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Yarycky L, Castillo LIR, Gagnon MM, Hadjistavropoulos T. Initiatives Targeting Patients: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults. Clin J Pain 2024; 40:243-252. [PMID: 38204295 DOI: 10.1097/ajp.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Older adults frequently experience persistent pain but are often unaware of self-management and other strategies that can help improve their condition. In a related article, we reported on pain assessment and management knowledge translation initiatives related to older adults that were targeting health professionals. In this paper, we report on initiatives targeting older adults. MATERIALS AND METHODS Using systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related knowledge translation programs targeted towards older adults, their informal caregivers, and health care professionals were examined. RESULTS From an initial 21,669 search results, 172 studies met our inclusion criteria. Of these studies, 49 targeted older adults. These studies varied widely in focus and delivery format, but the majority were associated with a significant risk of bias. Older adults with musculoskeletal pain were the primary recipients of education. Most programs were classified as knowledge mobilization initiatives. The remainder were considered self-management programs. Knowledge users were satisfied with the suitability of the information presented, and patient outcomes were a primary concern across all studies. Behavioral changes and pain management outcomes, however, were underemphasized in the literature. CONCLUSION Knowledge acquisition outcomes are overrepresented in the current literature compared with behavioral outcomes changes. Nonetheless, older adults report benefitting from the guidance provided in self-management programs when applying knowledge to practice. Future research is needed to better understand the facilitators and barriers to pain management changes in this population.
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Affiliation(s)
- Laney Yarycky
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Louise I R Castillo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Michelle M Gagnon
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK Canada
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Mosteiro Miguéns DG, Rodríguez Fernández A, Zapata Cachafeiro M, Vieito Pérez N, Represas Carrera FJ, Novío Mallón S. Community Activities in Primary Care: A Literature Review. J Prim Care Community Health 2024; 15:21501319231223362. [PMID: 38197384 PMCID: PMC10785739 DOI: 10.1177/21501319231223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.
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Affiliation(s)
| | - Almudena Rodríguez Fernández
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maruxa Zapata Cachafeiro
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Natalia Vieito Pérez
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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Wong C, O WW, Wong KS, Ma R, Hui E, Kwok CT. Randomized trial of a patient empowerment and cognitive training program for older people with diabetes mellitus and cognitive impairment. Geriatr Gerontol Int 2020; 20:1164-1170. [DOI: 10.1111/ggi.14062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Chit‐wai Wong
- Department of Medicine & Geriatrics Caritas Medical Centre, Hospital Authority Hong Kong
| | - Wai‐Tsun William O
- Department of Medicine & Therapeutics Prince of Wales Hospital Shatin Hong Kong
| | - Kin‐Wai Shirley Wong
- Senior Citizens Services, Social Services Department The Salvation Army Hong Kong & Macau Command Hong Kong
| | - Ronald Ma
- Department of Medicine & Therapeutics Prince of Wales Hospital Shatin Hong Kong
| | - Elsie Hui
- Medicine and Geriatric Unit Shatin Hospital, Hospital Authority Hong Kong
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Im E, Sakashita R, Lin C, Lee T, Tsai H, Inouye J. Current Trends in Nursing Research Across Five Locations: The United States, South Korea, Taiwan, Japan, and Hong Kong. J Nurs Scholarsh 2020; 52:671-679. [DOI: 10.1111/jnu.12592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Eun‐Ok Im
- Beta Epsilon Senior Associate Dean for Research and Innovation & Edith Folsom Honeycutt Endowed Chair Emory University Atlanta GA USA
| | | | - Chia‐Chin Lin
- Pi Iota Head & Professor University of Hong Kong Hong Kong China
| | - Tae‐Hwa Lee
- Lambda Alpha at Large Dean & Professor Yonsei University Seoul South Korea
| | - Hsiu‐Min Tsai
- Lambda Beta at Large Dean for Academic Affairs & Professor Chang Gung University of Science and Technology Taoyuan City Taiwan
| | - Jillian Inouye
- Gamma Psi at Large Professor University of Hawaii Manoa HI USA
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Multiple mediation effects of health locus of control and hope on the relationship between stroke patients’ social support and self-management. FRONTIERS OF NURSING 2020. [DOI: 10.2478/fon-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
This study aimed to identify the mediation effects of health locus of control (HLC) and hope between stroke patients’ social support and self-management.
Methods
A cross-sectional study was conducted. A total of 300 Chinese stroke patients were recruited by convenient sampling from the acupuncture department of two Chinese Traditional Medical Hospitals in Tianjin Province from June to September 2018. The self-report questionnaires include Social Support Assessment Scale, Herth Hope Index, Mental Health Locus of Control Scale, Stroke Self-management Behavior Scale, and personal information questionnaires. All the survey data were entered in Excel and analyzed using the SPSS 24.0 program. Mediation was tested with Bootstrapping in AMOS 23.0 program.
Results
The result showed that internal health locus of control (IHLC), chance health locus of control (CHLC) and hope were the mediators between social support and self-management. The direct, indirect, and total effects of social support on self-management behavior were 0.306 P < 0.01), 0.109 (P < 0.01), and 0.415 (P < 0.01), respectively.
Conclusions
Social support can directly influence self-management, and it can also indirectly influence self-management through IHLC, CHLC, and hope.
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Foo KM, Sundram M, Legido-Quigley H. Facilitators and barriers of managing patients with multiple chronic conditions in the community: a qualitative study. BMC Public Health 2020; 20:273. [PMID: 32106838 PMCID: PMC7045577 DOI: 10.1186/s12889-020-8375-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/19/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Approximately one-third of all adults worldwide are diagnosed with multiple chronic conditions (MCCs). The literature has identified several challenges facing providers and patients coping with managing MCCs in the community, yet few studies have considered their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. METHODS This study involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provide subsidised primary care services. Topic guides were developed with reference to the literature review, Chronic Care Model (CCM) and framework for patient-centred access to healthcare. RESULTS Despite the perceived affordability and availability of the support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those who did not visit the clinics might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges to delivering safe and quality care with limited consultation duration due to the need to manage high patient load and waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle-related guidelines, patients' actions are influenced by multiple factors, including work requirements, beliefs and environment. CONCLUSIONS There were barriers on care access, delivery and self-management. It is crucial to adopt a whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCC management. This study has also highlighted the importance of considering the different viewpoints of healthcare providers and users in policy formulation and community care planning.
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Affiliation(s)
- Kah Mun Foo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore.
- National University Polyclinics, Singapore, 1 Jurong East Street 21, Singapore, 609606, Singapore.
| | - Meena Sundram
- National University Polyclinics, Singapore, 1 Jurong East Street 21, Singapore, 609606, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
- London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
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Leong SM, Lei WI, Chan UW. The Six-Month and One-Year Outcome of a Chronic Disease Self-Management Program Among Older Adults in Macao: A Quasi-Experimental Study. SAGE Open Nurs 2020; 6:2377960820958231. [PMID: 35155758 PMCID: PMC8832321 DOI: 10.1177/2377960820958231] [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: 04/15/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Promoting older adults to self-manage their chronic conditions is a major
focus of the Macao government and healthcare professionals since more than
80% of older adults have suffered chronic conditions. Objectives This study evaluated the effect of the Chronic Disease Self-management
Program (CDSMP) on self-management behaviors, self-efficacy, health status,
and healthcare services utilization among Macao older adults with chronic
disease over six months, and assessed whether the intervention effect
persisted for one year. Methods A longitudinal and quasi-experimental design was used in this study. A total
number of 158 older adults with at least one chronic disease were recruited
from three Macao community centers. Participants in the study group engaged
in a six-session CDSMP in the community centers and participants in the
control group received usual care. The Chronic Disease Self-management
Questionnaire was used to assess the outcome measures for baseline,
six-month and one-year assessment. Results The age of subjects ranged from 60 to 88, 64.6% had three or more chronic
diseases. The results showed that the subjects in the study group had
significant improvement in self-management behaviors, self-efficacy, and
some health-related indicators at the point of six months, and these
improvements were still observable at the point of one year when comparing
to the control group. The results also showed that the study group had a
decrease in healthcare services utilization, but there was no significant
difference between the two groups. Conclusion This study confirmed that the community-dwelling older adults in Macao can
acquire positive outcomes in self-management and health-related indicators
from the CDSMP. Hence, it is worth promoting this program as a health
promotion activity in community.
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Affiliation(s)
- Sok Man Leong
- Education Department, Kiang Wu Nursing College of Macau, Macau SAR, China
| | - Wai In Lei
- Education Department, Kiang Wu Nursing College of Macau, Macau SAR, China
| | - Un Wa Chan
- Public Health Laboratory of Macau, Macau SAR, China (Former staff of Kiang Wu Nursing College of Macau)
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Shao JH, Chen SH. Who did it better? Gender differences in effects of a dietary self-management intervention for older community-dwelling adults. J Women Aging 2019; 33:473-486. [PMID: 31880992 DOI: 10.1080/08952841.2019.1707152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to determine whether there were gender differences in the effectiveness of a 12-week dietary self-management program for older community-dwelling adults in northeast Taiwan. This was a secondary analysis of a previous study; participants (N = 58) were purposively sampled from two public health centers. Non-parametric models examined differences in outcome measures because of the small sample size; 20 males and 38 females completed the study. The results showed males scored significantly better than females for nutritional status, internal health locus of control, and responsibility for food preparation, which may have implications for older female adults' nutritional health.
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Affiliation(s)
- Jung-Hua Shao
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Joint Reconstruction, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - Su-Hui Chen
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Allergy Immunology Rheumatology and Osteoarthrit, Chang Gung Memorial Hospital, Linkou, Taiwan
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9
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Man DWK, Tsang WSF, Lu EY, Tsang HWH. Bibliometric study of research productivity in occupational therapy and physical therapy/physiotherapy in four Western countries and five Asian countries/regions. Aust Occup Ther J 2019; 66:690-699. [PMID: 31595529 DOI: 10.1111/1440-1630.12608] [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] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION High-quality research is the foundation of occupational therapy and physical therapy/physiotherapy. A bibliometric study on the research productivity of occupational therapy and physical therapy/physiotherapy scholars in different Western and Asian countries/regions could provide a snapshot of current research achievement in rehabilitation science. METHOD On the basis of an understanding of the leading role of rehabilitation research in Western countries and a recognition of achievements made by Asian occupational therapy and physical therapy/physiotherapy scholars, the current bibliometric study examined the research productivity of occupational therapy and physical therapy/physiotherapy professors and associate professors from four Western countries (Australia, Canada, the United States and the United Kingdom) and five Asian countries/regions (Hong Kong, Japan, Taiwan, Singapore and South Korea). The h-indices of these scholars were retrieved online and aggregated to quantify the research productivity of institutions and countries/regions. RESULTS Australia, Canada, Hong Kong and the United States were identified as countries/regions with higher research productivity in occupational therapy and physical therapy/physiotherapy. The institutions were ranked on the basis of the median h-indices of their professors and associate professors; the top 20 productive institutions with occupational therapy programmes had a median h-index of 17.5 or higher, whereas the benchmark of the top 20 institutions with physical therapy/physiotherapy programmes was 25. CONCLUSION Professors and associate professors in Australia, Canada, Hong Kong and the United States are productive in occupational therapy and physical therapy/physiotherapy research. The number of faculty members and university connections are regarded as important for research achievement. Recommendations for various levels of collaboration are provided.
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Affiliation(s)
- David W K Man
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Walter S F Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Erin Yiqing Lu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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10
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Zhang Y, Liu S, Sheng X, Lou J, Fu H, Sun X. Evaluation of a community-based hypertension self-management model with general practitioners. Int J Health Plann Manage 2019; 34:960-974. [PMID: 31368128 DOI: 10.1002/hpm.2867] [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: 11/10/2022] Open
Abstract
BACKGROUND Preventive interventions of hypertension and health care activities are often performed in the community and at home. Studies have shown that self-management plays an indispensable role in the management of chronic diseases. This study aimed to explore an innovative community-based hypertension self-management model and to evaluate its effects. METHODS The study involved qualitative and quantitative research methods. A community-based hypertension self-management model was developed using consultation with experts and qualitative interviews. The intervention was executed in the communities of Pudong New Area in Shanghai, China. We enrolled 1080 patients with hypertension in the intervention group and 588 similar patients in the control group. A questionnaire was administered before and after the intervention to collect information on patients' health status, self-management skills, and disease management abilities. Analyses were conducted to evaluate changes in the health-related outcomes. RESULTS There was a significant difference in general health and health literacy after the intervention for the intervention patients group (P < .05). Furthermore, the proportion of health literacy was higher in the intervention group than in the control group (71.6% vs 59.6%). The significant differences were demonstrated in the comparison of the disease management ability data between the intervention and control group, especially in drug compliance, physical activity, regulate diet, and smoking. In addition, there is other evidence of the successful applicability and effectiveness of the community-based hypertension self-management program in 2007-2013, such as self-management teams formation and blood pressure control rate. CONCLUSIONS The community-based self-management hypertension model, which involved the participation of general practitioners, is suitable for the management of hypertension disease in Pudong of Shanghai and could provide a reference for its large-scale promotion and application.
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Affiliation(s)
- Yimin Zhang
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Shanshan Liu
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Xinchun Sheng
- General Office, Pudong New Area Center for Patriotic Sanitation Campaign and Health Promotion Counsel, Shanghai, China
| | - Jiquan Lou
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China
| | - Hua Fu
- School of Public Health, Fudan University, Shanghai, China
| | - Xiaoming Sun
- Health Development Research Center, Pudong Institute for Health Development, Shanghai, China.,School of Public Health, Fudan University, Shanghai, China
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Anderson N, Ozakinci G. "It all needs to be a full jigsaw, not just bits": exploration of healthcare professionals' beliefs towards supported self-management for long-term conditions. BMC Psychol 2019; 7:38. [PMID: 31234924 PMCID: PMC6591939 DOI: 10.1186/s40359-019-0319-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-Term Conditions are physical health issues which profoundly impact physical and psychological outcomes and have reached epidemic worldwide levels. An increasing evidence-base has developed for utilizing Supported Self-Management to ensure Health, Social Care & Voluntary staff are knowledgeable, skilled, and experienced to enable patients to have the confidence and capability to self-manage their conditions. However, despite Health Psychology theories underpinning chronic care models demonstrating beliefs are crucially associated with intention and behaviour, staff beliefs towards Supported Self-Management have received little attention. Therefore, the study aimed to explore healthcare professionals' beliefs towards Supported Self-Management for Long-Term Conditions using the Theory of Planned Behaviour. METHODS A mixed-methods approach was conducted within a single UK local government authority region in 2 phases: (1) Qualitative focus group of existing Supported Self-Management project staff (N = 6); (2) Quantitative online questionnaire of general Long-Term Conditions staff (N = 58). RESULTS (1) Eighty two utterances over 20 theme sub-codes demonstrated beliefs that Supported Self-Management improves healthcare outcomes, but requires enhancements to patient and senior stakeholder buy-in, healthcare culture-specific tailoring, and organizational policy and resources; (2) Mean scores indicated moderate-strength beliefs that Supported Self-Management achieves positive healthcare outcomes, but weak-strength intentions to implement Supported Self-Management and beliefs it is socially normative and perceived control over implementing it. Crucially, regression analyses demonstrated intentions to implement Supported Self-Management were only associated with beliefs that important others supported it and perceived control over, or by whether it was socially encouraged. CONCLUSIONS Healthcare professionals demonstrated positive attitudes towards Supported Self-Management improving healthcare outcomes. However, intentions towards implementing this approach were low with staff only slightly believing important others (including patients and clinicians) supported it and that they had control over using it. Future Supported Self-Management projects should seek to enhance intention (and consequently behaviour) through targeting beliefs that important others do indeed actually support this approach and that staff have control over implementing it, as well as enhancing social encouragement.
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Affiliation(s)
- Niall Anderson
- Public Health Department, NHS Borders, Melrose, TD6 9BD UK
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
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12
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Lederle M, Bitzer EM. A close look at lay-led self-management programs for chronic diseases and health care utilisation: A systematic review and meta-analysis. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2019; 17:Doc03. [PMID: 31148954 PMCID: PMC6533545 DOI: 10.3205/000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/11/2018] [Indexed: 01/08/2023]
Abstract
Introduction: Chronically ill people are confronted with significant challenges when dealing with health care services. Lay-led self-management programs aim to improve self-management skills and might enable patients to make appropriate decisions as to when to use health care services. Contrary to the general attitude that self-management programs reduce health care utilisation, we suspect that better self-management skills lead to increased or possibly more appropriate health care utilisation. Our review and meta-analysis sheds light on the relationship between lay-led self-management programs and health care utilisation. Methods: In March 2017, we searched 7 databases (CDSR, DARE, HTA, Medline, CINAHL, PsycInfo, and SSCI) to perform a systematic review and meta-analysis to identify studies that reported empirical data on lay-led self-management programs and health care utilisation. We extracted the characteristics of all primary studies and the data of four indicators of utilisation (physician visits, emergency department visits, hospital admissions, and length of stay in hospital), and analysed the role of health care utilisation in these studies. We present the results in frequency tables and as a conventional meta-analysis with the standardized mean difference (SMD), 95% confidence intervals (CI), and pooled overall effect sizes using RevMan 5.3.5. The manuscript follows the PRISMA checklist. Results: Overall, we include 49 primary studies; 10 studies provided sufficient data for the meta-analysis. Health care utilisation played a different role in the studies; 15 studies reported a clear explicit hypothesis on the influence of a lay-led self-management program on health care utilisation, and 17 studies assumed an implicit assumption. 8 studies discussed the possibility that a lay-led self-management program could lead to more appropriate health care utilisation. The meta-analysis showed mixed results, and many effect sizes were not statistically significant. The participants of a lay-led self-management program had fewer emergency department visits (SMD: -0.08; 95% CI: -0.15 to -0.01; p=0.02) than the control group. Conclusion: Although the statistically significant effects of the meta-analysis are low, our overall findings show that only a small number of the included studies tackled the task of comprehensively investigating self-management skills in the context of health care utilisation. This fails to do justice to the potential of self-management programs. It is essential to consider the appropriateness of health care utilisation. We propose the term self-management-sensitive utilisation for this purpose.
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Santos T, Lovell J, Shiell K, Johnson M, Ibrahim JE. The impact of cognitive impairment in dementia on self-care domains in diabetes: A systematic search and narrative review. Diabetes Metab Res Rev 2018; 34:e3013. [PMID: 29707902 DOI: 10.1002/dmrr.3013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/23/2018] [Accepted: 03/31/2018] [Indexed: 01/01/2023]
Abstract
Self-management is integral to effective chronic disease management. Cognitive impairments (CogImp) associated with dementia have not previously been reviewed in diabetes mellitus (DM) self-care. The aims of this study are to know (1) whether CogImp associated with dementia impact self-care and (2) whether specific CogImp affects key DM self-care processes. A systematic literature search with a narrative review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This review examined studies published from January, 2000 to February, 2016 describing the relationship between cognition and DM self-care domains in community dwelling older adults with dementia/CogImp. Eight studies met inclusion criteria. Decrements in all self-care domains were associated with CogImp. Problem solving was related to reduced disease knowledge (OR 0.87, 95% CI = 0.49-1.55), resulting in poorer glycemic control. Decision-making impairments manifested as difficulties in adjusting insulin doses, leading to more hospital admissions. People without CogImp were better able to find/utilize resources by adhering to recommended management (OR 1.03, 95% CI = 1.02-1.05). A lack of interaction with health care providers was demonstrated through reduced receipt of important routine investigation including eye examinations (ARR = 0.85, 95% CI = 0.85-0.86), HbA1c testing (ARR = 0.96, 95% CI = 0.96-0.97), and LDL-C testing (ARR = 0.91, 95% CI = 0.901-0.914). People without CogImp had better clinic attendance (OR 2.17, 95% CI = 1.30-3.70). Action taking deficits were apparent through less self-testing of blood sugar levels (20.2% vs 24.4%, P = 0.1) resulting in poorer glycemic control, self-care, and more frequent micro/macrovascular complications. Persons with diabetes and CogImp, particularly in domains of learning, memory and executive function, were significantly impaired in all self-care tasks.
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Affiliation(s)
- Tamsin Santos
- Subacute Service, Queen Elizabeth Centre, Ballarat Health Services, Ballarat Central, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Janaka Lovell
- Subacute Service, Queen Elizabeth Centre, Ballarat Health Services, Ballarat Central, Australia
| | - Kerrie Shiell
- Subacute Service, Queen Elizabeth Centre, Ballarat Health Services, Ballarat Central, Australia
| | - Marilyn Johnson
- Department of Civil Engineering, Monash University, Melbourne, Australia
| | - Joseph E Ibrahim
- Subacute Service, Queen Elizabeth Centre, Ballarat Health Services, Ballarat Central, Australia
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Melbourne, Australia
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14
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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: 9] [Impact Index Per Article: 1.5] [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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Garnett A, Ploeg J, Markle-Reid M, Strachan PH. Self-Management of Multiple Chronic Conditions by Community-Dwelling Older Adults: A Concept Analysis. SAGE Open Nurs 2018; 4:2377960817752471. [PMID: 33415188 PMCID: PMC7774451 DOI: 10.1177/2377960817752471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/29/2017] [Accepted: 12/10/2017] [Indexed: 11/16/2022] Open
Abstract
The proportion of the aging population living with multiple chronic conditions (MCC) is increasing. Self-management is valuable in helping individuals manage MCC. The purpose of this study was to conduct a concept analysis of self-management in community-dwelling older adults with MCC using Walker and Avant's method. The review included 30 articles published between 2000 and 2017. The following attributes were identified: (a) using financial resources for chronic disease management, (b) acquiring health- and disease-related education, (c) making use of ongoing social supports, (d) responding positively to health changes, (e) ongoing engagement with the health system, and (f) actively participating in sustained disease management. Self-management is a complex process; the presence of these attributes increases the likelihood that an older adult will be successful in managing the symptoms of MCC.
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Affiliation(s)
- Anna Garnett
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
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Psychological Treatments for Chronic Pain in East and Southeast Asia: A Systematic Review. Int J Behav Med 2017; 23:473-84. [PMID: 25814461 DOI: 10.1007/s12529-015-9481-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Psychological treatments are recognised as generally effective for chronic pain. However, little is known about the evidence for psychological treatments for chronic pain in Asia. PURPOSE This study aimed (1) to identify all treatment outcome studies in the area of psychological approaches to chronic pain in adult populations of East Asia and Southeast Asia and (2) to evaluate the treatment types, the evidence for treatment outcomes and research design quality with regard to these studies. METHODS We identified all psychologically based treatment outcome studies for chronic pain in East and Southeast Asia by searching CENTRAL, EMBASE, PsycINFO, MEDLINE (via Ovid), Global Health and Web of Science from the beginning of each abstracting service until December 2014 (week 4). RESULTS Seventeen studies met inclusion criteria including a total of N = 1,890 participants. Four were randomised controlled trials (RCTs), five controlled clinical trials (CCTs) and eight cohort studies. Treatment outcomes included pain, disability, depression and anxiety. Overall, the studies included in this review showed small to medium within-group effect sizes for all four outcomes. A majority of the studies were rated as weak in design quality. Three RCTs were found to be of strong quality, one of moderate quality and only one CCT of moderate quality. CONCLUSION The current available literature on psychological treatments for chronic pain in East and Southeast Asia is generally small in scale, mostly preliminary and lags behind on some developments occurring in North America and Europe. Further development of treatment methods and research designs is warranted.
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Cheung MKT, Chan SCC, Hung ATF, Leung AYM, Lee A, Chan FWK, Chung KL, Poon PKK, Chan CCH. A latent profile analysis on patient empowerment programme in a Hong Kong primary care setting. PATIENT EDUCATION AND COUNSELING 2017; 100:1890-1897. [PMID: 28599868 DOI: 10.1016/j.pec.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 04/29/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study identified the profiles of subgroups of type 2 diabetic (T2DM) patients of the Patient Empowerment Programme (PEP) by different levels of benefits gained in diabetic self-management behaviors, self-efficacy, and health literacy. METHODS This study adopted a non-experimental repeated-measures design on T2DM patients who joined PEP, using structured questionnaires. Latent profile analysis (LPA) was used to identify patterns of participants' change on the outcome measures. RESULTS Findings of LPA revealed that participants who were older, unemployed, weaker in diabetic self-management, and having a higher self-perception in personal disease risk were more likely to join the empowerment sessions and gained more benefits from the program. Participants with lower impairment in energy function and lower autonomy in personal health care showed more improvement in the outcomes. CONCLUSION The study identified significant factors associated with patients' participation on and benefits gained from a service delivery model integrating health education and patient empowerment in a primary care setting. PRACTICE IMPLICATION Findings from this study shed light on strategies to improve the PEP design in order to meet the needs of individuals with different health-related profiles.
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Affiliation(s)
- Mike K T Cheung
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China
| | - Sam C C Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Anchor T F Hung
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China.
| | - Angela Y M Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Albert Lee
- Centre for Health Education and Health Promotion, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank W K Chan
- Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China
| | - K L Chung
- Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China
| | - Peter K K Poon
- Centre on Research and Advocacy, The Hong Kong Society for Rehabilitation, Hong Kong, China
| | - Chetwyn C H Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Sit JW, Chair SY, Choi KC, Chan CW, Lee DT, Chan AW, Cheung JL, Tang SW, Chan PS, Taylor-Piliae RE. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clin Interv Aging 2016; 11:1441-1450. [PMID: 27789938 PMCID: PMC5072569 DOI: 10.2147/cia.s109560] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. PURPOSE To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. METHODS This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. RESULTS A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. CONCLUSION Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.
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Affiliation(s)
- Janet Wh Sit
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Sek Ying Chair
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Carmen Wh Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Diana Tf Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Aileen Wk Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Jo Lk Cheung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories
| | - Siu Wai Tang
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China
| | - Po Shan Chan
- Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong Hospital Authority, Causeway Bay, Hong Kong, People's Republic of China
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Chen SH, Huang YP, Shao JH. Effects of a dietary self-management programme for community-dwelling older adults: a quasi-experimental design. Scand J Caring Sci 2016; 31:619-629. [DOI: 10.1111/scs.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/06/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Su-Hui Chen
- School of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Yu-Ping Huang
- School of Nursing; National Quemoy University; Taiwan
| | - Jung-Hua Shao
- School of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
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Sell K, Amella E, Mueller M, Andrews J, Wachs J. Use of Social Cognitive Theory to Assess Salient Clinical Research in Chronic Disease Self-Management for Older Adults: An Integrative Review. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.63022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Ahn S, Smith ML, Altpeter M, Post L, Ory MG. Healthcare cost savings estimator tool for chronic disease self-management program: a new tool for program administrators and decision makers. Front Public Health 2015; 3:42. [PMID: 25964946 PMCID: PMC4410329 DOI: 10.3389/fpubh.2015.00042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
Abstract
Chronic disease self-management education (CDSME) programs have been delivered to more than 100,000 older Americans with chronic conditions. As one of the Stanford suite of evidence-based CDSME programs, the chronic disease self-management program (CDSMP) has been disseminated in diverse populations and settings. The objective of this paper is to introduce a practical, universally applicable tool to assist program administrators and decision makers plan implementation efforts and make the case for continued program delivery. This tool was developed utilizing data from a recent National Study of CDSMP to estimate national savings associated with program participation. Potential annual healthcare savings per CDSMP participant were calculated based on averted emergency room visits and hospitalizations. While national data can be utilized to estimate cost savings, the tool has built-in features allowing users to tailor calculations based on their site-specific data. Building upon the National Study of CDSMP's documented potential savings of $3.3 billion in healthcare costs by reaching 5% of adults with one or more chronic conditions, two heuristic case examples were also explored based on different population projections. The case examples show how a small county and large metropolitan city were not only able to estimate healthcare savings ($38,803 for the small county; $732,290 for the large metropolitan city) for their existing participant populations but also to project significant healthcare savings if they plan to reach higher proportions of middle-aged and older adults. Having a tool to demonstrate the monetary value of CDSMP can contribute to the ongoing dissemination and sustainability of such community-based interventions. Next steps will be creating a user-friendly, internet-based version of Healthcare Cost Savings Estimator Tool: CDSMP, followed by broadening the tool to consider cost savings for other evidence-based programs.
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Affiliation(s)
- SangNam Ahn
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA ; Department of Health Promotion and Community Health Sciences, Texas A&M University Health Science Center, School of Public Health , College Station, TX , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
| | - Mary Altpeter
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
| | - Lindsey Post
- Division of Health Systems Management and Policy, School of Public Health, The University of Memphis , Memphis, TN , USA
| | - Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M University Health Science Center, School of Public Health , College Station, TX , USA
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Kim SH, Youn CH. Efficacy of Chronic Disease Self-management Program in Older Korean Adults with Low and High Health Literacy. Asian Nurs Res (Korean Soc Nurs Sci) 2015; 9:42-6. [DOI: 10.1016/j.anr.2014.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/03/2014] [Accepted: 10/09/2014] [Indexed: 11/25/2022] Open
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Mirza NA, Akhtar-Danesh N, Staples E, Martin L, Noesgaard C. Comparative Analysis of External Validity Reporting in Non-randomized Intervention Studies. Can J Nurs Res 2014; 46:47-64. [PMID: 29509457 DOI: 10.1177/084456211404600405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This article describes a comparative analysis of external validity reporting in non-randomized behavioural and public health intervention studies that used and did not use the TREND (Transparent Reporting of Evaluations with Non-randomized Designs) statement. The search resulted in 14 non-randomized intervention studies that were rated based on Green and Glasgow's criteria for external validity reporting. Studies that used the TREND statement demonstrated improved external validity reporting when compared with studies that did not use the TREND statement. The implication is that the TREND statement and Green and Glasgow's criteria can improve external validity reporting of non-randomized behavioural and public health interventions.
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Affiliation(s)
- Noeman A Mirza
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Forjuoh SN, Ory MG, Jiang L, Vuong AM, Bolin JN. Impact of chronic disease self-management programs on type 2 diabetes management in primary care. World J Diabetes 2014; 5:407-414. [PMID: 24936263 PMCID: PMC4058746 DOI: 10.4239/wjd.v5.i3.407] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/16/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the effectiveness of the Chronic Disease Self-Management Program (CDSMP) on glycated hemoglobin A1c (HbA1c) and selected self-reported measures.
METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls who received usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life (HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.
RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6% (P < 0.0001), but the reductions did not differ significantly between the two groups (P = 0.885). Few significant differences were observed in participants’ diabetes self-care activities. No significant differences were observed in the participants’ HRQOL, pain, or fatigue measures.
CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.
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Aantjes CJ, Ramerman L, Bunders JFG. A systematic review of the literature on self-management interventions and discussion of their potential relevance for people living with HIV in sub-Saharan Africa. PATIENT EDUCATION AND COUNSELING 2014; 95:185-200. [PMID: 24560067 DOI: 10.1016/j.pec.2014.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 01/16/2014] [Accepted: 01/18/2014] [Indexed: 05/06/2023]
Abstract
OBJECTIVE This study systematically reviews the literature on self-management interventions provided by health care teams, community partners, patients and families and discusses the potential relevance of these interventions for people living with HIV in sub-Saharan Africa. METHODS We searched major databases for literature published between 1995 and 2012. 52 studies were included in this review. RESULTS The review found very few studies covering people living with HIV and generally inconclusive evidence to inform the development of chronic care policy and practice in sub-Saharan Africa. CONCLUSION Chronic care models and self-management interventions for sub-Saharan Africa has not been a research priority. Furthermore, the results question the applicability of these models and interventions in sub-Saharan Africa. There is a need for studies to fill this gap in view of the rapidly increasing number of people needing chronic care services in Africa. PRACTICE IMPLICATIONS The established practices for long-term support for HIV patients are still the most valid basis for promoting self-management. This will be the case until there are more studies which assess those practices and their effect on self-management outcomes and other studies which assess the utility and feasibility of applying chronic care models that have been developed in high-income countries.
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Affiliation(s)
- Carolien J Aantjes
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands; ETC Foundation, The Netherlands.
| | - Lotte Ramerman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
| | - Joske F G Bunders
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, The Netherlands
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Enhancing self-efficacy for optimized patient outcomes through the theory of symptom self-management. Cancer Nurs 2013; 36:E16-26. [PMID: 22495550 DOI: 10.1097/ncc.0b013e31824a730a] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND In today's world, greater patient empowerment is imperative because 90 million Americans live with 1 or more chronic conditions such as cancer. Evidence reveals that healthy behaviors such as effective symptom self-management can prevent or reduce much of the suffering from cancer. Oncology nurses play a pivotal role in developing a symptom self-management plan that is critical to optimizing a patient's symptom self-management behaviors. OBJECTIVE This article uses exemplars to describe how oncology nurses can apply a tested middle-range theory, the Theory of Symptom Self-management, to clinical practice by incorporating interventions to increase a patient's perceived self-efficacy to optimize patient outcomes. METHODS The Theory of Symptom Self-management provides a means to understand the dynamic aspects of symptom self-management and provides a tested framework for the development of efficacy-enhancing interventions for use by oncology nurses in clinical practice. RESULTS Exemplars based on the Theory of Symptom Self-management depict how oncology nursing can use perceived self-efficacy-enhancing symptom self-management interventions to improve the functional status and quality of life of their patients. CONCLUSION Guided by a theoretical approach, oncology nurses can have a significant positive impact on the lives of their patients by reducing the symptom burden associated with cancer and its treatment. IMPLICATIONS FOR PRACTICE Oncology nurses can partner with their patients to design tailored approaches to symptom self-management. These tailored approaches provide the ability to implement patient-specific behaviors that recognize, prevent, relieve, or decrease the timing, intensity, distress, concurrence, and unpleasant quality of symptoms.
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Brady TJ, Murphy L, O'Colmain BJ, Beauchesne D, Daniels B, Greenberg M, House M, Chervin D. A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program. Prev Chronic Dis 2013; 10:120112. [PMID: 23327828 PMCID: PMC3547675 DOI: 10.5888/pcd10.120112] [Citation(s) in RCA: 200] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program’s effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. Methods We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. Results Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months Conclusion Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.
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Affiliation(s)
- Teresa J Brady
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Brady TJ, Murphy L, O'Colmain BJ, Beauchesne D, Daniels B, Greenberg M, House M, Chervin D. A meta-analysis of health status, health behaviors, and health care utilization outcomes of the Chronic Disease Self-Management Program. Prev Chronic Dis 2013. [PMID: 23327828 DOI: 10.5888/pcd10.120112.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program's effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. METHODS We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. RESULTS Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months CONCLUSION Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy.
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Affiliation(s)
- Teresa J Brady
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Jaglal SB, Haroun VA, Salbach NM, Hawker G, Voth J, Lou W, Kontos P, Cameron JE, Cockerill R, Bereket T. Increasing access to chronic disease self-management programs in rural and remote communities using telehealth. Telemed J E Health 2013; 19:467-73. [PMID: 23570277 DOI: 10.1089/tmj.2012.0197] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study examined whether a telehealth chronic disease self-management program (CDSMP) would lead to improvements in self-efficacy, health behaviors, and health status for chronically ill adults living in Northern Ontario, Canada. Two telehealth models were used: (1) single site, groups formed by participants at one telehealth site; and (2) multi-site, participants linked from multiple sites to form one telehealth group, as a strategy to increase access to the intervention for individuals living in rural and remote communities. SUBJECTS AND METHODS Two hundred thirteen participants diagnosed with heart disease, stroke, lung disease, or arthritis attended the CDSMP at a preexisting Ontario Telemedicine Network studio from September 2007 to June 2008. The program includes six weekly, peer-facilitated sessions designed to help participants develop important self-management skills to improve their health and quality of life. Baseline and 4-month follow-up surveys were administered to assess self-efficacy beliefs, health behaviors, and health status information. Results were compared between single- and multi-site delivery models. RESULTS Statistically significant improvements from baseline to 4-month follow-up were found for self-efficacy (6.6±1.8 to 7.0±1.8; p<0.001), exercise behavior, cognitive symptom management, communication with physicians, role function, psychological well-being, energy, health distress, and self-rated health. There were no statistically significant differences in outcomes between single- and multi-site groups. CONCLUSIONS Improvements in self-efficacy, health status, and health behaviors were equally effective in single- and multi-site groups. Access to self-management programs could be greatly increased with telehealth using single- and multi-site groups in rural and remote communities.
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Affiliation(s)
- Susan B Jaglal
- Women's College Research Institute, Department of Physical Therapy, University of Toronto, Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario M5G 1V7, Canada.
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Groessl EJ, Ho SB, Asch SM, Stepnowsky CJ, Laurent D, Gifford AL. The hepatitis C self-management program: sustainability of primary outcomes at 1 year. HEALTH EDUCATION & BEHAVIOR 2013; 40:730-40. [PMID: 23445604 DOI: 10.1177/1090198113477112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to liver wellness and improved quality of life. Our objective was to evaluate whether the effects of the HCV self-management program were sustained at the 12-month follow-up assessment. METHODS Veteran Affairs patients with hepatitis C (N = 134; mean age = 54.6 years, 95% male, 41% ethnic minority, 48% homeless in last 5 years) were randomized to either a 6-week self-management workshop or an information-only intervention. The weekly 2-hour self-management sessions were based on a cognitive-behavioral program with hepatitis C-specific modules. Outcomes including hepatitis C knowledge, depression, energy, and health-related quality of life were measured at baseline, 6 weeks, 6 months, and 12 months later. Data were analyzed using repeated measures ANOVA. RESULTS Compared with the information-only group, participants attending the self-management workshop improved more on HCV knowledge (p < .005), SF-36 energy/vitality (p = .016), and the Quality of Well-Being Scale (p = .036). Similar trends were found for SF-36 physical functioning and Center for Epidemiologic Studies Short Depression Scale. CONCLUSION Better outcomes were sustained among self-management participants at the 12-month assessment despite the intervention only lasting 6 weeks. HCV health care providers should consider adding self-management interventions for patients with chronic HCV.
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Drenkard C, Dunlop-Thomas C, Easley K, Bao G, Brady T, Lim SS. Benefits of a self-management program in low-income African-American women with systemic lupus erythematosus: results of a pilot test. Lupus 2012; 21:1586-93. [DOI: 10.1177/0961203312458842] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minorities with systemic lupus erythematosus (SLE) are at high risk of poor disease outcomes and may face challenges in effectively self-managing multiple health problems. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based intervention that improves the health of people with chronic illnesses. Although the CDSMP is offered by organizations throughout the United States and many countries around the world, it has not been tested among SLE patients. We pilot tested the benefits of the CDSMP in low-income African American patients with SLE. CDSMP workshops were delivered to 49 African American women with SLE who received medical care at a public lupus clinic in Atlanta, Georgia, US. We compared pre-post CDSMP changes (from baseline to 4 months after the start of the intervention) in health status, self-efficacy and self-management behaviors using self-reported measures. Additionally, we assessed health care utilization changes using electronic administrative records in the 6-month periods before and after the intervention. We observed significant improvements post-intervention in the SF-36 physical health component summary (mean change = 2.4, p = 0.032); self-efficacy (mean change = 0.5, p = 0.035); and several self-management behaviors: cognitive symptoms management (mean change = 0.3, p = 0.036); communication with physicians (mean change = 0.4, p = 0.01); and treatment adherence (mean change = 0.4, p = 0.01). The median number of outpatient visits decreased from 3 to 1 (p < .0001). The CDSMP is a promising intervention for low-income African Americans with SLE. It is an inexpensive program with growing availability around the world that should be further evaluated as a resource to improve patient-centered outcomes and decrease health service utilization among SLE patients.
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Affiliation(s)
- C Drenkard
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - C Dunlop-Thomas
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - K Easley
- Department of Biostatistics and Bioinformatics, Emory Rollins School of Public Health, Atlanta, GA, USA
| | - G Bao
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - T Brady
- Arthritis Program, Centers for Disease Control and Prevention, Atlanta GA, USA
| | - SS Lim
- Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
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