1
|
Guo S, Liu D, Bi X, Feng Y, Zhang K, Jiang J, Wang Y. Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model. Midwifery 2024; 138:104141. [PMID: 39178483 DOI: 10.1016/j.midw.2024.104141] [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: 02/09/2023] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND Gestational diabetes mellitus is a common complication during pregnancy, and its prevalence rates have increased dramatically in recent years. Treatment of gestational diabetes requires the active self-management, however, this can be challenging. Understanding the barriers and facilitators of adherence to self-management recommendations is essential for designing effective interventions. AIM To identify and synthesize barriers and facilitators to self-management of gestational diabetes reported by pregnant women. METHODS This was a mixed-methods systematic review, including qualitative, quantitative, and mixed-methods studies. A literature search was conducted in four databases (PubMed, Embase, CINAHL, and the Web of Science). Eligible studies explored the barriers and/or facilitators, experiences and/or perceptions to engage in self-management in women with gestational diabetes. The Capability, Opportunity, Motivation, Behaviour model was used to classify barriers and facilitators affecting self-management. RESULTS Thirty-six studies (23 qualitative, 11 quantitative, and 2 mixed-methods) met the inclusion criteria. We identified barriers and facilitators relating to capability (e.g., physical discomforts and constraints; lack of knowledge of GDM and self-management behaviours; forgetfulness), opportunity (e.g., limited education and resources; social support from family, friends, and peer groups; conflict with existing lifestyles or cultural norms), and motivation (e.g., perceived negative consequence of self-management behaviours or not perceived benefits; negative emotion; concern the health of the baby). CONCLUSION In this study, we identified the barriers and facilitators of self-management in women with gestational diabetes, which were explained by relevant theoretical models. Interventions should be developed with full consideration of these findings to ensure that pregnant women have the correct knowledge and confidence to self-manage their complications.
Collapse
Affiliation(s)
- Shujie Guo
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China; Department of Clinical Nursing, School of Nursing, Air Force Medical University, Xi'an, China
| | - Dongmei Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoxuan Bi
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxuan Feng
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Ke Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Jingjing Jiang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
| |
Collapse
|
2
|
Nguyen TNM, Saunders R, Dermody G, Whitehead L. The influence of culture on the health beliefs and health behaviours of older Vietnam-born Australians living with chronic disease. J Adv Nurs 2024; 80:3781-3796. [PMID: 38922977 DOI: 10.1111/jan.16283] [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: 05/23/2023] [Revised: 04/05/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
AIM To explore the health beliefs and health behaviours of older Vietnam-born people living with chronic disease in Western Australia. DESIGN This study was designed as a focused ethnography guided by the interpretative research paradigm and Leininger's Theory of Culture Care. METHODS Data were collected through participant observation and interviews undertaken at participants' homes in Western Australia over 7 months in 2019. Data were analysed using Wolcott's approach for transferring qualitative data, comprising three phases: description, thematic analysis and interpretation. RESULTS This study included 12 participants. The health perspectives and practices of older Vietnam-born Australians significantly reflected the traditional Vietnamese values. These included the stigma towards chronic disease as an inevitable consequence of ageing; self-blame thoughts about chronic disease causations and maintained traditional dietary practices. However, some aspects of their health behaviours such as beliefs and practices in traditional medicine, Western medicine and physical exercise reflected a blended approach combining both Vietnamese-oriented and Westernized-orientated practices. Individual factors were also identified as contributing to chronic disease self-care among participants. CONCLUSION This study emphasizes culture played a significant role in shaping the way that older Vietnam-born Australians believed and behaved while living with chronic conditions. However, it also indicates that culture is not a stationary concept, it evolves gradually and is socially constructed. IMPLICATIONS A better understanding of the health beliefs and practices of older Vietnam-born Australians is expected to contribute to the delivery of culturally safe and effective support for this population. The achievement of culturally safe care requires a systemic approach and collaboration of strategies across sectors. PATIENT AND PUBLIC CONTRIBUTION This study encompassed the contribution of 12 older Vietnam-born Australians who offered the researcher the privilege to enter their world and the staff of social care organization who opened the gate for the researcher to approach participants.
Collapse
Affiliation(s)
- Thi Ngoc Minh Nguyen
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Gordana Dermody
- School of Health Science, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| |
Collapse
|
3
|
Chen Q, Liang C, Zhao Y, Kong J, Zhang H, Yan X, Zhang H. The mediating role of coping styles in illness perception and self-management in patients with obstructive sleep apnea. Sleep Med 2024; 113:349-356. [PMID: 38113617 DOI: 10.1016/j.sleep.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) has become a chronic disease that threatens human health. Self-management in patients with OSA can influence their quality of life, and illness perception and coping styles are relevant facilitators of self-management, but this specific relationship has not been adequately studied. The purpose of this study was to investigate the current status and relationship between illness perception, coping styles, and self-management behaviors in patients with OSA, and how coping styles mediate this relationship. METHODS This is a cross-sectional study. Conducted between September 2022 and March 2023, the study involved patients aged ≥18 years old in two hospitals who were diagnosed with OSA. The survey was conducted using the demographic characteristics questionnaire, the Brief Illness Perception Questionnaire, the Simple Coping Style Questionnaire, and the Self-management Behavior Questionnaire of patients with obstructive sleep apnea. Spearman's correlation analysis was used for correlation analysis and multiple linear regression and structural equation models were used for mediation effect testing. RESULTS There were 282 valid questionnaires, with a 94 % valid response rate. Higher levels of self-management behaviors were associated with low negative illness perceptions, high positive coping, and low negative coping. The study also demonstrated that the mediating effect accounted for 25.65 % (-0.049/-0.191) of the overall effect. CONCLUSION Illness perceptions in OSA patients were negatively related to positive coping styles, positively related to negative coping styles, and negatively related to self-management. This study suggests that coping styles of OSA patients mediate illness perception and self-management.
Collapse
Affiliation(s)
- Qing Chen
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
| | - Chunguang Liang
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
| | - Ying Zhao
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
| | - Jie Kong
- School of Nursing, Jinzhou Medical University, Jinzhou, China.
| | - Hui Zhang
- School of Nursing, Chongqing Medical University, Chongqing, China.
| | - Xiangru Yan
- Jining No.1 People's Hospital, Jining, China.
| | - Huiying Zhang
- Department of Otolaryngology Head & Neck Surgery, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China.
| |
Collapse
|
4
|
Okpako T, Woodward A, Walters K, Davies N, Stevenson F, Nimmons D, Chew-Graham CA, Protheroe J, Armstrong M. Effectiveness of self-management interventions for long-term conditions in people experiencing socio-economic deprivation in high-income countries: a systematic review and meta-analysis. J Public Health (Oxf) 2023; 45:970-1041. [PMID: 37553102 PMCID: PMC10687879 DOI: 10.1093/pubmed/fdad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Long-term conditions (LTCs) are prevalent in socio-economically deprived populations. Self-management interventions can improve health outcomes, but socio-economically deprived groups have lower participation in them, with potentially lower effectiveness. This review explored whether self-management interventions delivered to people experiencing socio-economic deprivation improve outcomes. METHODS We searched databases up to November 2022 for randomized trials. We screened, extracted data and assessed the quality of these studies using Cochrane Risk of Bias 2 (RoB2). We narratively synthesized all studies and performed a meta-analysis on eligible articles. We assessed the certainty of evidence using GRADE for articles included in the meta-analysis. RESULTS The 51 studies included in this review had mixed findings. For the diabetes meta-analysis, there was a statistically significant pooled reduction in haemoglobin A1c (-0.29%). We had moderate certainty in the evidence. Thirty-eight of the study interventions had specific tailoring for socio-economically deprived populations, including adaptions for low literacy and financial incentives. Each intervention had an average of four self-management components. CONCLUSIONS Self-management interventions for socio-economically deprived populations show promise, though more evidence is needed. Our review suggests that the number of self-management components may not be important. With the increasing emphasis on self-management, to avoid exacerbating health inequalities, interventions should include tailoring for socio-economically deprived individuals.
Collapse
Affiliation(s)
- Tosan Okpako
- Research Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Abi Woodward
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | | | | | - Megan Armstrong
- Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| |
Collapse
|
5
|
Baumeister A, Aldin A, Chakraverty D, Hübner C, Adams A, Monsef I, Skoetz N, Kalbe E, Woopen C. Interventions for improving health literacy in migrants. Cochrane Database Syst Rev 2023; 11:CD013303. [PMID: 37963101 PMCID: PMC10645402 DOI: 10.1002/14651858.cd013303.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Health literacy (HL) is a determinant of health and important for autonomous decision-making. Migrants are at high risk for limited HL. Improving HL is important for equitable promotion of migrants' health. OBJECTIVES To assess the effectiveness of interventions for improving HL in migrants. To assess whether female or male migrants respond differently to the identified interventions. SEARCH METHODS We ran electronic searches to 2 February 2022 in CENTRAL, MEDLINE, Embase, PsycInfo and CINAHL. We also searched trial registries. We used a study filter for randomised controlled trials (RCTs) (RCT classifier). SELECTION CRITERIA We included RCTs and cluster-RCTs addressing HL either as a concept or its components (access, understand, appraise, apply health information). DATA COLLECTION AND ANALYSIS We used the methodological procedures recommended by Cochrane and followed the PRISMA-E guidelines. Outcome categories were: a) HL, b) quality of life (QoL), c) knowledge, d) health outcomes, e) health behaviour, f) self-efficacy, g) health service use and h) adverse events. We conducted meta-analysis where possible, and reported the remaining results as a narrative synthesis. MAIN RESULTS We included 28 RCTs and six cluster-RCTs (8249 participants), all conducted in high-income countries. Participants were migrants with a wide range of conditions. All interventions were adapted to culture, language and literacy. We did not find evidence that HL interventions cause harm, but only two studies assessed adverse events (e.g. anxiety). Many studies reported results for short-term assessments (less than six weeks after total programme completion), reported here. For several comparisons, there were also findings at later time points, which are presented in the review text. Compared with no HL intervention (standard care/no intervention) or an unrelated HL intervention (similar intervention but different information topic) Self-management programmes (SMP) probably improve self-efficacy slightly (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.06 to 0.50; 2 studies, 333 participants; moderate certainty). SMP may improve HIV-related HL (understanding (mean difference (MD) 4.25, 95% CI 1.32 to 7.18); recognition of HIV terms (MD 3.32, 95% CI 1.28 to 5.36)) (1 study, 69 participants). SMP may slightly improve health behaviours (3 studies, 514 participants), but may have little or no effect on knowledge (2 studies, 321 participants) or subjective health status (MD 0.38, 95% CI -0.13 to 0.89; 1 study, 69 participants) (low certainty). We are uncertain of the effects of SMP on QoL, health service use or adverse events due to a lack of evidence. HL skills building courses (HLSBC) may improve knowledge (MD 10.87, 95% CI 5.69 to 16.06; 2 studies, 111 participants) and any generic HL (SMD 0.48, 95% CI 0.20 to 0.75; 2 studies, 229 participants), but may have little or no effect on depression literacy (MD 0.17, 95% CI -1.28 to 1.62) or any health behaviour (2 studies, 229 participants) (low certainty). We are uncertain if HLSBC improve QoL, health outcomes, health service use, self-efficacy or adverse events, due to very low-certainty or a lack of evidence. Audio-/visual education without personal feedback (AVE) probably improves depression literacy (MD 8.62, 95% CI 7.51 to 9.73; 1 study, 202 participants) and health service use (MD -0.59, 95% CI -1.11 to -0.07; 1 study, 157 participants), but probably has little or no effect on health behaviour (risk ratio (RR) 1.07, 95% CI 0.91 to 1.25; 1 study, 135 participants) (moderate certainty). AVE may improve self-efficacy (MD 3.51, 95% CI 2.53 to 4.49; 1 study, 133 participants) and may slightly improve knowledge (MD 8.44, 95% CI -2.56 to 19.44; 2 studies, 293 participants) and intention to seek depression treatment (MD 1.8, 95% CI 0.43 to 3.17), with little or no effect on depression (SMD -0.15, 95% CI -0.40 to 0.10) (low certainty). No evidence was found for QoL and adverse events. Adapted medical instruction may improve understanding of health information (3 studies, 478 participants), with little or no effect on medication adherence (MD 0.5, 95% CI -0.1 to 1.1; 1 study, 200 participants) (low certainty). No evidence was found for QoL, health outcomes, knowledge, health service use, self-efficacy or adverse events. Compared with written information on the same topic SMP probably improves health numeracy slightly (MD 0.7, 95% CI 0.15 to 1.25) and probably improves print literacy (MD 9, 95% CI 2.9 to 15.1; 1 study, 209 participants) and self-efficacy (SMD 0.47, 95% CI 0.3 to 0.64; 4 studies, 552 participants) (moderate certainty). SMP may improve any disease-specific HL (SMD 0.67, 95% CI 0.27 to 1.07; 4 studies, 955 participants), knowledge (MD 11.45, 95% CI 4.75 to 18.15; 6 studies, 1101 participants) and some health behaviours (4 studies, 797 participants), with little or no effect on health information appraisal (MD 1.15, 95% CI -0.23 to 2.53; 1 study, 329 participants) (low certainty). We are uncertain whether SMP improves QoL, health outcomes, health service use or adverse events, due to a lack of evidence or low/very low-certainty evidence. AVE probably has little or no effect on diabetes HL (MD 2, 95% CI -0.15 to 4.15; 1 study, 240 participants), but probably improves information appraisal (MD -9.88, 95% CI -12.87 to -6.89) and application (RR 1.51, 95% CI 1.29 to 1.77) (1 study, 608 participants; moderate certainty). AVE may slightly improve knowledge (MD 8.35, 95% CI -0.32 to 17.02; low certainty). No short-term evidence was found for QoL, depression, health behaviour, self-efficacy, health service use or adverse events. AVE compared with another AVE We are uncertain whether narrative videos are superior to factual knowledge videos as the evidence is of very low certainty. Gender differences Female migrants' diabetes HL may improve slightly more than that of males, when receiving AVE (MD 5.00, 95% CI 0.62 to 9.38; 1 study, 118 participants), but we do not know whether female or male migrants benefit differently from other interventions due to very low-certainty or a lack of evidence. AUTHORS' CONCLUSIONS Adequately powered studies measuring long-term effects (more than six months) of HL interventions in female and male migrants are needed, using well-validated tools and representing various healthcare systems.
Collapse
Affiliation(s)
- Annika Baumeister
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Angela Aldin
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Digo Chakraverty
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Constanze Hübner
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| | - Anne Adams
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christiane Woopen
- Center for Life Ethics/Hertz Chair TRA 4, University of Bonn, Bonn, Germany
| |
Collapse
|
6
|
Korenhof SA, Rouwet EV, Elstgeest LEM, Fierloos IN, Tan SS, Pisano-Gonzalez MM, Boone ALD, Pers YM, Pilotto A, López-Ventoso M, Diez Valcarce I, Zhang X, Raat H. The effect of a community-based group intervention on chronic disease self-management in a vulnerable population. Front Public Health 2023; 11:1221675. [PMID: 37670825 PMCID: PMC10475542 DOI: 10.3389/fpubh.2023.1221675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Chronic non-communicable diseases (NCDs) are predominantly related to modifiable health behaviors and account for 74% of global deaths at present. Behavior modification through self-management is a strategy to prevent NCDs. Chronic Disease Self-Management Programs (CDSMPs) have demonstrated improvements in health behaviors, health status, and use of healthcare. Objective We evaluated the effects of a 6-week CDSMP on self-efficacy, health behaviors, mental health, health-related quality of life (HR-QoL), and health responsibilities among vulnerable populations with chronic disease in Europe. Methods A prospective cohort study with a 6-month pre-post single-group design was conducted in five European countries. The intervention targeted adults with chronic conditions and low socioeconomic status, as well as their caregivers. The intervention was a 6-week community-based CDSMP in a group setting. Outcomes were measured per self-report questionnaire at baseline and 6-month follow-up: self-efficacy, health behaviors, mental health, HR-QoL, and health responsibilities. Results Of 1,844 participants, 1,248 (67.7%) completed follow-up and attended ≥4 sessions. For the chronic condition group, the following outcome measures at follow-up significantly improved compared with baseline (all P < 0.002): self-efficacy (SEMCD-6 6.7 vs. 6.4), mental health (PHQ-8 6.3 vs. 7.0), HR-QoL (SF-12 PCS 42.3 vs. 40.2, SF-12 MCS 42.8 vs. 41.4), health utility (EQ-5D-5L 0.88 vs. 0.86), self-rated health (EQ-5D-5L 67.2 vs. 63.9), communication with healthcare providers (2.28 vs. 2.11), understanding information (3.10 vs. 3.02), number of doctor visits (3.61 vs. 4.97), accident and emergency department visits (0.25 vs. 0.48), total nights in a hospital (0.65 vs. 1.13), and perceived medical errors (19.6 vs. 28.7%). No significant changes were detected in dietary habits, physical activity, substance use, and sleep and fatigue. For caregivers without a chronic condition, only doctor visits significantly decreased (1.54 vs. 2.25, P < 0.001). Discussion This CDSMP was associated with improvement in self-efficacy, depression, HR-QoL, and health responsibilities over 6 months in a diverse European population with a chronic condition. However, additional interventions targeting lifestyle risk factors are needed to improve health outcomes.
Collapse
Affiliation(s)
- Sophie A. Korenhof
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ellen V. Rouwet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Liset E. M. Elstgeest
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Reinier Academy, Reinier de Graaf Hospital, Delft, Netherlands
| | - Irene N. Fierloos
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Research Group City Dynamics, InHolland University of Applied Sciences, Rotterdam, Netherlands
| | - Marta M. Pisano-Gonzalez
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - An L. D. Boone
- Public Health General Directorate, Ministry of Health of the Principality of Asturias, Oviedo, Spain
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, Montpellier, France
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Mónica López-Ventoso
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - Isabel Diez Valcarce
- Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), General Directorate of Care, Ministry of Health, Oviedo, Spain
| | - Xuxi Zhang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | | | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| |
Collapse
|
7
|
Liu Q, Jin Y, Wang Y, Feng J, Qiao X, Ji L, Si H, Bian Y, Wang W, Yu J, Wang C. Association between self-efficacy and self-management behaviours among individuals at high risk for stroke: Social support acting as a mediator. J Clin Nurs 2023; 32:71-82. [PMID: 34981582 DOI: 10.1111/jocn.16191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To explore the association between self-efficacy and self-management by modelling three types of social support as mediators among stroke high-risk populations. BACKGROUND Self-efficacy and social support (i.e. objective support, subjective support and support utilisation) are important for self-management among stroke high-risk populations. Self-efficacy activates three types of social support, and the effect of social support on self-management varies by types among chronic patients. Therefore, social support may act as a mediator between self-efficacy and self-management, and the mediating role may vary by types of social support. Disentangling the role of these different types of social support can guide tailored interventions. DESIGN A cross-sectional study. METHODS This study was conducted among 448 Chinese adults at high risk for stroke. Self-efficacy, self-management and social support were assessed using the Self-Efficacy Scale, the Stroke Self-management Scale and the Social Support Rating Scale respectively. The PROCESS SPSS Macro version 3.3, model 4 was used to explore the mediating role of different types of social support in the relationship between self-efficacy and self-management. This study followed STROBE checklist for cross-sectional studies (Appendix S1). RESULTS Self-efficacy improved three types of social support, and subjective support and support utilisation promoted self-management, but objective support hindered self-management. The specific indirect effect of objective support and subjective support was significant but not that of support utilisation. Objective support, subjective support and support utilisation attenuated the total effect of self-efficacy on self-management by -23.8%, 23.8% and 7.7% respectively. CONCLUSIONS Mediating effect of social support in the relationship between self-efficacy and self-management varies by type, and the positive effect of subjective support is offset by the detrimental effect of objective support. RELEVANCE TO CLINICAL PRACTICE Among stroke high-risk populations, interventions should target objective support and subjective support as well as self-efficacy to efficiently improve their self-management.
Collapse
Affiliation(s)
- Qinqin Liu
- School of Nursing, Peking University, Beijing, China
| | - Yaru Jin
- School of Nursing, Peking University, Beijing, China
| | - Ying Wang
- Liaocheng People's Hospital, Liaocheng, China
| | | | - Xiaoxia Qiao
- School of Nursing, Peking University, Beijing, China
| | - Lili Ji
- School of Nursing, Peking University, Beijing, China
| | - Huaxin Si
- School of Nursing, Peking University, Beijing, China
| | - Yanhui Bian
- School of Nursing, Peking University, Beijing, China
| | - Wenyu Wang
- School of Nursing, Peking University, Beijing, China
| | - Jiaqi Yu
- School of Nursing, Peking University, Beijing, China
| | - Cuili Wang
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
8
|
Yu H, Gao Y, Tong T, Liang C, Zhang H, Yan X, Wang L, Zhang H, Dai H, Tong H. Self-management behavior, associated factors and its relationship with social support and health literacy in patients with obstructive sleep apnea–hypopnea syndrome. BMC Pulm Med 2022; 22:352. [PMID: 36115966 PMCID: PMC9482733 DOI: 10.1186/s12890-022-02153-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background The proportion of patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) is increasing year by year in China, which has become a major public health problem. Self-management of OSAHS and multiple support from caregivers are key to low hospital admissions and high quality of life for patients with OSAHS. Social support and health literacy are the main promoters of self-management behavior. However, their contributions have not been adequately studied. The purpose of this study is to investigate the level of self-management among patients with OSAHS and its relationship with general demographics, social support, and health literacy. Methods A total of 280 patients with OSAHS treated in two Classiii Grade A hospitals in Jinzhou City, Liaoning Province from October 2020 to July 2021 were selected as the study subjects. Patients were investigated by General Characteristics Questionnaire, Social Support Rating Scale (SSRS), Health Literacy Scale for Chronic Patients (HLSCP), and OSAHS Self-management Behavior Questionnaire, and the influencing factors of self-management of patients with OSAHS were analyzed. Results The average score of OSAHS self-management was 74.49(SD = 8.06), SSRS and HLSCP scores were positively correlated with total scores of self-management behavior. Furthermore, we found that disease duration, SSRS, and HLSCP scores were the main predictors of self-management behavior (R2 = 0.390, P < 0.001). Conclusion This study found that OSAHS patients with a longer duration of disease and higher SSRS or HLSCP scores also had higher levels of self-management. The factors discussed in this study may be helpful in developing individualized interventions in self-management for patients with OSAHS.
Collapse
|
9
|
Altun A, Brown H, Sturgiss L, Russell G. Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:1152-1169. [PMID: 34483005 DOI: 10.1016/j.pec.2021.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/09/2021] [Accepted: 08/22/2021] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Many studies investigating the management of chronic pain often exclude participation of people from refugee and immigrant backgrounds. This review seeks to understand and evaluate the effectiveness of interventions for chronic pain management when applied in the context of refugee and immigrant populations. METHODS A systematic review was undertaken using six databases and the PICO search strategy. Included studies were published in English, comprised of patients over 18 years of age and excluded cancer-related chronic pain. RESULTS Twenty-one papers met the inclusion criteria: 13 cohort studies and eight randomised control trials. The majority of interventions involved multidisciplinary or psychological interventions, with the remaining studies based on education, exercise therapy or culturally adapted information. Studies integrating multidisciplinary care to manage chronic pain showed more consistent improvements in pain intensity and function than other unimodal interventions. CONCLUSIONS Multidisciplinary interventions reduce pain intensity, improve functional impairment, and alleviate other psychosocial symptoms exhibited chronic pain patients from refugee or immigrant backgrounds. Additional well-designed, large-scale studies are needed to decisively estimate the effectiveness of culturally adapted, multidisciplinary intervention programs over time. PRACTICE IMPLICATIONS Clinical practice may benefit from adapting interventions to better support the management of chronic pain in refugee and immigrant populations.
Collapse
Affiliation(s)
- Areni Altun
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
| | - Helen Brown
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Liz Sturgiss
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
10
|
Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
Collapse
Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|
11
|
Morsch P, Pelaez M, Vega E, Hommes C, Lorig K. Evidence-based programs for older persons in the Americas. Rev Panam Salud Publica 2021; 45:e91. [PMID: 34475886 PMCID: PMC8369133 DOI: 10.26633/rpsp.2021.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022] Open
Abstract
In the current context of the aging of populations and the increase in multiple chronic conditions and dependence, it is important that health systems provide opportunities to improve capacities of older adults to enable healthy aging. Opportunities to enhance older adults’ abilities, including self-management, can be offered through evidence-based programs. Such programs have been proven effective in improving individuals’ symptoms and quality of life, often lowering health-care costs. Self-management evidence-based programs can foster the development of personal skills, increase confidence and motivation on self-care, and help individuals to make better decisions about their own health. This special report describes the implementation history of a self-management program in the Region of the Americas, and the barriers to and facilitators of implementation that can serve as examples for evidence-based program dissemination in the Region.
Collapse
Affiliation(s)
- Patricia Morsch
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Martha Pelaez
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Enrique Vega
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Carolina Hommes
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Kate Lorig
- Self-Management Resource Center, Aptos Calif. United States of America Self-Management Resource Center, Aptos, Calif., United States of America
| |
Collapse
|
12
|
Lambert S, Schaffler JL, Ould Brahim L, Belzile E, Laizner AM, Folch N, Rosenberg E, Maheu C, Ciofani L, Dubois S, Gélinas-Phaneuf E, Drouin S, Leung K, Tremblay S, Clayberg K, Ciampi A. The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1608-1635. [PMID: 33573916 DOI: 10.1016/j.pec.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review the effectiveness of health education interventions adapted for culturally and linguistically diverse (CALD) populations with a chronic illness. METHODS A systematic review and meta-analysis were conducted. Eligible studies were identified across six databases. Data were extracted and intervention effect was summarized using standardized mean difference. If there were insufficient data for meta-analysis, a descriptive summary was included. Modifying effects of intervention format, length, intensity, provider, self-management skills taught, and behavioral change techniques (BCTs) utilized were examined. RESULTS 58 studies were reviewed and data were extracted for 36 outcomes. Most interventions used multiple modes of delivery and were facilitated by bilingual health care professionals (HCPs). On average, interventions included 5.19 self-management skills and 4.82 BCTs. Interventions were effective in reducing BMI, cholesterol, triglycerides, blood glucose, HbA1C, and depression, and in increasing knowledge. Effectiveness was influenced partly by provider, with HCPs favored over lay providers or paraprofessionals in increasing knowledge; however, the opposite was noted for HbA1c. CONCLUSIONS Health education interventions are effective among CALD populations, particularly at improving objective, distal outcomes (e.g., anthropometric measures). These interventions may be equally effective in improving proximal patient-reported outcomes (PROs); however, diversity in PROs limited analyses. PRACTICE IMPLICATIONS Core outcome sets (COS) are needed to further investigate and compare health education intervention effectiveness on PROs.
Collapse
Affiliation(s)
- Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada.
| | | | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| | | | | | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Luisa Ciofani
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | | | - Susan Drouin
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Antonio Ciampi
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| |
Collapse
|
13
|
Harandi TF, Mahmoodi Z, Ghavidel N, Sharifipour Z. Factors affecting self-management in Iranian tuberculosis patients: A path analysis model. ACTA ACUST UNITED AC 2021; 57:73-78. [PMID: 34212074 PMCID: PMC8221375 DOI: 10.29390/cjrt-2021-009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Self-management behaviors can reduce the progression of an illness. Although various factors affect self-management, no study has been conducted on the self-management of tuberculosis (TB) through path analysis. Objectives This study evaluated the factors affecting self-management in TB patients using path analysis. Methods A cross-sectional study was done on 133 non-prisoner TB patients that referred to all health centers in Karaj, Iran, in 2017. A structured questionnaire was applied. Data were analyzed with SPSS-17 and Lisrel 8.8, utilizing statistical path analysis to evaluate the relationships between self-management and its related factors. Results Overall, 52.3% of the participants in the study were female and 47.7% were male. Respondents of were 46.9% smear-positive, 9.4% smear-negative, and 43.8% extra-pulmonary TB. Fit indices confirmed the model fitness and logical relationships between the variables according to the conceptual model (χ2 = 49.80, df = 25). The final path model showed that age (β = 0.84), attitude (β = 0.10), marital status (β = 0.04), and house condition (β = 0.03) impact self-management through the direct path. Knowledge (β = 0.83) and education (β = 0.16) affect self-management through both direct and indirect paths. Education indirectly affects self-management through both knowledge and attitude. Knowledge indirectly impacts self-management through attitude. In other words, knowledge and attitude mediate the relationship between some factors and self-management. Conclusions This study provided an empirical model that illustrates the relationships between self-management and related factors in TB patients. The knowledge can be the target of interventions in support of self-management.
Collapse
Affiliation(s)
- Tayebeh Fasihi Harandi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.,Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nooshin Ghavidel
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zhila Sharifipour
- Department of Health Education and Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Angwenyi V, Bunders‐Aelen J, Criel B, Lazarus JV, Aantjes C. An evaluation of self-management outcomes among chronic care patients in community home-based care programmes in rural Malawi: A 12-month follow-up study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:353-368. [PMID: 32671938 PMCID: PMC7983972 DOI: 10.1111/hsc.13094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/02/2020] [Accepted: 06/12/2020] [Indexed: 05/08/2023]
Abstract
This paper investigates the impact of community home-based care (CHBC) on self-management outcomes for chronically ill patients in rural Malawi. A pre- and post-evaluation survey was administered among 140 chronically ill patients with HIV and non-communicable diseases, newly enrolled in four CHBC programmes. We translated, adapted and administered scales from the Stanford Chronic Disease Self-Management Programme to evaluate patient's self-management outcomes (health status and self-efficacy), at four time points over a 12-month period, between April 2016 and May 2017. The patient's drop-out rate was approximately 8%. Data analysis included descriptive statistics, tests of associations, correlations and pairwise comparison of outcome variables between time points, and multivariate regression analysis to explore factors associated with changes in self-efficacy following CHBC interventions. The results indicate a reduction in patient-reported pain, fatigue and illness intrusiveness, while improvements in general health status and quality of life were not statistically significant. At baseline, the self-efficacy mean was 5.91, which dropped to 5.1 after 12 months. Factors associated with this change included marital status, education, employment and were condition-related; whereby self-efficacy for non-HIV and multimorbid patients was much lower. The odds for self-efficacy improvement were lower for patients with diagnosed conditions of longer duration. CHBC programme support, regularity of contact and proximal location to other services influenced self-efficacy. Programmes maintaining regular home visits had higher patient satisfaction levels. Our findings suggest that there were differential changes in self-management outcomes following CHBC interventions. While self-management support through CHBC programmes was evident, CHBC providers require continuous training, supervision and sustainable funding to strengthen their contribution. Furthermore, sociodemographic and condition-related factors should inform the design of future interventions to optimise outcomes. This study provides a systematic evaluation of self-management outcomes for a heterogeneous chronically ill patient population and highlights the potential and relevant contribution of CHBC programmes in improving chronic care within sub-Saharan Africa.
Collapse
Affiliation(s)
- Vibian Angwenyi
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFaculty of SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
- Unit of Equity and HealthDepartment of Public HealthInstitute of Tropical MedicineAntwerpBelgium
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Joske Bunders‐Aelen
- Athena Institute for Research on Innovation and Communication in Health and Life SciencesFaculty of SciencesVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Bart Criel
- Unit of Equity and HealthDepartment of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal)Hospital ClínicUniversity of BarcelonaBarcelonaSpain
| | - Carolien Aantjes
- Health Economics and HIV/AIDS Research Division (HEARD)University of KwaZulu‐NatalDurbanSouth Africa
| |
Collapse
|
15
|
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
| | | |
Collapse
|
16
|
Molton IR, Ordway A. Aging With Disability: Populations, Programs, and the New Paradigm An Introduction to the Special Issue. J Aging Health 2020; 31:3S-20S. [PMID: 31718415 DOI: 10.1177/0898264319880120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: The purpose of this article is to introduce a special issue dedicated to research at the intersection of aging and disability. Method: We provide some context for the importance of cross-disciplinary collaboration among aging and disability researchers and summarize the nine articles in this issue. Results: Articles in the special issue are centered around several overarching themes. These include meaningful social and community participation, goals and values in the context of disability, and the reach and effectiveness of programs and policies on rehabilitation and service utilization. Conclusion: As care models continue to merge aging and disability services, collaboration among traditional aging and disability research networks can lead to improved outcomes for adults aging with long-term disability.
Collapse
|
17
|
Levesque JV, Gerges M, Girgis A. Psychosocial Experiences, Challenges, and Coping Strategies of Chinese-Australian Women with Breast Cancer. Asia Pac J Oncol Nurs 2020; 7:141-150. [PMID: 32478131 PMCID: PMC7233569 DOI: 10.4103/apjon.apjon_53_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/03/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Chinese migrant women with breast cancer are at risk of poorer psychosocial outcomes. However, little is known about the cancer-related challenges experienced by these women, or how they self-manage their concerns. This qualitative study aims to explore the experience of breast cancer for Chinese-Australian women and gain insight into their coping behaviors. METHODS Twenty-four Chinese-Australian women, previously diagnosed with breast cancer, participated in a semi-structured interview or focus group session, conducted in the participant's preferred language. Qualitative data were subjected to thematic analysis. RESULTS Three main themes emerged, reflecting the psychological impact of the diagnosis, the challenges experienced, and the use of social support and other coping behaviors. The theme of psychological impact highlighted the emotional toll of diagnosis and the ongoing anxiety surrounding the fear of cancer recurrence. The theme of challenges identified stressors relating to treatment side effects and the need for psychological support. The social support and coping theme identified the various levels of social support participants received and how Chinese-Australian women may limit their use of social support to protect others. Participants used several behavioral (e.g., diet and exercise) and cognitive (e.g., reframing) strategies to cope with their cancer experience. CONCLUSIONS Chinese-Australian women with breast cancer face significant challenges that impact on their psychological well-being. Varying levels of social support, and the desire to protect others through self-sacrifice, may reflect the cultural expectations of women. The results highlight the need for cultural understanding when developing strategies that optimally support Chinese migrant women with breast cancer.
Collapse
Affiliation(s)
- Janelle V. Levesque
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Centre for Oncology Education and Research Translation, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| |
Collapse
|
18
|
Exploring Pain Management Among Asian Immigrants with Chronic Pain: Self-Management and Resilience. J Immigr Minor Health 2020; 21:1123-1136. [PMID: 30182206 DOI: 10.1007/s10903-018-0820-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Asians immigrants (AIs) are one of the fastest growing racial groups in many countries globally. Despite pain prevalence, studies on chronic pain management among AIs is limited in the literature. An integrative review was conducted exploring the current state of science on chronic pain management among AIs. Several databases were used to identify related articles and 15 studies met the inclusion criteria. Two major themes emerged: (a) self-management, pertaining to how AIs take responsibility for their pain, and (b) resilience, their adaptive behaviors indicating low levels of pain-related dysfunction and burden despite chronic pain severity. Resilience plays a significant role in the mechanism by which self-management works in pain among AIs. Chronic pain management is a complex process where challenges to effective treatments exist. Findings have significant implications to healthcare providers and the general pain population. Future research directions include the necessity for increased participation of AIs in studies.
Collapse
|
19
|
Danet Danet A, Prieto Rodríguez MÁ, Toro Cárdenas SM, Garrido Peña F, Escudero Carretero MJ, March Cerdà JC. [Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors]. Aten Primaria 2020; 52:112-121. [PMID: 30982640 PMCID: PMC7025955 DOI: 10.1016/j.aprim.2018.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/13/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT Andalusia. PARTICIPANTS Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS Peer-training intervention for self-efficacy for chronic patients. MAIN MEASUREMENT Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations.
Collapse
Affiliation(s)
- Alina Danet Danet
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España.
| | - María Ángeles Prieto Rodríguez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Silvia María Toro Cárdenas
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | | | - María José Escudero Carretero
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Joan Carles March Cerdà
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Park MJ, Green J, Jung HS, Park YS. Trajectories of change after a health-education program in Japan: decay of impact in anxiety, depression, and patient-physician communication. PeerJ 2019; 7:e7229. [PMID: 31341730 PMCID: PMC6637923 DOI: 10.7717/peerj.7229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background Health education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be “diluted.” Methods To test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression. Results Growth-mixture modeling revealed two trajectories—two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication. Conclusions These results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect “dilution” of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.
Collapse
Affiliation(s)
- Min Jeong Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea.,Department of Health Communication, University of Tokyo, Tokyo, Japan
| | - Joseph Green
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hun Sik Jung
- College of Global Business, Konyang University, Nonsan, South Korea
| | - Yoon Soo Park
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
22
|
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.
Collapse
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Brady B, Veljanova I, Schabrun S, Chipchase L. Integrating culturally informed approaches into physiotherapy assessment and treatment of chronic pain: a pilot randomised controlled trial. BMJ Open 2018; 8:e021999. [PMID: 29980547 PMCID: PMC6042550 DOI: 10.1136/bmjopen-2018-021999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To evaluate patient engagement with, and the feasibility of, a novel, culturally adapted physiotherapy pain management approach. DESIGN A participant-blinded and assessor-blinded pilot randomised controlled trial. SETTING Outpatient physiotherapy departments at two public hospitals and one district pain clinic. PARTICIPANTS Adults (n=48) with chronic musculoskeletal pain (daily pain >3 months), who self-identified as Mandaean, Assyrian or Vietnamese, were randomised to one of two physiotherapy treatment conditions. INTERVENTIONS 24 participants underwent combined group and individualised treatment described as 'culturally adapted physiotherapy', while 24 underwent evidence-informed 'usual physiotherapy care'. Both treatment arms consisted of up to 10 sessions over a 3-month period. OUTCOME MEASURES Patient engagement was measured via participant attendance, adherence and satisfaction data. Secondary outcomes included clinical measures of pain severity, interference and suffering, physical function and negative emotional state. RESULTS 96% of participants undergoing culturally adapted physiotherapy completed treatment, compared with 58% of the usual physiotherapy group. For the culturally adapted group attendance (87%±18%) and adherence (68%±32%) were higher relative to usual care (68%±32% and 55%±43%). Satisfaction was similar for the culturally adapted (82.7%±13.4%) and usual care (79.3±17.3) groups. For secondary outcomes, a significant between-group effect for pain-related suffering in favour of the culturally adapted group was observed with a medium effect size (partial η2 0.086, mean 3.56, 95% CI 0.11 to 7), while results for pain severity, interference, physical function and negative emotional state were similar. CONCLUSIONS Aligning treatment with the beliefs and values of culturally and linguistically diverse communities enhances patient engagement with physiotherapy. These results support the feasibility of a larger, multisite trial to determine if improved engagement with culturally adapted physiotherapy translates to improved clinical outcomes. TRIAL REGISTRATION NUMBER ACTRN12616000857404; Pre-results.
Collapse
Affiliation(s)
- Bernadette Brady
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
- Departments of Pain Medicine and Physiotherapy, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Irena Veljanova
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Siobhan Schabrun
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Lucinda Chipchase
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Danet A, Rodríguez MÁP, Peña FG, Doblas ML, Martín NL, Cerdà JCM. Chronicity and use of health services: peer education of the School of Patients. Rev Esc Enferm USP 2017; 51:e03280. [PMID: 29267742 DOI: 10.1590/s1980-220x2017004203280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/17/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the training strategy of the Escuela de Pacientes (School of Patients) on the use of health services among people with chronic diseases. METHOD Quantitative design study of pretest and posttest evaluation with a population of 3,350 chronic patients of the Escuela de Pacientes (Andalusia, 2013-2015). A questionnaire adapted from the Stanford University was used. It measured the self-perceived health, number of health visits, and level of trust and communication with health personnel. A descriptive and bivariate study, a correlation study and a pretest/posttest net gain analysis were performed. RESULTS Participation of 964 patients (28.8% of the population), of which 18.8% were men, mean age 56 years. Training increased trust in Primary Care (PC) and Hospital Care (HC) professionals (0.44 and 0.65 points), medical visits decreased by 25%, and hospital admissions fell by 51% with statistically significant differences by sex and disease. The correlation index between trust in professionals and use of health services was -0.215. CONCLUSION The training strategy had a positive impact on the use of health services and trust in health professionals, and were identified areas of improvement from which recommendations are established.
Collapse
Affiliation(s)
- Alina Danet
- Ciber Epidemiología y Salud Pública, Madrid, España.,Escuela Andaluza de Salud Pública, Granada, España.,Instituto de Investigación Biosanitaria de Granada, España
| | - María Ángeles Prieto Rodríguez
- Ciber Epidemiología y Salud Pública, Madrid, España.,Escuela Andaluza de Salud Pública, Granada, España.,Instituto de Investigación Biosanitaria de Granada, España
| | | | - Manuela López Doblas
- Escuela Andaluza de Salud Pública, Granada, España.,Instituto de Investigación Biosanitaria de Granada, España
| | - Nuria Luque Martín
- Escuela Andaluza de Salud Pública, Granada, España.,Instituto de Investigación Biosanitaria de Granada, España
| | - Joan Carles March Cerdà
- Ciber Epidemiología y Salud Pública, Madrid, España.,Escuela Andaluza de Salud Pública, Granada, España.,Instituto de Investigación Biosanitaria de Granada, España
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Cancer survivors’ perspectives on adjustment-focused self-management interventions: a qualitative meta-synthesis. J Cancer Surviv 2016; 10:1012-1034. [DOI: 10.1007/s11764-016-0546-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
|
28
|
How older adults would like falls prevention information delivered: fresh insights from a World Café forum. AGEING & SOCIETY 2016. [DOI: 10.1017/s0144686x16000192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTTranslation of falls prevention evidence into practice is problematic. Understanding older adults’ views about falls prevention information could enhance delivery of falls prevention, resulting in better engagement and uptake of recommended activities. The aim of this study was to examine the views and preferences of community-dwelling older adults about seeking and receiving falls prevention information. A community forum using a modified World Café approach was conducted. Participants discussed five topic areas in small groups, under the guidance of table facilitators. Perspectives were captured on paper. Thematic analysis was conducted to identify factors that influence participants’ engagement and uptake of information. Seventy-three older adults participated in the forum covering wide-ranging preferences around falls prevention information. Personal experience was considered the key influence on an older adult's decision to initiate seeking information. While health professionals were often approached, alternative sources such as public libraries, peer educators and seniors’ organisations were also favoured as credible sources of information. Older adults proposed falls prevention information should be delivered with a positive tone, coupled with highly valued qualities of respect, empathy and time to listen to foster motivation to engage in recommended activities. Consumer-focused practical strategies were proposed to potentially improve future design, communication and dissemination of falls prevention information. This improvement could enhance engagement of messages and subsequent uptake of falls prevention recommended strategies.
Collapse
|
29
|
Danet A, Prieto Rodríguez MÁ, Gamboa Moreno E, Ochoa de Retana Garcia L, March Cerdà JC. [Peer training for patients with diabetes mellitus 2. A quantitative and qualitative evaluation in the Basque Country and Andalusia]. Aten Primaria 2016; 48:507-517. [PMID: 26970914 PMCID: PMC6877786 DOI: 10.1016/j.aprim.2015.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/30/2015] [Accepted: 10/13/2015] [Indexed: 11/10/2022] Open
Abstract
Objetivo Evaluar la estrategia formativa entre iguales para pacientes con diabetes mellitus tipo 2 de los programas «Paciente Activo» (País Vasco) y «Escuela de Pacientes» (Andalucía). Diseño Diseño mixto cuantitativo/cualitativo de evaluación pre/post de los programas de formación llevado a cabo entre 2012 y 2014. Emplazamiento País Vasco y Andalucía. Participantes Un total de 409 pacientes y pacientes-formadores, participantes en la formación entre iguales. Muestreo intencional de 44 pacientes para el estudio cualitativo. Método Análisis estadístico bivariante y ganancias netas de las variables comunes de cuestionarios pre/post del País Vasco y Andalucía: salud autopercibida, actividades diarias, ejercicio físico, uso de servicios sanitarios y autocuidados. Análisis de contenido de 8 grupos focales con pacientes y pacientes-formadores, incluyendo: codificación, árbol de categorías y triangulación de resultados. Resultados La formación entre iguales incide positivamente en la realización de ejercicio físico, uso de recursos sanitarios y autoeficacia en los cuidados, con diferencias por género en algunas dimensiones. La formación se valora positivamente en cuanto que: favorece la relación de los/las pacientes con el personal sanitario, genera apoyo grupal y autoconfianza y facilita la gestión emocional. Las áreas de mejora identificadas son: acceso y continuidad de la formación, y aceptación y apoyo por parte del personal y las instituciones sanitarias. Conclusiones Los beneficios en salud y calidad de vida promovidos a través de la formación entre iguales requiere la colaboración de las instituciones y personal sanitario, que deben facilitar el acceso, la continuidad y la adecuación de los contenidos a las necesidades y expectativas de los/las pacientes.
Collapse
Affiliation(s)
- Alina Danet
- Ciber Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, España.
| | - María Ángeles Prieto Rodríguez
- Ciber Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, España; Escuela Andaluza de Salud Pública, Granada, España
| | | | | | - Joan Carles March Cerdà
- Ciber Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, España; Escuela Andaluza de Salud Pública, Granada, España
| |
Collapse
|
30
|
Ko D, Lee I, Muehrer RJ. Informational needs of liver transplant recipients during a two-year posttransplant period. Chronic Illn 2016; 12:29-40. [PMID: 26289361 PMCID: PMC5027924 DOI: 10.1177/1742395315601415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/08/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To describe the informational needs of liver transplant (LTx) recipients, examine potential differences in informational needs by sociodemographic and clinical variables, and examine informational needs at various time points posttransplant. METHODS A descriptive, cross-sectional design was used. Informational needs were assessed by the Informational Needs Questionnaire-liver, a new questionnaire developed to include LTx recipients' perspectives. To examine informational needs at different posttransplant time points, participants were classified into four groups (0-1, 2-4, 5-9, and 10-24 months). RESULTS Participants (159) who were married, single, had higher education, or higher monthly incomes had significantly greater informational needs. Informational needs regarding disease and physical and emotional management remained high after transplant. Four subscales (medication, wound management, diet, and daily and social activities) indicated informational needs were different across time. Participants 2-4 months posttransplant had higher informational needs regarding wound management and daily and social activities. Participants 5-9 months posttransplant had the highest informational needs regarding medication and diet. DISCUSSION Findings indicate informational needs vary among LTx recipients at different posttransplant time points. Marital status, education, and monthly income can influence informational needs. CONCLUSION Healthcare providers should tailor information given to LTx recipients based on informational needs. Longitudinal studies are needed to confirm changing patterns of informational needs.
Collapse
Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin-Madison, Madison, USA
| | - Insook Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Rebecca J Muehrer
- School of Nursing, University of Wisconsin-Madison, Madison, USA Department of Medicine, Section of Nephrology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
| |
Collapse
|
31
|
Ehrlich C, Kendall E, Parekh S, Walters C. The impact of culturally responsive self-management interventions on health outcomes for minority populations: A systematic review. Chronic Illn 2016; 12:41-57. [PMID: 26026156 DOI: 10.1177/1742395315587764] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/20/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The health of people from Indigenous and ethnic minorities is poorer than the remainder of the population. Frequently, Westernized health systems respond by introducing self-management interventions to improve chronic illness health outcomes. The aim of this study was to answer the research question: "Can self-management programs that have been adapted or modified still be effective for ethnic minority and Indigenous populations?" METHODS A systematic review across four databases was conducted. RESULTS Twenty-three publications met the inclusion criteria. As the studies were heterogeneous, meta-analysis was not possible. Overall, interventions resulted in more positive health outcomes than usual care, but findings were inconsistent. DISCUSSION We argue that rather than focusing on individual skills, knowledge, self-efficacy, and attitudes toward self-management, it may be more important to explore the structures and processes that underpin the sharing of information and skills within clinical or education encounters. Given that self-management is a Western cultural construct, creating empathic and responsive systems might be more effective for improving health of Indigenous and ethnic minority groups rather than relying predominantly on individual skill development.
Collapse
Affiliation(s)
- Carolyn Ehrlich
- CONROD, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Elizabeth Kendall
- CONROD, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Sanjoti Parekh
- CONROD, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| | - Caroline Walters
- CONROD, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia
| |
Collapse
|
32
|
Systematic Review and Meta-Analysis of Peer-Led Self-Management Programs for Increasing Physical Activity. Int J Behav Med 2016; 23:527-38. [DOI: 10.1007/s12529-016-9540-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
33
|
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]
|
34
|
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.
Collapse
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.
| |
Collapse
|
35
|
Yin AC. Standardized management of pain in advanced liver cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:5423-5426. [DOI: 10.11569/wcjd.v23.i34.5423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Terminal cancer patients suffer from severe pain mentally and physically, especially patients with hepatic carcinoma. However, there is still a lack of standardized pain management strategies for advanced liver cancer in China, and formulating a standardized pain management system is imminent. In this article, we discuss the standardization of pain assessment and management in advanced liver cancer with regard to drug management, traditional Chinese medicine management, psychological management and self-management.
Collapse
|
36
|
Li WW, Tsoh JY. Recruiting and Retaining Chinese Elders in a Longitudinal Study: Lessons Learned. J Transcult Nurs 2015; 28:63-69. [PMID: 26446140 DOI: 10.1177/1043659615609405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This article describes strategies for recruiting and retaining Chinese elders in a longitudinal research study related to hypertension management. DESIGN Chinese participants were recruited for a pilot, longitudinal intervention study. The information presented represents observations on both the recruitment process and participant retention. RESULTS Recruiting via convenience sampling, offering frequent incentives, and having culturally competent research staff were important in this study with Chinese elders as participants. Among the various approaches used, the highest recruitment rate (50% [11/22]) was obtained from personal referrals with a retention rate of 91% (20/22) over a 6-month intervention period. CONCLUSION/PRACTICE IMPLICATION Personal referral is the best approach for recruiting Chinese elders in the study. In addition, frequent incentives and reminder calls are helpful in retaining participants.
Collapse
|
37
|
Jonker AAGC, Comijs HC, Knipscheer KCPM, Deeg DJH. Benefits for elders with vulnerable health from the Chronic Disease Self-management Program (CDSMP) at short and longer term. BMC Geriatr 2015; 15:101. [PMID: 26275714 PMCID: PMC4537543 DOI: 10.1186/s12877-015-0090-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 07/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background When health declines, older persons may benefit from an intervention program that strengthens their self-management and empowers them to keep in control of their own body and life. Therefore we conducted a Randomized Controlled Trial using the Chronic Disease Self-Management Program (CDSMP) in a sample of 169 older persons in frail health and in need of elderly care. Methods We assessed psychological coping resources and wellbeing, pre- and posttreatment and at 6-month follow-up, and investigated whether specific subgroups would benefit in particular from the intervention. Results The CDSMP appeared effective with respect to sense of mastery but only in the lower educated participants (p < .05). Furthermore, the intervention stabilized valuation of life in participants, whereas in the controls valuation of life decreased. The high appreciation score and low drop-out are indicative for the applicability of the CDSMP for this specific target group. Conclusions We recommend integration of the ingredients of the program into the daily healthcare practice of professionals working with vulnerable older persons. This would involve professional guidance starting from interpersonal equality and emphasising a persons possibilities given their physical or cognitive limitations. This will help older vulnerable persons to focus on their own attainable goals and to experience being successful. Trial registration The trial was registered in the Dutch Trial Register as NTR 1173 at 08-03-2008; ‘Is selfmanagement benefical for well-being of average older persons?’ http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1173
Collapse
Affiliation(s)
- Angèle A G C Jonker
- Department of Epidemiology & Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Hannie C Comijs
- Department of Epidemiology & Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Kees C P M Knipscheer
- Department of Epidemiology & Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Dorly J H Deeg
- Department of Epidemiology & Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| |
Collapse
|
38
|
McGowan P. The relative effectiveness of self-management programs for type 2 diabetes. Can J Diabetes 2015; 39:411-9. [PMID: 26165582 DOI: 10.1016/j.jcjd.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/24/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objectives of the study were to investigate the effectiveness of 2 types of peer-led self-management programs in bringing about improvements in subjects with type 2 diabetes mellitus and to determine whether there were differences in effectiveness between the 2 programs. METHODS The study used a 3-arm randomized controlled trial design with clinical measures taken at baseline and at 6 and 12 months post-program. In total, 405 persons completed baseline questionnaires and were randomly allocated to a diabetes self-management program (n=130), to a general self-management program (n=109) or to a control group (n=122). A 2-way factorial analyses of variance was employed as the primary statistical analysis. RESULTS The findings showed that the self-management programs had affected 5 of the 30 measures: fatigue, cognitive symptom management, self-efficacy with regard to the disease in general, communication with physician, and the score on the Diabetes Empowerment Scale. In addition, 3 variables-social role limitations, total hospital nights and glycated hemoglobin levels-showed marginally significant interaction effects. The second analysis found similar results, with 4 of the 5 measures remaining statistically significant: fatigue, cognitive symptom management, communication with physician and diabetes empowerment, with neither program being more effective than the other. CONCLUSIONS The major findings are that although both programs were effective in bringing about positive changes in the outcome measures, there was little difference in effectiveness between the Diabetes Self-Management Program and the Chronic Disease Self-Management Program. This finding is consistent with the principle that behaviour-change strategies using self-efficacy are key components in health education programs.
Collapse
Affiliation(s)
- Patrick McGowan
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Delta, British Columbia, Canada.
| |
Collapse
|
39
|
Garvey J, Connolly D, Boland F, Smith SM. OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial. BMC FAMILY PRACTICE 2015; 16:59. [PMID: 25962515 PMCID: PMC4438474 DOI: 10.1186/s12875-015-0267-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/24/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. METHODS Pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion. RESULTS There was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation. CONCLUSIONS OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings. TRIAL REGISTRATION TRIAL NUMBER ISRCTN67235963.
Collapse
Affiliation(s)
- Jess Garvey
- Department of Occupational Therapy, Trinity College Dublin, Trinity Centre, St James's Hospital, Dublin 8, Ireland.
| | - Deirdre Connolly
- Department of Occupational Therapy, Trinity College Dublin, Trinity Centre, St James's Hospital, Dublin 8, Ireland.
| | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeon's in Ireland, Beaux Lane House, Lower Mercer Street, 2, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeon's in Ireland, Beaux Lane House, Lower Mercer Street, 2, 123 St Stephen's Green, Dublin 2, Ireland.
| |
Collapse
|
40
|
Snowden MB, Steinman LE, Carlson WL, Mochan KN, Abraido-Lanza AF, Bryant LL, Duffy M, Knight BG, Jeste DV, Leith KH, Lenze EJ, Logsdon RG, Satariano WA, Zweiback DJ, Anderson LA. Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research. Front Public Health 2015; 2:213. [PMID: 25964921 PMCID: PMC4410348 DOI: 10.3389/fpubh.2014.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/13/2014] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health. METHODS A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). RESULTS In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence. CONCLUSION Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.
Collapse
Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Whitney L. Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kara N. Mochan
- University of Washington School of Nursing with Environmental Health Focus, Seattle, WA, USA
- Adolescent Medicine, Seattle Children’s, Seattle, WA, USA
| | - Ana F. Abraido-Lanza
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Michael Duffy
- Department of Educational Psychology, Counseling Psychology Program, Texas A&M University, College Station, TX, USA
| | - Bob G. Knight
- Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Rebecca G. Logsdon
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | | | - Damita J. Zweiback
- Division of Chronic Disease and Injury Prevention, Michigan Department of Community Health, Lansing, MI, USA
- Healthy Aging Council and Health Equity Council, National Association of Chronic Disease Directors, Atlanta, GA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
41
|
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
|
42
|
Ritter PL, Ory MG, Laurent DD, Lorig K. Effects of chronic disease self-management programs for participants with higher depression scores: secondary analyses of an on-line and a small-group program. Transl Behav Med 2014; 4:398-406. [PMID: 25584089 PMCID: PMC4286546 DOI: 10.1007/s13142-014-0277-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Depression often accompanies chronic illness. Study aims included determining (1) the level of current depression (Patient Health Questionnaire (PHQ)-8 ≥ 10) for two sets of Chronic Disease Self-Management Programs (CDSMP) participants; (2) if depression or other outcomes improved for those with PHQ-8 ≥ 10; and (3) if outcomes differed for participants with or without depression. This study utilized longitudinal secondary data analysis of depression cohorts (PHQ-8 ≥ 10) from two independent translational implementations of the CDSMP, small-group (N = 175) and Internet-based (N = 110). At baseline, 27 and 55 % of the two samples had PHQ-8 10 or greater. This decreased to 16 and 37 % by 12 months (p < 0.001). Both depressed and non-depressed cohorts demonstrated improvements in most 12-month outcomes (pain, fatigue, activity limitations, and medication adherence). The CDSMP was associated with long-term improvements in depression regardless of delivery mode or location, and the programs appeared beneficial for participants with and without depression.
Collapse
Affiliation(s)
- Philip L Ritter
- />Stanford Patient Education Research Center, School of Medicine, Stanford University, 1000 Welch Road Rd., Suite 204, Palo Alto, CA 94304 USA
| | - Marcia G Ory
- />Health Science Center, Texas A&M University, College Station, TX USA
| | - Diana D Laurent
- />Stanford Patient Education Research Center, School of Medicine, Stanford University, 1000 Welch Road Rd., Suite 204, Palo Alto, CA 94304 USA
| | - Kate Lorig
- />Stanford Patient Education Research Center, School of Medicine, Stanford University, 1000 Welch Road Rd., Suite 204, Palo Alto, CA 94304 USA
| |
Collapse
|
43
|
Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
44
|
Williams A, Manias E, Cross W, Crawford K. Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy. J Clin Nurs 2014; 24:1269-79. [PMID: 25265991 DOI: 10.1111/jocn.12700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To examine the perceptions of a group of culturally and linguistically diverse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. BACKGROUND These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically diverse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically diverse people to improve their medication self-efficacy. DESIGN A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. METHODS Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. RESULTS The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. CONCLUSION This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically diverse backgrounds have the appropriate skills to self-manage their complex medical conditions. RELEVANCE TO CLINICAL PRACTICE Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.
Collapse
Affiliation(s)
- Allison Williams
- Peninsula Campus School of Nursing and Midwifery, Monash University Health Sciences, Frankston, Vic., Australia
| | | | | | | |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Simmons LA, Wolever RQ, Bechard EM, Snyderman R. Patient engagement as a risk factor in personalized health care: a systematic review of the literature on chronic disease. Genome Med 2014; 6:16. [PMID: 24571651 PMCID: PMC4064309 DOI: 10.1186/gm533] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 02/21/2014] [Indexed: 01/22/2023] Open
Abstract
Background The role of patient engagement as an important risk factor for healthcare outcomes has not been well established. The objective of this article was to systematically review the relationship between patient engagement and health outcomes in chronic disease to determine whether patient engagement should be quantified as an important risk factor in health risk appraisals to enhance the practice of personalized medicine. Methods A systematic review of prospective clinical trials conducted between January 1993 and December 2012 was performed. Articles were identified through a medical librarian-conducted multi-term search of Medline, Embase, and Cochrane databases. Additional studies were obtained from the references of meta-analyses and systematic reviews on hypertension, diabetes, and chronic care. Search terms included variations of the following: self-care, self-management, self-monitoring, (shared) decision-making, patient education, patient motivation, patient engagement, chronic disease, chronically ill, and randomized controlled trial. Studies were included only if they: (1) compared patient engagement interventions to an appropriate control among adults with chronic disease aged 18 years and older; (2) had minimum 3 months between pre- and post-intervention measurements; and (3) defined patient engagement as: (a) understanding the importance of taking an active role in one’s health and health care; (b) having the knowledge, skills, and confidence to manage health; and (c) using knowledge, skills and confidence to perform health-promoting behaviors. Three authors and two research assistants independently extracted data using predefined fields including quality metrics. Results We reviewed 543 abstracts to identify 10 trials that met full inclusion criteria, four of which had ‘high’ methodological quality (Jadad score ≥ 3). Diverse measurement of patient engagement prevented robust statistical analyses, so data were qualitatively described. Nine studies documented improvements in patient engagement. Five studies reported reduction in clinical markers of disease (for example HbA1C). All studies reported improvements in self-reported health status. Conclusions This review suggests patient engagement should be quantified as part of a comprehensive health risk appraisal given its apparent value in helping individuals to effectively self-manage chronic disease. Patient engagement measures should include assessment of the knowledge, confidence and skills to prevent and manage chronic disease, plus the behaviors to do so.
Collapse
Affiliation(s)
- Leigh Ann Simmons
- Current address: Duke University School of Nursing, DUMC Box 3322, Durham, NC 27710-3322, USA ; Center for Research on Prospective Health Care, Duke University Health System, Durham, NC 27710, USA
| | - Ruth Q Wolever
- Current address: Duke Integrative Medicine, DUMC Box 102904, Durham, NC 27710-2904, USA ; Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Durham, NC 27710-2904, USA
| | - Elizabeth M Bechard
- Current address: Duke Integrative Medicine, DUMC Box 102904, Durham, NC 27710-2904, USA
| | - Ralph Snyderman
- Center for Research on Prospective Health Care, Duke University Health System, Durham, NC 27710, USA ; Current address: Department of Medicine, DUMC Box 3059, Durham, NC 27710-3059, USA
| |
Collapse
|
47
|
Sun GG, Wang YD, Lu YF, Hu WN. Different association of manganese superoxide dismutase gene polymorphisms with risk of prostate, esophageal, and lung cancers: evidence from a meta-analysis of 20,025 subjects. Asian Pac J Cancer Prev 2014; 14:1937-43. [PMID: 23679296 DOI: 10.7314/apjcp.2013.14.3.1937] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Altered expression or function of manganese superoxide dismutase (MnSOD) has been shown to be associated with cancer risk but assessment of gene polymorphisms has resulted in inconclusive data. Here a search of published data was made and 22 studies were recruited, covering 20,025 case and control subjects, for meta- analyses of the association of MnSOD polymorphisms with the risk of prostate, esophageal, and lung cancers. The data on 12 studies of prostate cancer (including 4,182 cases and 6,885 controls) showed a statistically significant association with the risk of development in co-dominant models and dominant models, but not in the recessive model. Subgroup analysis showed there was no statistically significant association of MnSOD polymorphisms with aggressive or nonaggressive prostate cancer in different genetic models. In addition, the data on four studies of esophageal cancer containing 620 cases and 909 controls showed a statistically significant association between MnSOD polymorphisms and risk in all comparison models. In contrast, the data on six studies of lung cancer with 3,375 cases and 4,050 controls showed that MnSOD polymorphisms were significantly associated with the decreased risk of lung cancer in the homozygote and dominant models, but not the heterozygote model. A subgroup analysis of the combination of MnSOD polymorphisms with tobacco smokers did not show any significant association with lung cancer risk, histological type, or clinical stage of lung cancer. The data from the current study indicated that the Ala allele MnSOD polymorphism is associated with increased risk of prostate and esophageal cancers, but with decreased risk of lung cancer. The underlying molecular mechanisms warrant further investigation.
Collapse
Affiliation(s)
- Guo-Gui Sun
- Department of Chemoradiation Therapy, Tangshan People's Hospital, 3Department of Endocrinology, Tangshan Workers Hospital, Tangshan, China
| | | | | | | |
Collapse
|
48
|
Lorig K, Ritter PL, Pifer C, Werner P. Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community Ment Health J 2014; 50:96-103. [PMID: 23748554 DOI: 10.1007/s10597-013-9615-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/29/2013] [Indexed: 12/16/2022]
Abstract
Evaluation of evidence-based interventions in new settings and new populations is the hallmark of successful translation. We evaluated the Chronic Disease Self-Management Program in persons with serious mental illness who were receiving care through Michigan Community Mental Health Services (N = 139). At 6-months, participants demonstrated improvements in health indicators (fatigue, quality of life, sleep, depression, health distress, and days health bad) and health behaviors (medical adherence and communication with doctor). The program was successfully administrated in a "real world" setting and continues to be used. In addition, the program appears to be an effective resource for people with serious mental illness.
Collapse
Affiliation(s)
- Kate Lorig
- Stanford Patient Education Research Center, Stanford University School of Medicine, 1000 Welch Rd., Palo Alto, CA, 94304, USA
| | | | | | | |
Collapse
|
49
|
Carolan-Olah MC, Cassar A, Quiazon R, Lynch S. Diabetes care and service access among elderly Vietnamese with type 2 diabetes. BMC Health Serv Res 2013; 13:447. [PMID: 24168109 PMCID: PMC4231357 DOI: 10.1186/1472-6963-13-447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use. METHODS Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework. RESULTS Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access. CONCLUSIONS Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.
Collapse
Affiliation(s)
- Mary C Carolan-Olah
- College of Health and Biomedicine, Victoria University, McKechnie Street, St Albans, Victoria, Australia.
| | | | | | | |
Collapse
|
50
|
Williams A, Manias E. Exploring motivation and confidence in taking prescribed medicines in coexisting diseases: a qualitative study. J Clin Nurs 2013; 23:471-81. [DOI: 10.1111/jocn.12171] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Allison Williams
- School of Nursing and Midwifery; Monash University Health Sciences; Frankston Vic. Australia
| | - Elizabeth Manias
- School of Health Sciences; The University of Melbourne; Carlton Vic. Australia
| |
Collapse
|