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Woodward A, Walters K, Davies N, Nimmons D, Protheroe J, Chew‐Graham CA, Stevenson F, Armstrong M. Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: A systematic review and qualitative synthesis. Health Expect 2024; 27:e14070. [PMID: 38751247 PMCID: PMC11096776 DOI: 10.1111/hex.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The number of people living with diabetes is rising worldwide and a higher prevalence of diabetes has been linked to those experiencing socioeconomic deprivation. Self-management strategies are vital and known to reduce the risks of long-term complications amongst people living with diabetes. Lack of knowledge about self-care activity required to manage diabetes is a key barrier to successful self-management. Self-management interventions can be less effective in socioeconomically deprived populations which can increase the risk of exacerbating health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management of diabetes amongst people who are socioeconomically disadvantaged. METHODS MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions amongst socioeconomically disadvantaged populations. Relevant papers which focused on diabetes were identified. Data were coded and thematically synthesised using NVivo. FINDINGS From the search results, 79 qualitative studies were identified after full-text screening and 26 studies were included in the final thematic analysis. Two overarching analytical themes were identified alongside a set of subthemes: (1) Socioeconomic barriers to diabetes self-management; healthcare costs, financial costs of healthy eating, cultural influences, living in areas of deprivation, competing priorities and time constraints, health literacy, (2) facilitators of diabetes self-management; lifestyle and having goals, support from healthcare providers, informal support. DISCUSSION Self-management of diabetes is challenging for people experiencing socioeconomic deprivation due to barriers associated with living in areas of deprivation and financial barriers surrounding healthcare, medication and healthy food. Support from healthcare providers can facilitate self-management, and it is important that people with diabetes have access to interventions that are designed to be inclusive from a cultural perspective as well as affordable. PATIENT OR PUBLIC CONTRIBUTION A patient advisory group contributed to the research questions and interpretation of the qualitative findings by reflecting on the themes developed.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Danielle Nimmons
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | | | - Fiona Stevenson
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Megan Armstrong
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
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Armstrong M, Walters K, Davies N, Nimmons D, Pigott J, Read J, Schrag A. Intervention components in the self-management of Parkinson's: a mixed-methods synthesis of qualitative and quantitative evidence. BMC Health Serv Res 2024; 24:92. [PMID: 38233917 PMCID: PMC10795310 DOI: 10.1186/s12913-023-10436-4] [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: 05/02/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Self-management interventions consist of multiple components to support people in the management of medical, emotional, and behavioural aspects of their condition, and aim to improve quality of life, function, and other outcomes. A systematic review of self-management interventions in Parkinson's showed no conclusive evidence for effectiveness of specific self-management approaches in Parkinson's to date but identified several potentially useful components. AIM To identify the key required components for self-management in people with Parkinson's by synthesising evidence from a body of primary qualitative evidence and systematic reviews, and to explore which of these key components should be incorporated into trials of self-management in Parkinson's. METHOD A mixed-methods synthesis was conducted. We combined data from two primary qualitative studies and a systematic review of qualitative studies that focused on self-management in Parkinson's to identify key intervention components. These were then mapped onto the results of a systematic review of Randomised Controlled Trials (RCTs) using matrices. First, data were extracted from the qualitative studies with people with Parkinson's and healthcare professionals on the key self-management components in this population. Second, a matrix table was created to map the identified Parkinson's specific self-management components against potential effectiveness from published RCTs of self-management interventions. RESULTS Synthesis of qualitative data identified 15 potential self-management components. These 15 components included components needed to start self-managing (e.g., information, skill acquirement) and components needed to maintain self-managing (e.g., self-motoring, increasing motivation). From 18 RCTs, interventions varied in how many components were included (range 1-10). Trials reporting significant beneficial effects of their intervention included a higher number of components (4 or more self-management components) than trials without significant findings (1-3 self-management components). CONCLUSION Fifteen key self-management components were identified that should be incorporated into interventions or programs of self-management in Parkinson's. No current trial has incorporated all aspects, but a higher number of these key components appears to make trials of self-management interventions more likely to be successful.
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Affiliation(s)
- Megan Armstrong
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Nathan Davies
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Danielle Nimmons
- Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK
| | - Jennifer Pigott
- Institute of Neurology, University College London, London, UK
| | - Joy Read
- Institute of Neurology, University College London, London, UK
| | - Anette Schrag
- Institute of Neurology, University College London, London, UK
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Woodward A, Davies N, Walters K, Nimmons D, Stevenson F, Protheroe J, Chew-Graham CA, Armstrong M. Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation. PLoS One 2023; 18:e0282036. [PMID: 36809286 PMCID: PMC9942951 DOI: 10.1371/journal.pone.0282036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Multiple long-term conditions are rising across all groups but people experiencing socioeconomic deprivation are found to have a higher prevalence. Self-management strategies are a vital part of healthcare for people with long-term conditions and effective strategies are associated with improved health outcomes in a variety of health conditions. The management of multiple long-term conditions are, however, less effective in people experiencing socioeconomic deprivation, leaving them more at risk of health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management on long-term conditions in those experiencing socioeconomic deprivation. METHODS MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions among socioeconomically disadvantaged populations. Data were coded and thematically synthesised using NVivo. FINDINGS From the search results, 79 relevant qualitative studies were identified after the full text screening and 11 studies were included in the final thematic synthesis. Three overarching analytical themes were identified alongside a set of sub-themes: (1) Challenges of having multiple long-term conditions; prioritisation of conditions, impact of multiple long-term conditions on mental health and wellbeing, polypharmacy, (2) Socioeconomic barriers to self-management; financial, health literacy, compounding impact of multiple long-term conditions and socioeconomic deprivation, (3) Facilitators of self-management in people experiencing socioeconomic deprivation; maintaining independence, 'meaningful' activities, support networks. DISCUSSION Self-management of multiple long-term conditions is challenging for people experiencing socioeconomic deprivation due to barriers around financial constraints and health literacy, which can lead to poor mental health and wellbeing. To support targeted interventions, greater awareness is needed among health professionals of the barriers/challenges of self-management among these populations.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Joanne Protheroe
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | | | - Megan Armstrong
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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Wu SFV, Wang TJ, Liang SY, Lin LJ, Lu YY, Lee MC. Differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease. J Clin Nurs 2022; 31:2287-2295. [PMID: 34558131 DOI: 10.1111/jocn.16046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/27/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
AIMS The study compares the differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease (CKD), and predicts the influential factors of self-management. DESIGN A cross-sectional study. METHODS A total of 185 subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self-Care Instrument Knowledge, the Chronic Kidney Disease Self-Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self-Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t-test, one-way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. RESULTS Our results showed that a significant difference was found in the age (p = 0.005), systolic pressure (p = .006), self-care knowledge (p = .011) and depression level (p = .003) between patients with early- and end-stage CKD. Furthermore, patients with early-stage CKD have less self-care knowledge and lower depression levels compared with patients with end-stage CKD. However, self-efficacy is the most significant predictor of self-management for patients with early- and end-stage CKD. For patients with early-stage CKD, self-efficacy explained 69.1% of the variation in self-management. CONCLUSION According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self-care knowledge of patients with end-stage CKD may improve their self-management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early- and late-stage of CKD. RELEVANCE TO CLINICAL PRACTICE Nurses should strive to improve the self-care knowledge of patients with early-stage CKD to delay the progression of the disease to end-stage. Screening for depression among patients with end-stage CKD is relevant, and these patients should be referred to professional counsellors when necessary.
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Affiliation(s)
- Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Ju Lin
- International and Cross-Strait Education Center, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yu-Yin Lu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Powell C, Tomlinson J, Quinn C, Fylan B. Interventions for self-management of medicines for community-dwelling people with dementia and mild cognitive impairment and their family carers: a systematic review. Age Ageing 2022; 51:6593707. [PMID: 35639800 PMCID: PMC9154223 DOI: 10.1093/ageing/afac089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background people with dementia or mild cognitive impairment (MCI) and their family carers face challenges in managing medicines. How medicine self-management could be supported for this population is unclear. This review identifies interventions to improve medicine self-management for people with dementia and MCI and their family carers, and the core components of medicine self-management that they address. Methods a database search was conducted for studies with all research designs and ongoing citation search from inception to December 2021. The selection criteria included community-dwelling people with dementia and MCI and their family carers, and interventions with a minimum of one medicine self-management component. The exclusion criteria were wrong population, not focusing on medicine management, incorrect medicine self-management components, not in English and wrong study design. The results are presented and analysed through narrative synthesis. The review is registered [PROSPERO (CRD42020213302)]. Quality assessment was carried out independently applying the QATSDD quality assessment tool. Results 13 interventions were identified. Interventions primarily addressed adherence. A limited number focused on a wider range of medicine self-management components. Complex psychosocial interventions with frequent visits considered the person’s knowledge and understanding, supply management, monitoring effects and side effects and communicating with healthcare professionals, and addressed more resilience capabilities. However, these interventions were delivered to family carers alone. None of the interventions described patient and public involvement. Conclusion interventions, and measures to assess self-management, need to be developed which can address all components of medicine self-management to better meet the needs of people with dementia and MCI and their family carers.
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Affiliation(s)
- Catherine Powell
- School of Pharmacy and Medical Sciences , University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research , Bradford, UK
| | - Justine Tomlinson
- School of Pharmacy and Medical Sciences , University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research , Bradford, UK
- Medicines Management & Pharmacy Services , Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catherine Quinn
- Centre for Applied Dementia Studies , University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research , Bradford, UK
| | - Beth Fylan
- School of Pharmacy and Medical Sciences , University of Bradford, Bradford, UK
- NIHR Yorkshire and Humber Patient Safety Translational Research Centre , Bradford Institute for Health Research, Bradford, UK
- Wolfson Centre for Applied Health Research , Bradford, UK
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Ali L, Wallström S, Fors A, Barenfeld E, Fredholm E, Fu M, Goudarzi M, Gyllensten H, Lindström Kjellberg I, Swedberg K, Vanfleteren LEGW, Ekman I. Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial. J Med Internet Res 2021; 23:e26794. [PMID: 34898447 PMCID: PMC8713094 DOI: 10.2196/26794] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/15/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. OBJECTIVE The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. METHODS A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. RESULTS No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. CONCLUSIONS PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. TRIAL REGISTRATION ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817.
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Affiliation(s)
- Lilas Ali
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Wallström
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Emmelie Barenfeld
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Fredholm
- The Swedish Heart & Lung Foundation, Stockholm, Sweden
| | - Michael Fu
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mahboubeh Goudarzi
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Gyllensten
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Irma Lindström Kjellberg
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- Chronic Obstructive Pulmonary Disease Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
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Lee MC, Wu SFV, Lu KC, Liu CY, Liu WI, Liu JH. The effect of a self-management program on renal function control in patients with hemodialysis in Taiwan: A longitudinal randomized controlled trial. Jpn J Nurs Sci 2020; 17:e12345. [PMID: 32390339 DOI: 10.1111/jjns.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/02/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Abstract
AIM This study was designed to investigate the longitudinal effect of participating in a self-management program (SMP) on renal function control in patients receiving hemodialysis. METHODS This randomized controlled trial enrolled a total of 58 patients at the hemodialysis center of a teaching hospital in Taiwan. The control group (n = 30) received the usual care and the experimental group (n = 28) received a 4-week SMP intervention. The results of the follow-up on the longitudinal data at 3, 6, and 9 months showed that the renal function indices, potassium and phosphorus levels, and interdialytic weight gain were significantly better than at the pre-test for the experimental group. RESULTS In terms of the interaction between group and time, the potassium level dropped significantly below the pre-test value only after 3 months (B = -0.31, SE = 0.15, p = .044), suggesting that the post-test potassium level had significantly decreased after 3 months. In terms of the interaction between group and time, the phosphorus level dropped significantly below the pre-test value only after 6 months (B = -0.53, SE = 0.28, p = .050), suggesting that the post-test phosphorus level significantly decreased after 6 months. Finally, the intervention could effectively control the weight change between dialysis sessions for up to 9 months (B = -1.34, SE = 0.30, p < .001). CONCLUSIONS The SMP intervention decreased potassium and phosphorus levels and helped control interdialytic weight gain in patients undergoing hemodialysis.
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Affiliation(s)
- Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang V Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chief-Yu Liu
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wen-I Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Ju-Han Liu
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Tonga JB, Eilertsen DE, Solem IKL, Arnevik EA, Korsnes MS, Ulstein ID. Effect of Self-Efficacy on Quality of Life in People With Mild Cognitive Impairment and Mild Dementia: The Mediating Roles of Depression and Anxiety. Am J Alzheimers Dis Other Demen 2020; 35:1533317519885264. [PMID: 31916847 PMCID: PMC10623983 DOI: 10.1177/1533317519885264] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the mediating effects of depression and anxiety in the relationship between self-efficacy and quality of life among people with mild cognitive impairment (MCI) or mild dementia. METHOD A total of 196 patients diagnosed with MCI or dementia due to Alzheimer disease completed structured measures of self-efficacy, quality of life, and depressive and anxiety symptoms. We examined direct and mediated effects by fitting structural equation models to data. RESULTS Our analyses supported that the effects of self-efficacy on quality of life may be partially mediated by depression and anxiety. Both anxiety and depression had significant mediating effects, with depression showing a stronger effect. CONCLUSION These results suggest that increased self-efficacy may have a positive effect on quality of life in people with MCI or dementia-partly by reducing depression and anxiety. These findings may have important practical implications for tailoring therapeutic interventions.
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Affiliation(s)
- Johanne B. Tonga
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Norwegian Health Association, Oslo, Norway
- Institute of Psychology, University of Oslo, Norway
| | | | - Ingrid K. Ledel Solem
- Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Espen A. Arnevik
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Maria S. Korsnes
- Department of Old Age Psychiatry, Oslo University Hospital, Gaustad, Norway
- Institute of Psychology, University of Oslo, Norway
| | - Ingun D. Ulstein
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Norway
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Fors A, Blanck E, Ali L, Ekberg-Jansson A, Fu M, Lindström Kjellberg I, Mäkitalo Å, Swedberg K, Taft C, Ekman I. Effects of a person-centred telephone-support in patients with chronic obstructive pulmonary disease and/or chronic heart failure - A randomized controlled trial. PLoS One 2018; 13:e0203031. [PMID: 30169539 PMCID: PMC6118377 DOI: 10.1371/journal.pone.0203031] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/07/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate the effects of person-centred support via telephone in two chronically ill patient groups, chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF). Method 221 patients ≥ 50 years with COPD and/or CHF were randomized to usual care vs. usual care plus a person-centred telephone-support intervention and followed for six months. Patients in the intervention group were telephoned by a registered nurse initially to co-create a person-centred health plan with the patient and subsequently to discuss and evaluate the plan. The primary outcome measure was a composite score comprising General Self-Efficacy (GSE), re-hospitalization and death. Patients were classified as deteriorated if GSE had decreased by ≥ 5 points, or if they had been re-admitted to hospital for unscheduled reasons related to COPD and/or CHF or if they had died. Results At six-month follow-up no difference in the composite score was found between the two study groups (57.6%, n = 68 vs. 46.6%, n = 48; OR = 1.6, 95% CI: 0.9–2.7; P = 0.102) in the intention-to-treat analysis (n = 221); however, significantly more patients in the control group showed a clinically important decrease in GSE (≥ 5 units) (22.9%, n = 27 vs. 9.7%, n = 10; OR = 2.8, 95% CI: 1.3–6.0; P = 0.011). There were 49 clinical events (14 deaths, 35 re-admissions) in the control group and 41 in the intervention group (9 deaths, 32 re-admissions). Per-protocol analysis (n = 202) of the composite score showed that more patients deteriorated in the control group than in the intervention group (57.6%, n = 68 vs. 42.9%, n = 36; OR = 1.8, 95% CI 1.0–3.2; P = 0.039). Conclusion Person-centred support via telephone mitigates worsening self-efficacy without increasing the risk of clinical events in chronically ill patients with CHF and/or COPD. This indicates that a patient-healthcare professional partnership may be established without the need for face-to-face consultations, even in vulnerable patient groups. Trial registration ISRCTN.comISRCTN55562827.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- * E-mail:
| | - Elin Blanck
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Ann Ekberg-Jansson
- Department of Respiratory medicine and Allergology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development department, Region Halland, Halmstad, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Irma Lindström Kjellberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Åsa Mäkitalo
- Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Charles Taft
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Fors A, Gyllensten H, Swedberg K, Ekman I. Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial. Int J Cardiol 2016; 221:957-62. [PMID: 27441475 DOI: 10.1016/j.ijcard.2016.07.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. METHOD 199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. RESULTS In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097). CONCLUSION A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. TRIAL REGISTRATION Swedish registry, Researchweb.org, ID NR 65 791.
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Affiliation(s)
- Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. http://www.gpcc.gu.se
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; National Heart and Lung Institute, Imperial College, London, United Kingdom. http://www.gpcc.gu.se
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. http://www.gpcc.gu.se
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11
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Lee MC, Wu SFV, Hsieh NC, Tsai JM. Self-Management Programs on eGFR, Depression, and Quality of Life among Patients with Chronic Kidney Disease: A Meta-Analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2016; 10:255-262. [PMID: 28057311 DOI: 10.1016/j.anr.2016.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/06/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time. Self-management programs have been widely applied to chronic disease education programs, which are designed to delay deteriorating kidney functions, preclude depression, and improve quality of life. This study aims to analyze effectiveness of self-management programs in bettering CKD patients' eGFR, mitigating depression symptoms and improving quality of life in randomized control or clinical trials. METHODS Using key terms, a search was conducted in English-language, peer-reviewed journals on CKD that were published between 2002 and 2014 on databases including CINAHL, Cochrane Library, MEDLINE. The measurable variables included CKD patients' eGFR, depression, and quality of life. Random and fixed effects meta analysis were applied with standard error and correlation based measure of effect size. RESULTS Eight studies met the inclusion criteria. A self-management program significantly impacted CKD patients' depression and mental quality-of-life dimensions, with an effect size of .29 [95% confidence interval (CI) (0.07, 0.53)] and -.42 [95% CI (-0.75, -0.10)]. However, the intervention of a self-management program had no significant effect on patients' eGFR as well as physical quality-of-life dimensions, with effect sizes of .06 [95% CI (-0.69, 0.81)] and -.16 [95% CI (-0.81, 0.50)]. CONCLUSIONS Self-management programs of patients with chronic kidney disease can improve the depression and mental quality of life. Aside from providing more objective evidence-based results, this study provides a reference for clinical health care personnel who tend to patients with CKD.
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Affiliation(s)
- Mei-Chen Lee
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shu-Fang Vivienne Wu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
| | - Nan-Chen Hsieh
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Juin-Ming Tsai
- Department of Long Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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12
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Lau-Walker M, Presky J, Webzell I, Murrells T, Heaton N. Patients with alcohol-related liver disease--beliefs about their illness and factors that influence their self-management. J Adv Nurs 2015; 72:173-85. [PMID: 26446497 DOI: 10.1111/jan.12826] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 12/19/2022]
Abstract
AIM To determine the association between illness belief and self-efficacy to provide the evidence-base to develop a personalized framework to support self-management in patients with alcohol-related liver disease. BACKGROUND Research in a variety of long-term illnesses suggests patients' illness beliefs are a more influential factor for patient recovery than the severity of the illness. However, research into illness belief and self-efficacy of patients with alcohol-related liver disease is sparse. DESIGN A cross-sectional survey. METHODS A cohort of 159 patients with alcohol-related liver disease who attended the Liver Outpatient Clinics at a London Hospital (October 2012-November 2013) completed a set of validated instruments measuring illness beliefs, self-efficacy, emotional states and quality of life. FINDINGS The mean age of enrolled patients was 52 years, 67% male, 26% live on their own, 61% had no previous history of other chronic illness and average Model for End-Stage Liver Disease and The AUDIT Alcohol Consumption Questions scores were 11·0 and 3·5 respectively. After adjusting for demographic and illness characteristic components, multiple regression analysis shows that the three illness belief components 'Symptoms', 'Understanding' and 'Concerns' made a significant contribution to their confidence to self-manage their liver condition and the 'Symptoms' component makes a signification contribution across to all outcome measures: Anxiety, Depression, Quality of Life and Self-Efficacy. CONCLUSION Interventions designed to improve these patients' understanding of their illness and strategies to manage their symptoms are likely to improve their self-management, quality of life and reduce anxiety and depression.
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Affiliation(s)
| | | | - Ian Webzell
- Kings College Hospital NHS Foundation Trust, London, UK
| | | | - Nigel Heaton
- Kings College Hospital NHS Foundation Trust, London, UK
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13
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Quinn C, Toms G, Anderson D, Clare L. A Review of Self-Management Interventions for People With Dementia and Mild Cognitive Impairment. J Appl Gerontol 2015; 35:1154-1188. [PMID: 25608870 DOI: 10.1177/0733464814566852] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 11/20/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022] Open
Abstract
Self-management offers a way of helping people with dementia or mild cognitive impairment (MCI) to play an active role in managing their condition. Barlow, Wright, Sheasby, Turner, and Hainsworth have defined self-management as the "individual's ability to manage the symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition." Although commonly used in other chronic health conditions, there has been relatively little exploration of the role of self-management in dementia or MCI. This review aimed to identify group-based psychosocial interventions for people with dementia or MCI that incorporate significant elements of self-management. Fifteen interventions were included in the review: 12 for people with dementia and 3 for participants with MCI. In both the dementia and MCI interventions, the most commonly included self-management components were information, communication, and social support, and skills training. The review findings indicate that components of self-management have been incorporated into group-based interventions for people with dementia and MCI. Further studies are needed to address the methodological limitations of the included studies and to determine the effectiveness of self-management interventions with these populations.
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Toms GR, Quinn C, Anderson DE, Clare L. Help yourself: perspectives on self-management from people with dementia and their caregivers. QUALITATIVE HEALTH RESEARCH 2015; 25:87-98. [PMID: 25192761 DOI: 10.1177/1049732314549604] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Self-management interventions are increasingly offered to people with chronic health conditions. However, there has been limited exploration of how applicable such an approach is in early stage dementia. In this study we explored the views of people with dementia and family caregivers on the use of self-management in dementia. We conducted semistructured interviews with 13 people with early stage dementia and 11 caregivers. We analyzed transcripts using thematic analysis. We found eight themes in the analysis, and they indicated that self-management occurs in the context of peoples' family and social relationships as well as relationships with professional services. Six of the themes involved barriers to and facilitators of self-management. It is evident from these findings that people with dementia and caregivers use self-management techniques. Their use of such techniques could be enhanced by the development of interventions designed to help people with dementia to develop their self-management skills.
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Quinn C, Anderson D, Toms G, Whitaker R, Edwards RT, Jones C, Clare L. Self-management in early-stage dementia: a pilot randomised controlled trial of the efficacy and cost-effectiveness of a self-management group intervention (the SMART study). Trials 2014; 15:74. [PMID: 24606601 PMCID: PMC3974022 DOI: 10.1186/1745-6215-15-74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The possibility of living well with a long-term condition has been identified as centrally relevant to the needs of people living with dementia. Growing numbers of people with early-stage dementia are contributing accounts that emphasise the benefits of actively engaging in managing the condition. Self-management interventions share the common objectives of educating about the condition, optimising well-being, enhancing control over the situation and enabling people to take more responsibility for managing the condition. Benefits of such an approach can include improved knowledge, self-efficacy, health status, and better performance of self-management behaviours. However, there is only preliminary evidence that people with early-stage dementia can benefit from such interventions. METHODS This feasibility study involves the development of a self-management group intervention for people with early-stage Alzheimer's disease, vascular dementia or mixed Alzheimer's and vascular dementia. This study is a single-site pilot randomised-controlled trial. Forty-two people with early stage dementia, each with a caregiver (family member/friend), will be randomised to either the self-management group intervention or to treatment as usual.The self-management group intervention will involve eight weekly sessions, each lasting 90 minutes, held at a memory clinic in North Wales. All participants will be re-assessed three and six months post-randomisation. This study is intended to supply an early evaluation of the self-management intervention so that a full scale trial may be powered from the best available evidence. It will assess the feasibility of the intervention, the study design and the recruitment strategies. It will estimate the parameters and confidence intervals for the research questions of interest. The primary outcome of interest is the self-efficacy score of the person with dementia at three months post-randomisation. Secondary outcomes for the person with dementia are self-efficacy at six months post-randomisation and cognitive ability, mood and well-being at three and six months post-randomisation. Secondary outcomes for caregivers are their distress and stress at three and six months post-randomisation. The cost-effectiveness of the intervention will also be examined. DISCUSSION This study will provide preliminary information about the feasibility, efficacy and cost-effectiveness of a self-management group intervention for people in the early stages of dementia. TRIAL REGISTRATION Current Controlled Trials, ISRCTN02023181.
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Affiliation(s)
- Catherine Quinn
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
| | | | - Gill Toms
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health, Y Wern, Bangor University, The Normal Site, Holyhead Road, Gwynedd LL57 2PZ, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Dean Street, Gwynedd LL57 1UT, UK
| | - Carys Jones
- Centre for Health Economics and Medicines Evaluation, Bangor University, Dean Street, Gwynedd LL57 1UT, UK
| | - Linda Clare
- School of Psychology, Bangor University, Bangor, Gwynedd LL57 2AS, UK
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Abstract
The aim of study was to investigate whether the process of making photo stories in health care (the photo instrument) matches with requirements of self-motivation in self-management programs. Although training and advice in self-management were absent, the photo instrument shared important elements with self-management: the call upon responsibility, the focus on concrete (visual) details of the life world, and the sharpened awareness of choices to make. Expressing one's views, prolonged reflection, a dialogue, and sharing of the photo stories are components that can be considered building stones for commitment to self-representation of an illness story and a life beyond illness.
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Grose J, Freeman J, Marsden J. Service delivery for people with hereditary spastic paraparesis living in the South West of England. Disabil Rehabil 2013; 36:907-13. [DOI: 10.3109/09638288.2013.824032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Martin F, Turner A, Wallace LM, Bradbury N. Conceptualisation of self-management intervention for people with early stage dementia. Eur J Ageing 2013; 10:75-87. [PMID: 28804285 PMCID: PMC5549115 DOI: 10.1007/s10433-012-0253-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dementia is a major challenge for health and social care services. People living with dementia in the earlier stages experience a "care-gap". Although they may address this gap in care, self-management interventions have not been provided to people with dementia. It is unclear how to conceptualise self-management for this group and few published papers address intervention design. Initial focusing work used a logic mapping approach, interviews with key stakeholders, including people with dementia and their family members. An initial set of self-management targets were identified for potential intervention. Self-management for people living with dementia was conceptualised as covering five targets: (1) relationship with family, (2) maintaining an active lifestyle, (3) psychological wellbeing, (4) techniques to cope with memory changes, and (5) information about dementia. These targets were used to focus literature reviewing to explore an evidence base for the conceptualisation. We discuss the utility of the Corbin and Strauss (Unending work and care: managing chronic illness at home. Jossey-Bass, Oxford, 1988) model of self-management, specifically that self-management for people living with dementia should be conceptualised as emphasising the importance of "everyday life work" (targets 1 and 2) and "biographical work" (target 3), with inclusion of but less emphasis on specific "illness work" (targets 4, 5). We argue that self-management is possible for people with dementia, with a strengths focus and emphasis on quality of life, which can be achieved despite cognitive impairments. Further development and testing of such interventions is required to provide much needed support for people in early stages of dementia.
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Affiliation(s)
- Faith Martin
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Andrew Turner
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Louise M. Wallace
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Nicola Bradbury
- Mental Health Services Older People Division, Birmingham & Solihull Mental Health NHS Foundation Trust, Juniper Centre, Moseley Hall Hospital, Alcester Road, Moseley, Birmingham, B13 8AQ UK
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19
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Lhussier M, Eaton S, Forster N, Thomas M, Roberts S, Carr SM. Care planning for long-term conditions – a concept mapping. Health Expect 2013; 18:605-24. [PMID: 23565881 DOI: 10.1111/hex.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This article focuses on approaches within clinical practice that seek to actively involve patients with long-term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation. METHODS Searches were conducted in the Cochrane database for systematic reviews, CINHAL and MEDLINE. A staged approach to conducting the concept mapping was undertaken, by (i) an examination of the literature on care planning in LTCs; (ii) identification of related terms; (iii) locating reviews of those terms. Retrieved articles were subjected to a content analysis, which formed the basis of our concept maps. (iv) We then appraised these against knowledge and experience of the implementation of care planning in clinical practice. RESULTS AND CONCLUSIONS Thirteen articles were retrieved, in which the core importance of patient-centredness, shared decision making and self-management was highlighted. Literature searches on these terms retrieved a further 24 articles. Our concept mapping exercise shows that whilst there are common themes across the concepts, the differences between them reflect the context and intended outcomes within clinical practice. We argue that this clarification exercise will allow for further development of both research and clinical implementation agendas.
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Affiliation(s)
- Monique Lhussier
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Simon Eaton
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Mathew Thomas
- NHS County Durham and Darlington, Durham, UK.,NHS North East, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Sue Roberts
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Susan M Carr
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Abstract
The aim of this article is to understand the reasons for attending a chronic obstructive pulmonary disease (COPD)-specific self-management (SM) programme and how attendance at such programmes might be improved. A total of 20 qualitative semistructured interviews were carried out with patients and with lay programme tutors involved in the Better Living with Long term Airways disease (BELLA) pilot trial. Thematic framework data analysis was used. Common reasons for participant attendance arising from patients and tutors include (1) desire to learn about SM, (2) social benefits of meeting others with COPD and (3) altruism. Patients' reasons for poor attendance include (1) being too ill or not feeling ill enough and (2) practical, physical and emotional barriers. Tutor’s explanations for patients’ poor attendance were (1) failure to accept their condition, (2) fear of making a change, (3) lack of adequate support, (4) guilt about smoking and (5) the ‘scripted’ nature of the course. Suggestions for improving programme participation included (1) having choice of several start dates, (2) minimal delay inviting participant onto courses, (3) planning for ‘special needs’. Participation may be better amongst those who have accepted their condition or who are motivated towards improving their condition or to help others. Providing solutions for practical barriers may improve participation. However, alternatives to group-based interventions need to be developed for people with functional and emotional barriers to attendance.
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21
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Brink E, Alsén P, Herlitz J, Kjellgren K, Cliffordson C. General self-efficacy and health-related quality of life after myocardial infarction. PSYCHOL HEALTH MED 2012; 17:346-55. [PMID: 22292865 DOI: 10.1080/13548506.2011.608807] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.
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Affiliation(s)
- Eva Brink
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Thompson DR, Chair SY, Chan SW, Astin F, Davidson PM, Ski CF. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs 2011; 20:1236-44. [PMID: 21492271 DOI: 10.1111/j.1365-2702.2010.03558.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To review and synthesise, systematically, the research findings regarding motivational interviewing and to inform education, research and practice in relation to cardiovascular health. BACKGROUND Motivational interviewing is designed to engage ambivalent or resistant clients in the process of health behaviour change, and it has been widely used in different clinical conditions such as substance abuse, dietary adherence and smoking cessation. Motivational interviewing has also been proposed as a method for improving modifiable coronary heart disease risk factors of patients. DESIGN Systematic review. METHOD Eligible studies published in 1999-2009 were identified from the following databases: CINAHL, Medline, PsycINFO, Cochrane Library, EBSCO, Web of Science, Embase and British Nursing Index. A manual search was conducted of bibliographies of the identified studies and relevant journals. Two researchers independently reviewed the studies. RESULTS Four meta-analyses, one systematic review and three literature reviews of motivational interviewing and five primary studies of motivational interviewing pertaining to cardiovascular health were identified. Despite a dearth of primary studies in cardiovascular health settings, there appears to be strong evidence that motivational interviewing is an effective approach focusing on eliciting the person's intrinsic motivation for change of behaviour. CONCLUSION Motivational interviewing is an effective approach to changing behaviour. It offers promise in improving cardiovascular health status. RELEVANCE TO CLINICAL PRACTICE This review indicates that motivational interviewing is a useful method to help nurses improve health behaviour in people with coronary risk factors.
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Affiliation(s)
- David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Melbourne, Victoria, Australia.
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Martin F, Caramlau IO, Sutcliffe P, Martin S, Bayley J, Choudhry K. Self-management interventions for people living with HIV/AIDS. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- David R. Thompson
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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