
- General Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States
| | - Chloe Ryan
- Department of Social Work, UPMC Western Psychiatric Hospital, Pittsburgh, PA, United States
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - David C Mohr
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Evan H Goulding
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Gao Q, Peng L, Min W, Nie J, Wang A, Shi Y, Shi H, Teuwen DE, Yi H. Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249297. [PMID: 33322671 PMCID: PMC7764382 DOI: 10.3390/ijerph17249297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/13/2023]
Abstract
Chronic diseases can be controlled through effective self-management. The purpose of this study is to explore the regularity of clinical visits and medication adherence of patients with hypertension or diabetes (PWHD), and its association with the first experience with care and individual factors in rural Southwestern China. This cross-sectional study was carried out in Yunnan province in 2018 and recruited 292 PWHD and 122 village clinics from 122 villages in 10 counties. Participants were interviewed using a structured questionnaire. Results show around 39% of hypertensive and 25% of diabetic patients neither visited physicians nor took medicine regularly during the preceding three months of the interview date. The regression results further indicated that individual characteristics of the PWHD, including patient age, health status, and economic level, as well as their first experience with care, were significantly associated with their regular healthcare behavior. In addition to providing medical services, on average each sample village clinic, with around two physicians, simultaneously managed 180 hypertensive and 45 diabetic patients. This study revealed the need for further reforms in terms of improving self-management and thus recommends an increase in the quantity and the quality of human resources in the primary healthcare realm in rural China.
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Affiliation(s)
- Qiufeng Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Lanxi Peng
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Wenbin Min
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Jingchun Nie
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Aiqin Wang
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China
- Correspondence:
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Haonan Shi
- Business Department Center of Red Cross Society of China, Beijing 100007, China;
| | - Dirk E. Teuwen
- Corporate Societal Responsibility, UCB, 1070 Brussels, Belgium;
| | - Hongmei Yi
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing 100871, China;
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Shalaby RAH, Agyapong VIO. Peer Support in Mental Health: Literature Review. JMIR Ment Health 2020; 7:e15572. [PMID: 32357127 PMCID: PMC7312261 DOI: 10.2196/15572] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/06/2019] [Accepted: 02/15/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A growing gap has emerged between people with mental illness and health care professionals, which in recent years has been successfully closed through the adoption of peer support services (PSSs). Peer support in mental health has been variously defined in the literature and is simply known as the help and support that people with lived experience of mental illness or a learning disability can give to one another. Although PSSs date back to several centuries, it is only in the last few decades that these services have formally evolved, grown, and become an integral part of the health care system. Debates around peer support in mental health have been raised frequently in the literature. Although many authors have emphasized the utmost importance of incorporating peer support into the health care system to instill hope; to improve engagement, quality of life, self-confidence, and integrity; and to reduce the burden on the health care system, other studies suggest that there are neutral effects from integrating PSSs into health care systems, with a probable waste of resources. OBJECTIVE In this general review, we aimed to examine the literature, exploring the evolution, growth, types, function, generating tools, evaluation, challenges, and the effect of PSSs in the field of mental health and addiction. In addition, we aimed to describe PSSs in different, nonexhaustive contexts, as shown in the literature, that aims to draw attention to the proposed values of PSSs in such fields. METHODS The review was conducted through a general search of the literature on MEDLINE, Google Scholar, EMBASE, Scopus, Chemical Abstracts, and PsycINFO. Search terms included peer support, peer support in mental health, social support, peer, family support, and integrated care. RESULTS There is abundant literature defining and describing PSSs in different contexts as well as tracking their origins. Two main transformational concepts have been described, namely, intentional peer support and transformation from patients to peer support providers. The effects of PSSs are extensive and integrated into different fields, such as forensic PSSs, addiction, and mental health, and in different age groups and mental health condition severity. Satisfaction of and challenges to PSS integration have been clearly dependent on a number of factors and consequently impact the future prospect of this workforce. CONCLUSIONS There is an internationally growing trend to adopt PSSs within addiction and mental health services, and despite the ongoing challenges, large sections of the current literature support the inclusion of peer support workers in the mental health care workforce. The feasibility and maintenance of a robust PSS in health care would only be possible through collaborative efforts and ongoing support and engagement from all health care practitioners, managers, and other stakeholders.
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BRANTNELL ANDERS, BARALDI ENRICO. THE ROLES OF ACADEMIC INVENTORS IN MEDICAL INNOVATION PROCESSES: EXPLORING THE INFLUENCE OF IPR OWNERSHIP AND IP NATURE. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2020. [DOI: 10.1142/s1363919620500450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper analyses four medical innovation processes originating from Stanford and Uppsala universities with the purpose of understanding how intellectual property rights (IPR) ownership and intellectual property (IP) nature influence the behaviour of academic inventors. We analyse this behaviour through the roles enacted and evaluate the requirements the roles pose by developing a method to assess the requirements of individual roles, which we label as role intensity. We find that both IPR ownership and IP nature can influence the academic inventors’ roles and role intensities. In contrast to assumptions in research and policy, we find that IPR ownership does not influence the roles and role intensities in a remarkable way. We also find support that research and policy should distinguish between patentable and non-patentable inventions in the field of medical invention as these two types of IP nature are associated with different roles and role intensities. These findings contribute to the literature on commercialisation of science and innovation management by demonstrating the importance of IP nature in influencing the roles of inventors. Managerial and policy implications are provided.
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Affiliation(s)
- ANDERS BRANTNELL
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - ENRICO BARALDI
- Department of Engineering Sciences, Uppsala University, Sweden
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16
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Polacsek M, Boardman GH, McCann TV. Factors influencing self-management of depression in older adults: a qualitative study. Aging Ment Health 2020; 24:939-946. [PMID: 30621440 DOI: 10.1080/13607863.2018.1562538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives: A considerable body of work addresses prevalence and treatment options for depression in older adults. However, less is known about their capacity to self-manage their depression. Effective self-management of depression has the potential to improve individuals' quality of life through information, empowerment and perceived control, while enabling more efficient health service utilisation. The aim of this paper was to identify the barriers and facilitators to self-management of depression in older adults.Method: A qualitative study comprising in-depth, semi-structured interviews with 32 older adults with a diagnosis of moderate depression.Results: Three over-arching themes captured the barriers and facilitators to participants' capacity to self-manage their depression. Perspectives on age and depression represented how views of older age and mental health influenced the approach to self-management. Ability to access the health care system concerned the ability to identify and engage with different services and support. Individual capacity for self-management reflected participants' views on and the resources required for effective self-management.Conclusion: This study offers a better understanding of the factors that positively or negatively influence older adults' ability to self-manage their depression. Strategies to improve self-management should address misconceptions about age and depression, and older adults' interest in and capacity to embrace self-management practices.
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Affiliation(s)
- Meg Polacsek
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Gayelene H Boardman
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Terence V McCann
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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De León-Ramírez M, Peñarrieta-de Córdova M, León-Hernández R, Gutiérrez-Gómez T, Piñones-Martínez M, Quintero-Valle L. Relación entre automanejo y síntomas depresivos en personas con diabetes e hipertensión. ENFERMERÍA UNIVERSITARIA 2020. [DOI: 10.22201/eneo.23958421e.2020.1.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introducción: Las personas con diabetes e hipertensión experimentan con mayor frecuencia sintomatología depresiva, lo cual contribuye a un inadecuado automanejo de la enfermedad, que implica tareas como: la toma de la medicación, asistir a las consultas médicas, el conocimiento de signos y síntomas, además de la toma de decisiones.
Objetivo: Por lo anterior, el objetivo de este trabajo es identificar la relación entre automanejo en general y sus dimensiones con síntomas depresivos en personas con diabetes e hipertensión.
Método: Estudio transversal-correlacional con n=205 pacientes con diagnóstico de diabetes (100) e hipertensión (105). Muestreo no probabilístico por conveniencia. Se utilizó la estadística descriptiva y r de Pearson. Se aplicaron los instrumentos Partners in Health (PIH) y The Patient Health Questionnaire (PHQ-8).
Resultados: Se encontró correlación estadísticamente significativa entre la sintomatología depresiva y el automanejo (r=-0.308 ρ<0.001).
Discusión y Conclusiones: Se concluye que la sintomatología depresiva se relaciona con el automanejo de la enfermedad de la siguiente manera: a mayor automanejo menor sintomatología de depresión, o a mayor sintomatología depresiva menor automanejo; dicha relación confirma que ambas variables se afectan mutuamente y/o mantienen una relación estrecha.
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The Impact of the Chronic Disease Self-Management Program on Health Literacy: A Pre-Post Study Using a Multi-Dimensional Health Literacy Instrument. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010058. [PMID: 31861752 PMCID: PMC6982295 DOI: 10.3390/ijerph17010058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/13/2019] [Accepted: 12/17/2019] [Indexed: 01/20/2023]
Abstract
This study assessed the impact of the Chronic Disease Self-Management Program (CDSMP) on different domains of health literacy using a pre-post study design. Participants aged over 16 years and with one or more self-reported chronic diseases were recruited for the CDSMP in western Sydney (a highly diverse area of New South Wales, Australia) between October 2014 and September 2018. Health literacy was assessed pre- and immediately post-intervention using the Health Literacy Questionnaire (HLQ), with differences in mean scores for each HLQ domain analysed using paired sample t-tests. A total of 486 participants were recruited into the CDSMP. Of those, 316 (65.0%) completed both pre- and post-intervention surveys and were included in the analysis. The median age of the participants was 68 years, the majority were female (62.5%), and most were born in a country other than Australia (80.6%). There were statistically significant (P < 0.001) improvements across all nine domains of the HLQ. This is the first study evaluating the potential impact of the CDSMP on improving different domains of health literacy amongst a diverse sample of participants with chronic diseases using a multi-dimensional instrument. The absence of a control population in this study warrants caution when interpreting the results.
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Stiekema APM, van Heugten CM, de Vugt ME. Joining forces to improve psychosocial care for people with cognitive deficits across diagnoses: social health as a common framework. Aging Ment Health 2019; 23:1275-1281. [PMID: 30450949 DOI: 10.1080/13607863.2018.1498446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cognitive deficits such as memory problems have a major impact on independence in daily life and participation in society in several populations, such as people with dementia, brain injury (i.e. stroke) or a severe mental illness such as schizophrenia. Similarities in the impact on participation and well-being have resulted in the development of comparable psychosocial interventions across populations, aiming to support people to adapt to cognitive deficits or by adapting the environment. These interventions are developed separately, without using the expertise in other fields. We argue that each of the fields and the field of psychosocial care in general would benefit from closer collaboration on development and evaluation of innovative psychosocial interventions. Collaboration has been complicated by the use of different care models and theoretical frameworks, each with their own terminology. The concept of social health - the ability to participate in work or other meaningful activities and to feel healthy despite a condition - translates to the leading care models within the fields of dementia, brain injury and severe mental illness. The concept of social health provides a common language and framework. In this paper, we elaborate on strategies for collaboration using examples of interventions to improve social health.
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Affiliation(s)
- Annemarie P M Stiekema
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands
| | - Caroline M van Heugten
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands.,b School for Mental Health and Neuroscience, Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University , Maastricht , The Netherlands
| | - Marjolein E de Vugt
- a School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center , Maastricht , The Netherlands
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Evaluation of impact self-management counseling on health-seeking behavior's self-efficacy pulmonary tuberculosis outpatients. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Boucher LM, O'Brien KK, Baxter LN, Fitzgerald ML, Liddy CE, Kendall CE. Healthy aging with HIV: The role of self-management support. PATIENT EDUCATION AND COUNSELING 2019; 102:1565-1569. [PMID: 30827568 DOI: 10.1016/j.pec.2019.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/19/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
People living with HIV on antiretroviral treatment have significantly improved longevity, but as a result may also face increasing multimorbidity due to aging and long-term medication use. Thus, care needs for this population have evolved to require a chronic disease management approach in which self-management plays a central role. Here we highlight the importance of expanding self-management support options for people living with HIV, and discuss strategies for implementing and evaluating self-management interventions, outlining potential opportunities, challenges and solutions. We contend that standardized programs such as those offered through the Self-Management Resource Centre provide a rich opportunity to build the evidence base regarding the potential effectiveness of self-management support among people living with HIV. Thus we recommend enhancing self-management support through meaningful community-level collaboration with people with lived experience, careful assessment of process and outcome factors including who does not participate and why, attention to stigma and the specific needs of HIV priority groups, and consideration of how to extend engagement with services to address social and material needs beyond self-management program participation. We hope this reflection will serve as an aide for researchers and program managers to improve the array of evidence-based self-management support options available to people living with HIV.
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Affiliation(s)
- Lisa M Boucher
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | | | - Michael L Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Clare E Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; Institute of Clinical and Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Schnock KO, P Howard E, Dykes PC. Fall Prevention Self-Management Among Older Adults: A Systematic Review. Am J Prev Med 2019; 56:747-755. [PMID: 30885516 DOI: 10.1016/j.amepre.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors. EVIDENCE ACQUISITION Medical and nursing literature related to fall prevention self-management was searched in PubMed, Embase, and CINAHL (1997-2017), and relevant publications were selected by three researchers to assess whether the papers included subject characteristics and their fall prevention self-management actions and behaviors. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used by the researchers to assess the quality of the included studies and to determine the significance of the extracted characteristics. EVIDENCE SYNTHESIS Searching literature through 2017, a total of 972 papers were identified, and 28 papers remained after removing those that did not meet inclusion criteria. Nine papers that addressed subject characteristics in relation to the study outcomes were included in a sub-analysis. The authors identified the following characteristics of older adults who participated in fall prevention self-management actions and behaviors: younger males, not living alone and with self-reported good health, having greater fear of falling and high fall prevention self-efficacy, and possessing high motivation for engagement with self-management activities. CONCLUSIONS The systematic literature review revealed the personal characteristics of older adults who engage in fall prevention self-management actions and behaviors.
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Affiliation(s)
- Kumiko O Schnock
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Elizabeth P Howard
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Patricia C Dykes
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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[Models of peer support in psychiatric care]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:214-221. [PMID: 30671605 DOI: 10.1007/s00103-018-2875-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In the past decades, psychiatric care has changed from the traditional medical model to a more person-centered and recovery-focused approach. In this process, peer support workers are essential, because with their lived experience of crisis and recovery they are able to spread hope.This article gives an overview of the recent literature describing the current change model of peer support, reporting the evidence of peer support, as well as the current stage of implementation of peer support in different psychiatric contexts.An overview of the current state of research, selected by the authors, based on repeated systematic literature searches in peer support research projects, is given. Additionally, some examples of user involvement from the Hamburg EX-IN Curriculum, trialogs between sufferers, relatives and professionals, as well as the so-called psychosis seminars are described in more detail.Peer support has shown promising results in one-to-one and group settings, case management, crisis interventions, and the reduction of coercive measures.Although there are promising results of peer support in various clinical contexts, multiple challenges in the implementation of peer support are reported. They need to be overcome by the inclusion of all staff members in the change process of the system in order to further develop user-oriented and recovery-oriented psychiatric care.
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Muralidharan A, Brown CH, E Peer J, A Klingaman E, M Hack S, Li L, Walsh MB, Goldberg RW. Living Well: An Intervention to Improve Medical Illness Self-Management Among Individuals With Serious Mental Illness. Psychiatr Serv 2019; 70:19-25. [PMID: 30353790 PMCID: PMC6494087 DOI: 10.1176/appi.ps.201800162] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many adults with serious mental illness have significant medical illness burden and poor illness self-management. In this study, the authors examined Living Well, a group-based illness self-management intervention for adults with serious mental illness that was cofacilitated by two providers, one of whom has lived experience with co-occurring mental health and medical conditions. METHODS Adults with serious mental illness (N=242) were randomly assigned to Living Well or an active control condition. Participants completed assessments of quality of life; health attitudes; self-management behaviors; and symptoms at baseline, posttreatment, and follow-up. Emergency room use was assessed by means of chart review. Mixed-effects models examined group × time interactions on outcomes. RESULTS Compared with the control group, adults in Living Well had greater improvements at posttreatment in mental health-related quality of life (t=2.15, p=.032), self-management self-efficacy (t=4.10, p<.001), patient activation (t=2.08, p=.038), internal health locus of control (t=2.01, p=.045), behavioral and cognitive symptom management (t=2.77, p=.006), and overall psychiatric symptoms (t=-2.02, p=.044); they had greater improvements at follow-up in physical activity-related self-management (t=2.55, p=.011) and relationship quality (t=-2.45, p=.015). No effects were found for emergency room use. The control group exhibited greater increases in physical health-related quality of life at posttreatment (t=-2.23, p=.026). Significant group differences in self-management self-efficacy (t=2.86,p=.004) and behavioral and cognitive symptom management (t=2.08, p= .038) were maintained at follow-up. CONCLUSIONS Compared with an active control group, a peer-cofacilitated illness self-management group was more effective in improving quality of life and self-management self-efficacy among adults with serious mental illness.
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Affiliation(s)
- Anjana Muralidharan
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Clayton H Brown
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Jason E Peer
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Elizabeth A Klingaman
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Samantha M Hack
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Lan Li
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Mary Brighid Walsh
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
| | - Richard W Goldberg
- Mental Illness, Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Capitol Health Care Network (Veterans Integrated Service Network [VISN] 5), Baltimore (Muralidharan, Brown, Klingaman, Hack, Walsh, Goldberg); Division of Psychiatric Services Research, Department of Psychiatry (Muralidharan, Klingaman, Li, Goldberg), and Department of Epidemiology and Public Health (Brown), all at University of Maryland School of Medicine, Baltimore; VA Maryland Healthcare System, Baltimore (Peer); University of Maryland School of Social Work, Baltimore (Hack)
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van Grieken RA, van Tricht MJ, Koeter MWJ, van den Brink W, Schene AH. The use and helpfulness of self-management strategies for depression: The experiences of patients. PLoS One 2018; 13:e0206262. [PMID: 30359444 PMCID: PMC6201928 DOI: 10.1371/journal.pone.0206262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore which of 50 self-management strategies are actually used and which are perceived as most helpful by patients in their day-to-day management of depression, in order to empower patients and promote active engagement in their own care. METHODS Retrospective study using an online self-report survey to assess the use and perceived helpfulness of 50 previously identified self-management strategies in 193 participants who recently recovered from a major depressive episode. RESULTS Forty-five of the 50 strategies were used by at least half of all participants and about one third of all participants perceived almost 50% of all strategies as (very) helpful. The most used strategies, such as 'finding strategies to create pleasurable distractions', 'engaging in leisure activities' or 'identifying the cause of the depression', were not always perceived as most helpful. In addition, the perceived most helpful strategies, such as 'completing treatment' and 'leaving the house regularly' were not always the most used ones. CONCLUSIONS Patients use and perceive a wide range of self-management strategies as helpful to recover from their depression. Patients use and perceive strategies about engagement in treatment and physical activities as being most helpful. These finding may contribute to the further development and implementation of self-management programs for the prevention or the rehabilitation of depression.
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Affiliation(s)
- Rosa A. van Grieken
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam J. van Tricht
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W. J. Koeter
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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Castellanos D, Capo M, Valderrama D, Jean-Francois M, Luna A. Relationship of peer specialists to mental health outcomes in South Florida. Int J Ment Health Syst 2018; 12:59. [PMID: 30377441 PMCID: PMC6195727 DOI: 10.1186/s13033-018-0239-6] [Citation(s) in RCA: 4] [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] [Received: 01/22/2018] [Accepted: 10/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background In recent years the use of peer specialists in the delivery of mental health of care across the US has increased. Although data on the benefits of using peer specialists is limited and/or equivocal, states are making policy and funding decisions to support the expansion of peer specialist services. This data is even more limited in the state of Florida where no studies were found to document the effect of peer specialists on mental health care outcomes. The purpose of this study was to assess whether local decisions to use peer specialists can be supported through the measurement of outcomes of service utilization and mental health functioning when peer specialists are involved in the treatment of individuals living with serious mental illness. Methods The study was conducted using service data collected by South Florida Behavioral Health Network (SFBHN). SFBHN is the Managing Entity for publicly funded mental health and substance abuse services in Miami-Dade and Monroe Counties in Florida. We compared mental health outcomes and service utilization between individuals who received peer specialist services (n = 367) and a treatment as usual group (n = 1468) matched on gender, age and severity of diagnosis in the period July 2013 and June 2015. Multilevel models were used to evaluate the functioning outcomes between the groups. Service utilization was assessed using negative binomial regression. Results Individuals in the treatment group receiving peer specialist services utilized more ambulatory/lower levels of care services and had more frequent crisis stabilization unit admissions. Those in the treatment group also displayed more functional difficulties with a variety of practical activities, employment and housing and violent temper, hostility, threatening behaviors. Conclusions The findings of the study further support existing evidence documenting the mixed benefits of using peer services compared to treatment as usual care. Policy makers and other stakeholders are encouraged to advance mental health recovery by examining outcomes more comprehensively. Future research should include examination of the subjective benefits of peer support for recipients, understanding the impact on service utilization and a better definition of the roles, supervision and expectations of peer support programs.
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Affiliation(s)
- Daniel Castellanos
- 1Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, AHC1 349, Miami, FL 33199 USA
| | - Mayte Capo
- South Florida Behavioral Health Network, 7205 Corporate Drive, Suite 200, Miami, FL 33126 USA
| | - Diana Valderrama
- South Florida Behavioral Health Network, 7205 Corporate Drive, Suite 200, Miami, FL 33126 USA
| | - Melissa Jean-Francois
- 3Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th St, AHC1 349, Miami, FL 33199 USA
| | - Aniuska Luna
- 1Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th St, AHC1 349, Miami, FL 33199 USA
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Horrell LN, Kneipp SM. Strategies for recruiting populations to participate in the chronic disease self-management program (CDSMP): A systematic review. Health Mark Q 2018; 34:268-283. [PMID: 29173109 DOI: 10.1080/07359683.2017.1375240] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The purpose of this review was to better understand how to market the Chronic Disease Self-Management Program to new audiences. Eight databases were searched for peer-reviewed studies of the CDSMP. A total of 39 articles were analyzed to describe the theoretical basis of recruitment strategies and their effectiveness while engaging diverse populations. Findings included that female, Caucasian, and elderly groups are overrepresented in CDSMP literature and recruitment efforts have not been explicitly grounded in theory. This review provides insight into trends in CDSMP recruitment and identifies the need for further research regarding the application of marketing theory to future enrollment efforts.
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Affiliation(s)
- Lindsey N Horrell
- a School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Shawn M Kneipp
- a School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
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Moayed MS, Ebadi A, Khodaveisi M, Nassiri Toosi M, Soltanian AR, Khatiban M. Factors influencing health self-management in adherence to care and treatment among the recipients of liver transplantation. Patient Prefer Adherence 2018; 12:2425-2436. [PMID: 30510406 PMCID: PMC6248226 DOI: 10.2147/ppa.s180341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Liver transplantation is the global treatment of end-stage liver diseases. Since the patients' survival rate has been improved, the patient may experience reductions in physical, cognitive, and psychosocial functions after liver transplantation influencing their adherence to care and treatment. The transplant survival is complex and patients' adherence to care and treatment should be considered when health care providers make decisions regarding treatment. This qualitative study aimed to explore factors influencing health self-management in adherence to care and treatment among the recipients of care and treatment. METHODS In this study, 23 interview sessions were carried out with a total 18 patients, 2 family members and 3 transplantation team members from May to November 2017. The patients were selected using the purposive method from both genders, with a various age range and initial diseases leading to liver transplantation, and time passed from liver transplantation. A semi-structured interview guide was developed based on literature review and pilot interviews. The participants were asked to describe their experiences of self-management behaviors in adherence to treatment and care. The data were analyzed using a conventional content analysis method and managing via the MAXQDA-10 software. RESULTS Two themes were developed during data analysis as "self-regulation" and "self-care". "Self-regulation" consisted of "intentionally changing", "positively thinking", "information seeking", "problem-solving", "past knowledge transferring", and "self-controlling". "Self-care" had three sub-themes "shift to independence", "vigilance", and "self-care support". CONCLUSION The participants perceived the health self-management in adherence to care as a set of factors related to "self-regulation" and "self-care" behaviors. "Self-regulation" is required to create a balance in life. Also, "self-care" efforts can help with maintaining and improving patients' health.
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Affiliation(s)
- Malihe Sadat Moayed
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Ebadi
- Nursing Education, Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Home Care) Research Center, Community Health Nursing Department, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohssen Nassiri Toosi
- Internal Medicine, Hepatologist, Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Soltanian
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahnaz Khatiban
- Mother and Child Care Research Center, Medical-Surgical Nursing Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran,
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Iribarren S, Siegel K, Hirshfield S, Olender S, Voss J, Krongold J, Luft H, Schnall R. Self-Management Strategies for Coping with Adverse Symptoms in Persons Living with HIV with HIV Associated Non-AIDS Conditions. AIDS Behav 2018; 22:297-307. [PMID: 28488165 DOI: 10.1007/s10461-017-1786-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
People living with HIV (PLWH) are living longer, but many are now affected by HIV-associated non-AIDS (HANA) conditions and their associated adverse symptoms. An online survey was conducted with 769 PLWH with HANA conditions in the US. Information was elicited on symptoms experienced, self-management strategies employed, and the helpfulness of these strategies. Open ended responses were collected for self-management strategies. A qualitative data analytic approach was used to organize the 4036 self-management strategies into thematic categories, with eight main categories emerging, including: taking medication, modifying activity, altering diet, seeking help, waiting, substance use, managing thoughts and attitudes, and altering the physical environment. Of the self-management strategy subcategories, social support was the most helpful self-management strategy with waiting/doing nothing being the least helpful approach. Findings can be used to inform the development of self-management interventions and to support health care professionals in recommending symptom self-management strategies to their patients.
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Gibert SH, DeGrazia D, Danis M. Ethics of patient activation: exploring its relation to personal responsibility, autonomy and health disparities. JOURNAL OF MEDICAL ETHICS 2017; 43:670-675. [PMID: 28774956 DOI: 10.1136/medethics-2017-104260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/19/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Abstract
Discussions of patient-centred care and patient autonomy in bioethics have tended to focus on the decision-making context and the process of obtaining informed consent, leaving open the question of how patients ought to be counselled in the daily maintenance of their health and management of chronic disease. Patient activation is an increasingly prominent counselling approach and measurement tool that aims to improve patients' confidence and skills in managing their own health conditions. The strategy, which has received little conceptual or ethical analysis, raises important questions about how clinicians ought to foster confidence and a sense of control in their patients without exposing them to blame, stigma and other harms. In this paper, we describe patient activation, discuss its relationship to personal responsibility, autonomy and health disparities, and make recommendations regarding its use and measurement.
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Affiliation(s)
- Sophia H Gibert
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - David DeGrazia
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Commentary on "Evidence-Based Self-management Programs for Seniors and Other With Chronic Diseases": Patient Experience-Patient Health-Return on Investment. J Ambul Care Manage 2017; 40:185-188. [PMID: 28570356 DOI: 10.1097/jac.0000000000000204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Assessment of a Chronic Disease Self-Management Program to Increase Physical Activity of Adults With Severe Mental Illness. Arch Psychiatr Nurs 2017; 31:137-140. [PMID: 28104052 DOI: 10.1016/j.apnu.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/10/2016] [Accepted: 08/15/2016] [Indexed: 11/22/2022]
Abstract
Individuals with severe mental illness (SMI) experience excessive co-morbidities and early mortality. Self-management programs have the potential to increase physical activity levels of individuals with SMI and reduce the incidence of co-morbidities. The purpose of this quality improvement project was to assess a chronic disease self-management program (CDSMP) to increase physical activity of adults with SMI measured by daily steps tracked with a pedometer. Results of data analysis indicated no statistically significant difference in steps across the six-week program. However, findings suggested that individuals with SMI are capable of using a pedometer and tracking steps on a daily basis.
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Cabassa LJ, Camacho D, Vélez-Grau CM, Stefancic A. Peer-based health interventions for people with serious mental illness: A systematic literature review. J Psychiatr Res 2017; 84:80-89. [PMID: 27701013 DOI: 10.1016/j.jpsychires.2016.09.021] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/26/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
Health interventions delivered by peer specialists or co-facilitated by peer specialists and health professionals can help improve the physical health of people with serious mental illness (SMI). Yet, the quality of the studies examining these health interventions and their impact on health outcomes remains unclear. To address this gap, we conducted a systematic literature review of peer-based health interventions for people with SMI. We rated the methodological quality of studies, summarized intervention strategies and health outcomes, and evaluated the inclusion of racial and ethnic minorities in these studies. We used the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to conduct our systematic literature review. Electronic bibliographic databases and manual searches were used to locate articles that were published in English in peer-reviewed journals between 1990 and 2015, described peer-based health interventions for people with SMI, and evaluated the impact of the interventions on physical health outcomes. Two independent reviewers used a standardized instrument to rate studies' methodological quality, abstracted study characteristics, and evaluated the effects of the interventions on different health outcomes. Eighteen articles were reviewed. Findings indicated that the strength of the evidence generated from these studies is limited due to several methodological limitations. Mixed and limited intervention effects were reported for most health outcomes. The most promising interventions were self-management and peer-navigator interventions. Efforts to strengthen the evidence of peer-based interventions require a research agenda that focuses on establishing the efficacy and effectiveness of these interventions across different populations and settings.
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Affiliation(s)
| | - David Camacho
- Columbia University School of Social Work, New York, NY, USA.
| | | | - Ana Stefancic
- Columbia University School of Social Work, New York, NY, USA.
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Cedeño-Moreno D, Vargas-Lombardo M, Salas-Zárate MP, Paredes-Valverde MA, Valencia-García R. Analysis of Mobile Applications for Self-healthcare of Panamanian Patients with Hepatitis. COMMUNICATIONS IN COMPUTER AND INFORMATION SCIENCE 2017. [DOI: 10.1007/978-3-319-67283-0_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Whiteman KL, Naslund JA, DiNapoli EA, Bruce ML, Bartels SJ. Systematic Review of Integrated General Medical and Psychiatric Self-Management Interventions for Adults With Serious Mental Illness. Psychiatr Serv 2016; 67:1213-1225. [PMID: 27301767 PMCID: PMC5089924 DOI: 10.1176/appi.ps.201500521] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Adults with serious mental illness are disproportionately affected by general medical comorbidity, earlier onset of disease, and premature mortality. Integrated self-management interventions have been developed to address both general medical and psychiatric illnesses. This systematic review examined evidence about the effect of self-management interventions that target both general medical and psychiatric illnesses and evaluated the potential for implementation. METHODS Databases, including CINAHL, Cochrane Central, Ovid MEDLINE, PsycINFO, and Web of Science, were searched for articles published between 1946 and July 2015. Studies evaluating integrated general medical and psychiatric self-management interventions for adults with schizophrenia spectrum or mood disorders and general medical comorbidity were included. RESULTS Fifteen studies (nine randomized controlled trials and six pre-post designs) reported on nine interventions: automated telehealth, Health and Recovery Peer program, Helping Older People Experience Success, Integrated Illness Management and Recovery, Life Goals Collaborative Care, Living Well, Norlunga Chronic Disease Self-Management program, Paxton House, and Targeted Training in Illness Management. Most studies demonstrated feasibility, acceptability, and preliminary effectiveness; however, clinical effectiveness could not be established in most studies because of methodological limitations. Factors identified that may deter implementation included operating costs, impractical length, and workforce requirements. CONCLUSIONS Integrated general medical and psychiatric illness self-management interventions appear feasible and acceptable, with high potential for clinical effectiveness. However, implementation factors were rarely considered in intervention development, which may contribute to limited uptake and reach in real-world settings.
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Affiliation(s)
- Karen L Whiteman
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - John A Naslund
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Elizabeth A DiNapoli
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Martha L Bruce
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Stephen J Bartels
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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Stenberg U, Haaland-Øverby M, Fredriksen K, Westermann KF, Kvisvik T. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness. PATIENT EDUCATION AND COUNSELING 2016; 99:1759-1771. [PMID: 27461944 DOI: 10.1016/j.pec.2016.07.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/14/2016] [Accepted: 07/16/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness. METHODS We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O'Malley's framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data. RESULTS Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope. CONCLUSION A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed. PRACTICE IMPLICATIONS The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants.
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Affiliation(s)
- Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway; Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Kari Fredriksen
- Learning and Mastery Center, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
| | - Karl Fredrik Westermann
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Toril Kvisvik
- Patient Education Resource Center, Møre and Romsdal Hospital, Herman Døhlens vei 1, 6508 Kristiansund, Norway.
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Blixen C, Perzynski AT, Bukach A, Howland M, Sajatovic M. Patients' perceptions of barriers to self-managing bipolar disorder: A qualitative study. Int J Soc Psychiatry 2016; 62:635-644. [PMID: 27647605 PMCID: PMC5578914 DOI: 10.1177/0020764016666572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Self-management of bipolar disorder (BD) is challenging for many individuals. MATERIAL Interviews were used to assess perceived barriers to disease self-management among 21 high-risk patients with BD. Content analysis, with an emphasis on dominant themes, was used to analyze the data. RESULTS Three major domains of barriers emerged: individual barriers (psychological, knowledge, behavioral and physical health); family/community-level barriers (lack of support and resources); and provider/healthcare system (inadequate communication and access to care). CONCLUSION Care approaches providing social and peer support, optimizing communication with providers and integrating medical and psychiatric care may improve self-management of BD in this vulnerable population.
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Affiliation(s)
- Carol Blixen
- 1 Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
- 2 Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Adam T Perzynski
- 2 Center for Health Care Research and Policy, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ashley Bukach
- 1 Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Molly Howland
- 3 School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- 4 Department of Psychiatry, Neurology, and Biostatistics & Epidemiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- 5 Neurological Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
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Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LR, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein MG. Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:175-193. [DOI: 10.1007/s10865-016-9794-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
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Happell B, Ewart SB, Platania-Phung C, Bocking J, Griffiths K, Scholz B, Stanton R. Embedding a physical health nurse consultant within mental health services: Consumers' perspectives. Int J Ment Health Nurs 2016; 25:377-84. [PMID: 26748945 DOI: 10.1111/inm.12185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 01/10/2023]
Abstract
The life expectancy of people living with mental illness is significantly shorter than that of the rest of the population. Despite the profound impact of physical health issues on both quality of life and life expectancy, the perspectives of mental health consumers have yet to be thoroughly explored. Furthermore, research has focused far more on describing barriers than on identifying solutions. This paper reports on findings from a qualitative exploratory research study, with the aim to examine the potential role of a specialist nurse with advanced physical health-care skills. Focus groups were conducted with 31 consumers. Data were analysed thematically. The concept of a role like this was supported; however, participants stressed: (i) the importance of integration between health professionals and various components of the health-care system; and (ii) the need for culture change for nurses to work from a less medically-dominated approach. Previous research literature suggests that a nursing position dedicated to physical health care and coordination might produce positive outcomes for mental health consumers. The findings from the current research project emphasize the need for consumers to be identified as key stakeholders in a solution-focused approach to improved physical health care for mental health consumers.
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Affiliation(s)
- Brenda Happell
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Stephanie B Ewart
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Chris Platania-Phung
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Julia Bocking
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Kathleen Griffiths
- National Institute for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Woden, Australian Capital Territory, Australia
| | - Brett Scholz
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, and ACT Health, Canberra Hospital, Woden, Australia
| | - Robert Stanton
- Central Queensland University, School of Medical and Applied Sciences, Rockhampton, Queensland, Australia
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Brainard J, Loke Y, Salter C, Koós T, Csizmadia P, Makai A, Gács B, Szepes M. Healthy ageing in Europe: prioritizing interventions to improve health literacy. BMC Res Notes 2016; 9:270. [PMID: 27176006 PMCID: PMC4866482 DOI: 10.1186/s13104-016-2056-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/20/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Health literacy (HL) is low for 40-50 % of the population in developed nations, and is strongly linked to many undesirable health outcomes. Older adults are particularly at risk. The intervention research on health literacy in ageing populations project systematically created a large inventory of HL interventions targeting adults age 50+ , to support practical production of policy and practice guidelines for promoting health literacy in European populations. METHODS We comprehensively surveyed international scientific literature, grey literature and other sources (published 2003+) for implemented HL interventions that involved older adults. Studies were screened for eligibility criteria and further selected for aspects important in European public health policy, including priority diseases, risk factors and vulnerable target groups. Interventions were prioritised using a multiple criteria tool to select final interventions that also featured strong evidence of efficacy and a broad range of strategies. RESULTS From nearly 7000 written summaries, 1097 met inclusion criteria, of which 233 were chosen for scoring and ranking. Of these, seven had the highest multi-criteria scores. Eight more articles were selected based on rounded criteria including a high multi-criteria score as well as elements of innovation. Final selections were 18 articles describing 15 programmes, which feature strong evidence of efficacy among important diseases or risk factors and vulnerable groups, or that had success with elements of innovation were identified. Most programmes tried to increase skills in communication, self-management and understanding healthcare or lifestyle choices. CONCLUSIONS These programmes have multiple positive attributes which could be used as guidance for developing innovative intervention programmes to trial on European older adults. They provide evidence of efficacy in addressing high priority diseases and risk factors.
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Affiliation(s)
- Julii Brainard
- />Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Yoon Loke
- />Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Charlotte Salter
- />Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Tamás Koós
- />Hungarian National Institute for Health Development, Budapest, 1437 Hungary
| | - Péter Csizmadia
- />Hungarian National Institute for Health Development, Budapest, 1437 Hungary
| | - Alexandra Makai
- />Hungarian National Institute for Health Development, Budapest, 1437 Hungary
- />Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, Pécs, 7621 Hungary
| | - Boróka Gács
- />Hungarian National Institute for Health Development, Budapest, 1437 Hungary
- />Department of Behavioural Sciences, University of Pécs Medical School, Pécs, 7624 Hungary
| | - Mária Szepes
- />Hungarian National Institute for Health Development, Budapest, 1437 Hungary
- />Institute of Behavioural Sciences, Semmelweis University Budapest, Budapest, 1089 Hungary
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Baughman KR, Bonfine N, Dugan SE, Adams R, Gallagher M, Olds RS, Piatt E, Ritter C. Disease Burden Among Individuals with Severe Mental Illness in a Community Setting. Community Ment Health J 2016; 52:424-32. [PMID: 26611625 DOI: 10.1007/s10597-015-9973-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Sara E Dugan
- Pharmacy Practice Department, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Richard Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, PO Box 5190, Kent, OH, 44242, USA
| | - Mary Gallagher
- Department of Sociology, Kent State University at Stark, 6000 Frank Ave NW, North Canton, OH, 44720, USA
| | - R Scott Olds
- Department of Family and Community Medicine, University of New Mexico, 1 University of New Mexico Bldg 177, Albuquerque, NM, 87131, USA
| | - Elizabeth Piatt
- Department of Sociology, Hiram College, 6832 Hinsdale St, Hiram, OH, 44234, USA
| | - Christian Ritter
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
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Coulombe S, Radziszewski S, Meunier S, Provencher H, Hudon C, Roberge P, Provencher MD, Houle J. Profiles of Recovery from Mood and Anxiety Disorders: A Person-Centered Exploration of People's Engagement in Self-Management. Front Psychol 2016; 7:584. [PMID: 27199819 PMCID: PMC4844930 DOI: 10.3389/fpsyg.2016.00584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/08/2016] [Indexed: 12/21/2022] Open
Abstract
Context: A shift toward person-centered care has been occurring in services provided to people with mood and anxiety disorders. Recovery is recognized as encompassing personal aspects in addition to clinical ones. Guidelines now recommend supporting people's engagement in self-management as a complementary recovery avenue. Yet the literature lacks evidence on how individualized combinations of self-management strategies used by people relate to their clinical and personal recovery indicators. Objectives: The aims of this study were to identify profiles underlying mental health recovery, describe the characteristics of participants corresponding to each profile, and examine the associations of profiles with criterion variables. Method: 149 people recovering from anxiety, depressive, or bipolar disorders completed questionnaires on self-management, clinical recovery (symptom severity), personal recovery (positive mental health), and criterion variables (personal goal appraisal, social participation, self-care abilities, coping). Results: Latent profile analysis (LPA) revealed three profiles. The Floundering profile included participants who rarely used self-management strategies and had moderately severe symptoms and the lowest positive mental health. The Flourishing profile was characterized by frequent use of self-empowerment strategies, the least severe symptoms, and the highest positive mental health. Participants in the Struggling profile engaged actively in several self-management strategies focused on symptom reduction and healthy lifestyle. They concomitantly reported high symptom severity and moderately high positive mental health. The study revealed that Floundering was associated with higher probabilities of being a man, being single, and having a low income. People in the Flourishing profile had the most favorable scores on criterion variables, supporting the profiles' construct validity. Discussion: The mixed portrait of Struggling participants on recovery indicators suggests the relationship between health engagement and recovery is more intricate than anticipated. Practitioners should strive for a holistic understanding of their clients' self-management strategies and recovery indicators to provide support personalized to their profile. While people presenting risk factors would benefit from person-centered support, societal efforts are needed in the long term to reduce global health inequalities. The integration of constructs from diverse fields (patient-centered care, chronic illness, positive psychology) and the use of person-oriented analysis yielded new insights into people's engagement in their health and well-being.
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Affiliation(s)
- Simon Coulombe
- Department of Psychology, Université du Québec à Montréal, Montréal QC, Canada
| | | | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal QC, Canada
| | | | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke Sherbrooke, QC, Canada
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke Sherbrooke, QC, Canada
| | | | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, MontréalQC, Canada; Research Centre, Institut universitaire en santé mentale de Montréal, MontréalQC, Canada
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Richard L, Furler J, Densley K, Haggerty J, Russell G, Levesque JF, Gunn J. Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations. Int J Equity Health 2016; 15:64. [PMID: 27068028 PMCID: PMC4828803 DOI: 10.1186/s12939-016-0351-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field. METHODS We distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation. RESULTS Seven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations were developed to enhance patients' or populations' abilities to access services (demand-side), and rarely did initiatives target both supply- and demand-side determinants of access. CONCLUSIONS A wide range of innovations improving access to PHC were identified. The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention to close the equity gap for vulnerable populations in accessing PHC services that correspond to their needs.
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Affiliation(s)
- Lauralie Richard
- />Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC 3004 Australia
| | - John Furler
- />Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC 3004 Australia
| | - Konstancja Densley
- />Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC 3004 Australia
| | - Jeannie Haggerty
- />St. Mary’s Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, Qc H3T 1M5 Canada
| | - Grant Russell
- />School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, VIC 3168 Australia
| | - Jean-Frederic Levesque
- />Bureau of Heath Information, Level 11, Sage Building, 67 Albert Avenue, Chatswood, NSW 2067 Australia
- />Centre for Primary Health Care and Equity, UNSW, Sydney, 2052 Australia
| | - Jane Gunn
- />Primary Care Research Unit, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 200, Berkeley street, Melbourne, VIC 3004 Australia
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Wolf TJ, Baum CM, Lee D, Hammel J. The Development of the Improving Participation after Stroke Self-Management Program (IPASS): An Exploratory Randomized Clinical Study. Top Stroke Rehabil 2016; 23:284-92. [PMID: 27077987 DOI: 10.1080/10749357.2016.1155278] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is a heavy emphasis in rehabilitation on restoration of function post-stroke at the expense of addressing how to manage the impact of stroke and the environment long term. Management of chronic health conditions is often and effectively addressed using self-management education; however, self-management is mostly focused on managing symptoms and health behaviors, not additional participation and community reintegration issues experienced following stroke. This study evaluated the Improving Participation after Stroke Self-Management Program (IPASS) to improve self-efficacy and participation in everyday life activities for individuals living with the long-term consequences of stroke. METHODS A multisite, single-blind, exploratory randomized clinical study was conducted with participants with mild-to-moderate chronic stroke (n = 185). Participants were randomized either to receive the IPASS intervention immediately or to a wait list control group. The assessment was completed pre- and post-intervention and at 6-9 months post-intervention follow-up. The primary outcome assessments included measures of self-efficacy to manage chronic health conditions and to participate in everyday life activities. RESULTS The results show that there was significant short-term increase in health-related self-efficacy both within-group and between-groups in managing chronic conditions which were retained at follow-up; the average effect size was 0.46, indicating moderate effect overall. Further, a significant short-term increase was found in participation self-efficacy, with an overall moderate effect size of 0.55. CONCLUSIONS These results provide early support for the use of IPASS to help improve self-efficacy to manage health behaviors and to improve participation post-stroke. Further investigation is warranted to confirm these findings with an active control group and a more sensitive outcome measure to capture participation changes.
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Affiliation(s)
- Timothy J Wolf
- a Department of Occupational Therapy , University of Missouri , Columbia , MO , USA
| | - Carolyn M Baum
- b Program in Occupational Therapy , Washington University School of Medicine , St. Louis , MO , USA
| | - Danbi Lee
- c Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Joy Hammel
- c Department of Occupational Therapy , University of Illinois at Chicago , Chicago , IL , USA
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Blixen CE, Kanuch S, Perzynski AT, Thomas C, Dawson NV, Sajatovic M. Barriers to Self-management of Serious Mental Illness and Diabetes. Am J Health Behav 2016; 40:194-204. [PMID: 26931751 PMCID: PMC4928189 DOI: 10.5993/ajhb.40.2.4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. METHODS We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. RESULTS Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). CONCLUSIONS Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.
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Affiliation(s)
- Carol E Blixen
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | - Stephanie Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Neal V Dawson
- Epidemiology & Biostatistics, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Haslbeck J, Zanoni S, Hartung U, Klein M, Gabriel E, Eicher M, Schulz PJ. Introducing the chronic disease self-management program in Switzerland and other German-speaking countries: findings of a cross-border adaptation using a multiple-methods approach. BMC Health Serv Res 2015; 15:576. [PMID: 26711458 PMCID: PMC4692063 DOI: 10.1186/s12913-015-1251-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/22/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Stanford's Chronic Disease Self-Management Program (CDSMP) stands out as having a large evidence-base and being broadly disseminated across various countries. To date, neither evidence nor practice exists of its systematic adaptation into a German-speaking context. The objective of this paper is to describe the systematic German adaptation and implementation process of the CDSMP (2010-2014), report the language-specific adaptation of Franco-Canadian CDSMP for the French-speaking part of Switzerland and report findings from the initial evaluation process. METHODS Multiple research methods were integrated to explore the perspective of workshop attendees, combining a longitudinal quantitative survey with self-report questionnaires, qualitative focus groups, and interviews. The evaluation process was conducted in for both the German and French adapted versions to gain insights into participants' experiences in the program and to evaluate its impact. Perceived self-efficacy was measured using the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G). RESULTS Two hundred seventy eight people attending 35 workshops in Switzerland and Austria participated in the study. The study participants were receptive to the program content, peer-led approach and found principal methods useful, yet the structured approach did not address all their needs or expectations. Both short and long-term impact on self-efficacy were observed following the workshop participation (albeit with a minor decrease at 6-months). Participants reported positive impacts on aspects of coping and self-care, but limited effects on healthcare service utilization. CONCLUSIONS Our findings suggest that the process for cross-border adaptation was effective, and that the CDSMP can successfully be implemented in diverse healthcare and community settings. The adapted CDSMP can be considered an asset for supporting self-management in both German-and French-speaking central European countries. It could have meaningful, wide-ranging implications for chronic illness care and primary prevention and potentially tertiary prevention of chronic disease. Further investigations are needed to tailor the program for better access to vulnerable and disadvantaged groups who might benefit the most, in terms of facilitating their health literacy in chronic illness.
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Affiliation(s)
- Jörg Haslbeck
- Research Institute of the Kalaidos University of Applied Science Department of Health, Careum Research, Zurich, Switzerland.
| | - Sylvie Zanoni
- Research Institute of the Kalaidos University of Applied Science Department of Health, Careum Research, Zurich, Switzerland.
| | - Uwe Hartung
- Institute of Communication and Health (ICH), Università della Svizzera Italiana, Lugano, Switzerland.
| | | | | | | | - Peter J Schulz
- Institute of Communication and Health (ICH), Università della Svizzera Italiana, Lugano, Switzerland.
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Van den Heuvel SCGH, Goossens PJJ, Terlouw C, Van Achterberg T, Schoonhoven L. Identifying and describing patients' learning experiences towards self-management of bipolar disorders: a phenomenological study. J Psychiatr Ment Health Nurs 2015; 22:801-10. [PMID: 26172454 DOI: 10.1111/jpm.12243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/26/2022]
Abstract
ACCESSIBLE SUMMARY Existing evidence suggest that patient education in promoting self-management strategies of bipolar disorder (BD) is effective. However, results across the full range of service users with BD vary. Learning experiences of service users look to be a crucial factor to take into account when designing, delivering, and evaluating effective interventions that promote self-management in chronic illness. What learning activities service users actually undertake themselves when self-managing BD that might explain varying success rates, and guide future self-management educational programmes has not been examined. Unlike previous studies that suggest that outcomes in self-management depend on individual learning activities, the current study found that learning to self-manage BD takes place in a social network that functions as a learning environment in which it is saved for service users to make mistakes and to learn from these mistakes. Especially, coping with the dormant fear of a recurrent episode and acknowledging the limitations of an individual approach are important factors that facilitate this learning process. Practitioners who provide patient education in order to promote self-management of BD should tailor future interventions that facilitate learning by reflecting on the own experiences of service users. Community psychiatric nurses should keep an open discussion with service users and caregivers, facilitate the use of a network, and re-label problems into learning situations where both play an active role in building mutual trust, thereby enhancing self-management of BD. ABSTRACT Existing evidence suggest that self-management education of bipolar disorder (BD) is effective. However, why outcomes differ across the full range of service users has not been examined. This study describes learning experiences of service users in self-managing BD that provide a possible explanation for this varying effectiveness. We have conducted a phenomenological study via face-to-face, in-depth interviews, guided by a topic list, along service users with BD I or II (n = 16) in three specialised community care clinics across the Netherlands. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7. Unlike existing studies, which suggest that individual abilities of service users determine outcomes in self-management of BD, the current study found that self-management of BD is a learning process that takes place in a collaborative network. We identified five categories: acknowledgment of having BD, processing the information load, illness management, reflecting on living with BD, and self-management of BD. The success of self-management depends on the acknowledgment of individual limitations in learning to cope with BD and willingness to use a social network as a back-up instead. Especially, the dormant fear of a recurrent episode is a hampering factor in this learning process.
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Affiliation(s)
- S C G H Van den Heuvel
- Saxion University of Applied Sciences, Expertise Centre for Health, Social Care and Technology, Deventer, The Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Dimence Group, Center for Mental Health Care, SCBS Bipolar Disorders, Deventer, The Netherlands.,KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium
| | - P J J Goossens
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Dimence, SCBS Bipolar Disorders, Institute for Mental Healthcare, Deventer, The Netherlands.,GGZ-VS, Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands.,University Centre of Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Services, Ghent University, Ghent, Belgium
| | - C Terlouw
- Saxion University of Applied Sciences, Expertise Centre for Educational Innovations, Enschede, The Netherlands
| | - T Van Achterberg
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,KU Leuven, Centre for Health Services and Nursing Research, Leuven, Belgium
| | - L Schoonhoven
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Faculty of Health Sciences, University of Southampton, Southampton, UK
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Coulombe S, Radziszewski S, Trépanier SG, Provencher H, Roberge P, Hudon C, Meunier S, Provencher MD, Houle J. Mental health self-management questionnaire: Development and psychometric properties. J Affect Disord 2015; 181:41-9. [PMID: 25917292 DOI: 10.1016/j.jad.2015.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Through self-management, people living with depression, anxiety or bipolar disorders can play an active role in their recovery. However, absence of a validated questionnaire limits empirical research on self-management. The study aimed to develop a French instrument, the Mental Health Self-Management Questionnaire (MHSQ), and to investigate its psychometric properties METHODS A pool of 86 items was created based on a qualitative study with 50 people in recovery from depression, anxiety or bipolar disorders. The 64 most pertinent items were identified following ratings from 14 experts. A sample of 149 people in recovery completed these items and criterion-related measures (specific aspects of self-management, clinical and personal recovery, social desirability), and 93 participants also completed MHSQ two weeks later RESULTS Exploratory and confirmatory factor analyses show that MHSQ is composed of three subscales: Clinical (getting help and using resources), Empowerment (building upon strengths and positive self-concept to gain control) and Vitality (active and healthy lifestyle). These subscales had satisfying consistency and test-retest reliability, and were mostly unrelated to social desirability. Correlations with criterion variables support convergent and concurrent validity, especially for Empowerment and Vitality. Comparison of structural models provides evidence of the distinct nature of MHSQ in comparison to the constructs of clinical and personal recovery LIMITATIONS Longitudinal studies with larger samples are needed to explore the validity of MHSQ for predicting recovery over time CONCLUSION MHSQ is a psychometrically-sound instrument, useful for establishing the role of self-management in recovery and monitoring the efficacy of self-management support programs.
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Affiliation(s)
- Simon Coulombe
- Département de psychologie, Université du Québec à Montréal, Canada
| | | | | | | | - Pasquale Roberge
- Département de médecine de famille et de médecine d׳urgence, Université de Sherbrooke, Canada
| | - Catherine Hudon
- Département de médecine de famille et de médecine d׳urgence, Université de Sherbrooke, Canada
| | - Sophie Meunier
- Département de psychologie, Université du Québec à Montréal, Canada
| | | | - Janie Houle
- Département de psychologie, Université du Québec à Montréal, Canada.
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Basu R, Ory MG, Towne SD, Smith ML, Hochhalter AK, Ahn S. Cost-effectiveness of the chronic disease self-management program: implications for community-based organizations. Front Public Health 2015; 3:27. [PMID: 25964945 PMCID: PMC4410335 DOI: 10.3389/fpubh.2015.00027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/02/2015] [Indexed: 01/17/2023] Open
Abstract
Chronic conditions are the leading cause of growing healthcare spending, disability, and death in the U.S. In the wake of national health reform, policy makers and healthcare professionals are becoming increasingly concerned in containing healthcare costs while improving quality of patient care. A basic policy question is whether the Chronic Disease Self-Management Program (CDSMP), a widely distributed evidenced-based self-managed program, can be cost-effective in managing chronic conditions while improving quality of life. Utilizing data from the National Study of CDSMP, the primary objective of the current study is to estimate cost-effectiveness of the CDSMP program among individuals with at least one chronic condition. The second objective is to determine how cost-effectiveness ratios vary by depression status. EuroQol-5D (EQ-5D) was used to measure health-related quality of life (HRQOL) of CDSMP participants, which was then converted to quality-adjusted life years (QALYs) for cost-effectiveness analysis. Participants who completed the CDSMP program experienced higher EQ-5D scores from baseline to 12-month follow-up (increased from 0.736 to 0.755; p < 0.001). The incremental cost-effectiveness ratio (ICER) ranges from $83,285 to $31,285 per QALYs, which can be comparable to the common benchmark of $50,000/QALYs. ICER by baseline depression status indicates that it will cost more per QALYs gained for those diagnosed with depression based on their Patient Health Questionnaire-8 score. However, cautions should be taken while considering this point estimate too literally because the average cost for CDSMP participants was a rough estimate and based on several simplifying assumptions. Identifying cost-effective strategies that can lower the burden of chronic disease among community-dwelling adults is critical for decision makers in allocating limited resources. Policy makers and community organizations can use this information to guide funding decisions and delivery of CDSMP programs for individuals with multiple chronic health conditions.
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Affiliation(s)
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Samuel D Towne
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center , College Station, TX , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | | | - SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA
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