1
|
McKenna S, Hutcheon A, Gorban C, Song Y, Scott E, Hickie I. Youth Perspectives on 'Highly Personalised and Measurement-Based Care': Qualitative Co-Design of Education Materials. Health Expect 2024; 27:e14137. [PMID: 38976368 PMCID: PMC11229696 DOI: 10.1111/hex.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/15/2024] [Accepted: 06/19/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVES Despite high levels of mental ill-health amongst young people (aged 15-30), this group demonstrates low help-seeking and high drop-out from mental health services (MHS). Whilst shared decision-making can assist people in receiving appropriate and effective health care, young people frequently report that they do not feel involved in treatment decisions. The current study focused on co-design of a clinical education and participant information programme for the Brain and Mind Centre Youth Model of Care. This model, which articulates a youth-focused form of highly personalised and measurement-based care, is designed to promote shared decision-making between young people and clinical service providers. METHODS We conducted workshops with 24 young people (16-31; MAge = 21.5) who had accessed mental health services. Participants were asked what advice they would give to young people entering services, before giving advice on existing materials. Workshops were conducted and transcripts were coded using thematic analysis by two lived experience researchers and a clinical researcher. RESULTS Young people found it empowering to be educated on transdiagnostic models of mental illness, namely clinical staging, which gives them a better understanding of why certain treatments may be inappropriate and ineffective, and thus reduce self-blame. Similarly, young people had limited knowledge of links between mental health and other life domains and found it helpful to be educated on multidisciplinary treatment options. Measurement-based care was seen as an important method of improving shared decision-making between young people and health professionals; however, to facilitate shared decision-making, young people also wanted better information on their rights in care and more support to share their expertise in their own needs, values and treatment preferences. CONCLUSIONS These findings will inform the delivery of the further development and implementation of a youth-specific clinical education and participant information programme for the BMC Youth Model. PATIENT OR PUBLIC CONTRIBUTION Workshops were facilitated by researchers with lived expertise in mental ill-health (A.H. and/or C.G.) and a clinical researcher (who has expertise as an academic and a clinical psychologist). A.H. and C.G. were also involved in conceptualisation, analysis, interpretation, review and editing of this paper.
Collapse
Affiliation(s)
- Sarah McKenna
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexis Hutcheon
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Song
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth Scott
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ian Hickie
- The Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
2
|
Reig-Garcia G, Cámara-Liebana D, Suñer-Soler R, Pau-Perich E, Sitjar-Suñer M, Mantas-Jiménez S, Roqueta-Vall-llosera M, Malagón-Aguilera MDC. Assessment of Standardized Care Plans for People with Chronic Diseases in Primary Care Settings. NURSING REPORTS 2024; 14:801-815. [PMID: 38651474 PMCID: PMC11036219 DOI: 10.3390/nursrep14020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases. METHODS A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis. RESULTS ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies. CONCLUSIONS This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered.
Collapse
Affiliation(s)
- Glòria Reig-Garcia
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | - David Cámara-Liebana
- Department of Nursing, University of Girona, 17003 Girona, Spain; (M.S.-S.); (M.R.-V.-l.)
| | - Rosa Suñer-Soler
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | - Eva Pau-Perich
- ABS Cassà de la Selva, Institut d’Assistència Sanitària, 17244 Cassà de la Selva, Spain;
| | - Miquel Sitjar-Suñer
- Department of Nursing, University of Girona, 17003 Girona, Spain; (M.S.-S.); (M.R.-V.-l.)
| | - Susana Mantas-Jiménez
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | | | - Maria del Carmen Malagón-Aguilera
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| |
Collapse
|
3
|
Albanesi B, Piredda M, Dimonte V, De Marinis MG, Matarese M. Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review. Healthcare (Basel) 2023; 11:1681. [PMID: 37372800 DOI: 10.3390/healthcare11121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.
Collapse
Affiliation(s)
- Beatrice Albanesi
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
- Palliative Care Centre 'Insieme nella Cura', Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
| | - Maria Matarese
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| |
Collapse
|
4
|
Zipfel N, de Wit M, Snippen NC, Bosma AR, Hulshof CTJ, de Boer AGEM, van der Burg-Vermeulen SJ. Improving person-centered occupational health care for workers with chronic health conditions: a feasibility study. BMC MEDICAL EDUCATION 2023; 23:224. [PMID: 37029404 PMCID: PMC10082533 DOI: 10.1186/s12909-023-04141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Person-centered care is needed to effectively support workers with chronic health conditions. Person-centered care aims to provide care tailored to an individual person's preferences, needs and values. To achieve this, a more active, supportive, and coaching role of occupational and insurance physicians is required. In previous research, two training programs and an e-learning training with accompanying tools that can be used in the context of person-centered occupational health care were developed to contribute to this changing role. The aim was to investigate the feasibility of the developed training programs and e-learning training to enhance the active, supportive, and coaching role of occupational and insurance physicians needed for person-centered occupational health care. Information about this is important to facilitate implementation of the tools and training into educational structures and occupational health practice. METHODS A qualitative study was conducted, with N = 29 semi-structured interviews with occupational physicians, insurance physicians, and representatives from occupational educational institutes. The aim was to elicit feasibility factors concerning the implementation, practicality and integration with regard to embedding the training programs and e-learning training in educational structures and the use of the tools and acquired knowledge and skills in occupational health care practice after following the trainings and e-learning training. Deductive analysis was conducted based on pre-selected focus areas for a feasibility study. RESULTS From an educational perspective, adapting the face-to-face training programs to online versions, good coordination with educational managers and train-the-trainer approaches were mentioned as facilitating factors for successful implementation. Participants underlined the importance of aligning the occupational physicians' and insurance physicians' competences with the educational content and attention for the costs concerning the facilitation of the trainings and e-learning training. From the professional perspective, factors concerning the content of the training and e-learning training, the use of actual cases from practice, as well as follow-up training sessions were reported. Professionals expressed good fit of the acquired skills into their consultation hour in practice. CONCLUSION The developed training programs, e-learning training and accompanying tools were perceived feasible in terms of implementation, practicality, and integration by occupational physicians, insurance physicians and educational institutes.
Collapse
Affiliation(s)
- Nina Zipfel
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
- Department of Public and Occupational Health, Amsterdam UMC, Coronel Institute of Occupational Health, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - M de Wit
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - N C Snippen
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A R Bosma
- Department of Public and Occupational Health, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - C T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - A G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - S J van der Burg-Vermeulen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Rostam Niakan Kalhori S, Rahmani Katigari M, Talebi Azadboni T, Pahlevanynejad S, Hosseini Eshpala R. The effect of m-health applications on self-care improvement in older adults: A systematic review. Inform Health Soc Care 2023. [PMID: 36867051 DOI: 10.1080/17538157.2023.2171878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PARTICIPANTS Four electronic databases were searched on March 6, 2020 including Scopus, PubMed, ISI, and Embase. METHODS Our search consisted of concepts of "self-care," "elderly" and "Mobile device." English journal papers and, RCTs conducted for individuals older than 60 in the last 10 years were included. A narrative approach was used to synthesize the data due to the heterogeneous nature of the data. RESULTS Initially, 3047 studies were obtained and finally 19 studies were identified for deep analysis. 13 outcomes were identified in m-health interventions to help older adults' self-care. Each outcome has at least one or more positive results. The psychological status and clinical outcome measures were all significantly improved. CONCLUSION According to the findings, it is not possible to draw a definite positive decision about the effectiveness of interventions on older adults because the measures are very diverse and have been measured with different tools. However, it might be declared that m-health interventions have one or more positive results and can be used along with other interventions to improve the health of older adults.
Collapse
Affiliation(s)
- Sharareh Rostam Niakan Kalhori
- Peter L. Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Braunschweig, Germany.,Ph.D of Medical Informatics, Health Information Technology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Rahmani Katigari
- PhD in Health Information Management, Health Information Technology Department, Saveh University of Medical Sciences, Saveh, Iran.,Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Tahere Talebi Azadboni
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.,Ph.D Candidate, Health Information Management Department, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Pahlevanynejad
- Ph.D in Health Information Management, Health Information Technology Department, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Rahil Hosseini Eshpala
- Ph.D Candidate, Health Information Management Department, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Boeykens D, Sirimsi MM, Timmermans L, Hartmann ML, Anthierens S, De Loof H, De Vliegher K, Foulon V, Huybrechts I, Lahousse L, Pype P, Schoenmakers B, Van Bogaert P, Van den Broeck K, Van Hecke A, Verhaeghe N, Vermandere M, Verté E, Van de Velde D, De Vriendt P. How do people living with chronic conditions and their informal caregivers experience primary care? A phenomenological-hermeneutical study. J Clin Nurs 2023; 32:422-437. [PMID: 35178849 DOI: 10.1111/jocn.16243] [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: 10/27/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES Gaining insight in how people living with chronic conditions experience primary healthcare within their informal network. BACKGROUND The primary healthcare system is challenged by the increasing number of people living with chronic conditions. To strengthen chronic care management, literature and policy plans point to a person-centred approach of care (PCC). A first step to identify an appropriate strategy to implement PCC is to gain more insight into the care experiences of these people and their informal caregivers. DESIGN A phenomenological-hermeneutical philosophy is used. The study is in line with the Consolidated Criteria for Reporting Qualitative Research Guidelines (COREQ). METHOD In-depth, semi-structured interviews with people living with chronic conditions and informal caregiver dyads (PCDs) (n = 16; 32 individuals) were conducted. An open-ended interview guide was used to elaborate on the PCDs' experiences regarding primary care. A purposive, maximal variation sampling was applied to recruit the participants. RESULTS Based on sixteen PCDs' reflections, ten themes were identified presenting their experiences with primary care and described quality care as listening and giving attention to what people with chronic conditions want, to what they strive for, and above all to promote their autonomy in a context wherein they are supported by a team of formal caregivers, family and friends. CONCLUSION To meet the PCDs' needs, self-management should be addressed in an interprofessional environment in which the PCD is an important partner. The findings may facilitate a shift to encourage PCDs in their strengths by enabling them to share their personal goals and by working towards meaningful activities in team collaboration. RELEVANCE TO CLINICAL PRACTICE Three strategies-self-management support, goal-oriented care, and interprofessional collaboration-have been suggested to improve the PCDs' primary care experiences. These strategies could guide nursing practice in using more and improve high-quality nursing care.
Collapse
Affiliation(s)
- Dagje Boeykens
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Muhammed Mustafa Sirimsi
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium.,Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lotte Timmermans
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Maja Lopez Hartmann
- Department of Welfare and Health, Karel de Grote University of Applied Sciences and Arts, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Faculty of Pharmaceutical Sciences, KU Leuven, Leuven, Belgium
| | - Ine Huybrechts
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Peter Van Bogaert
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University Centre of Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research group Social and Economic Policy and Social Inclusion, Research Institute for Work and Society, KU Leuven - HIVA, Leuven, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Emily Verté
- Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium.,Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) research group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
| | | |
Collapse
|
7
|
Rasmussen B, Wynter K, Hamblin PS, Rodda C, Steele C, Holton S, Zoffmann V, Currey J. Feasibility and acceptability of an online guided self-determination program to improve diabetes self-management in young adults. Digit Health 2023; 9:20552076231167008. [PMID: 37021125 PMCID: PMC10068990 DOI: 10.1177/20552076231167008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Objective Evaluate the feasibility and acceptability of an online guided self-determination (GSD) program to improve diabetes self-management skills among young adults with type 1 diabetes (YAD). Methods An online program comprising seven structured interactive conversations was designed. A pre- and post- interventional study used a sequential, two-phase multiple method design. Phase one comprised a training program for diabetes educators (DEs). In Phase two YAD participated in program and completed pre- and post-surveys assessing motivation to self-manage, perceived competence in diabetes and communication with DEs. Both YAD and DEs provided a program evaluation. Results The online GSD program was acceptable, feasible and effective in improving autonomous motivation in self-management and communication with DEs. Easy access and program flexibility were highly appreciated by both participant groups and perceived to assist YAD to stay motivated. Conclusion The program had a significant impact on the diabetes self-management of YAD and was a feasible and acceptable way to engage and communicate with DEs. The GSD platform contributes to age appropriate and person-centred diabetes self-management. It can potentially reach geographically distanced populations, or with social circumstances or other barriers impeding in-person service provision.
Collapse
Affiliation(s)
- Bodil Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient
Safety Research in the Institute for Health Transformation,
Deakin
University, Geelong, Australia
- The Centre for Quality and Patient Safety Research in the Institute
of Health Transformation – Western Health Partnership,
Western
Health, St Albans, Australia
- Faculty of Health and Medical Sciences,
University of
Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark and Steno
Diabetes Center, Odense, Denmark
- Bodil Rasmussen, School of Nursing and
Midwifery, Centre for Quality and Patient Safety Research in the Institute for
Health Transformation, Deakin University, Geelong, Australia; The Centre for
Quality and Patient Safety Research in the Institute of Health Transformation -
Western Health Partnership, Western Health, St Albans, Australia; Faculty of
Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes
Center, Odense, Denmark.
| | - Karen Wynter
- School of Nursing and Midwifery, Centre for Quality and Patient
Safety Research in the Institute for Health Transformation,
Deakin
University, Geelong, Australia
- The Centre for Quality and Patient Safety Research in the Institute
of Health Transformation – Western Health Partnership,
Western
Health, St Albans, Australia
| | - Peter S Hamblin
- Endocrinology & Diabetes Department,
Western
Health, St Albans, Australia
- Institute for Health Transformation, Faculty of Health,
Deakin
University, Burwood, Australia
- Western Health, University of Melbourne, St Albans, Australia
| | - Christine Rodda
- Western Health, University of Melbourne, St Albans, Australia
- Western Health, Sunshine Hospital, St Albans, Australia
| | - Cheryl Steele
- Western Health, Sunshine Hospital, St Albans, Australia
| | - Sara Holton
- School of Nursing and Midwifery, Centre for Quality and Patient
Safety Research in the Institute for Health Transformation,
Deakin
University, Geelong, Australia
- The Centre for Quality and Patient Safety Research in the Institute
of Health Transformation – Western Health Partnership,
Western
Health, St Albans, Australia
| | - Vibeke Zoffmann
- School of Nursing and Midwifery, Centre for Quality and Patient
Safety Research in the Institute for Health Transformation,
Deakin
University, Geelong, Australia
- Department of Public Health, University of
Copenhagen, Copenhagen K, Denmark
- The Interdisciplinary Research Unit of Women's, Children's and
Families’ Health, Juliane Marie Centre: Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
| | - Judy Currey
- School of Nursing and Midwifery, Centre for Quality and Patient
Safety Research in the Institute for Health Transformation,
Deakin
University, Geelong, Australia
| |
Collapse
|
8
|
Abey S, Anil K, Hendy P, Demain S. The application, character, and effectiveness of person-centred care with service-users, and the community within the discipline of podiatry: a scoping review. J Foot Ankle Res 2022; 15:63. [PMID: 35986405 PMCID: PMC9389826 DOI: 10.1186/s13047-022-00566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background The concept of person-centred care is embedded within healthcare policy, focusing on long-term conditions and multimorbidity. The evidence that person-centred care is being operationalised effectively across all areas of healthcare is limited. The aim of this scoping review was to explore the application, features, and effectiveness of person-centred care with service-users, carers, and the community within podiatry. Methods The scoping review was based upon Arksey and Malley’s five stage framework. The following databases were searched between January 2010 and March 2021: AMED, CINAHL, Embase, Cochrane library, SocINDEX, British Education Index, Business Source Complete, MEDLINE (EBSCO), and the EThOS 'Global electronic thesis and dissertation' repository, Prospero, and reference lists of included papers. Primary research articles were included if they reported on a person-centred care focused intervention with podiatry. Research terms were developed, appropriate databases identified, and an initial search resulted in 622 papers which, following removal of duplicates and critical appraisal, resulted in 18 eligible papers. Data extracted involved the types of person-centred care utilised, intervention details, motivations for engaging in person-centred care interventions, and intervention barriers and challenges. Results Eighteen articles were included in the review. The main type of person-centred care utilised was patient/carer activities around self-management. None of the studies considered the role of the podiatrist as a person-centred care agent. The data on interventions generated the following themes ‘service facilitated person-centred care’ where a change has been made to service delivery, ‘direct clinician delivery’ where the intervention is delivered by the clinician with the patient present and ‘patient instigated participation’ where patient motivation is required to engage with an activity beyond the consultation. Outcome measures associated with quality of care and effectiveness were absent. Conclusion There is a lack of congruency between the concept of person-centred care and how it is operationalised. A whole system approach that considers commissioning, organisational leadership, the role of the practitioners and patients has not been considered. There is immense scope for the podiatrist to play an important part in the personalised-care agenda, but currently research that can evidence the effectiveness of person-centred care in podiatry is absent. Review registration Open Science Framework (osf.io/egjsd).
Collapse
|
9
|
Head KJ, Hartsock JA, Bakas T, Boustani MA, Schroeder M, Fowler NR. Development of Written Materials for Participants in an Alzheimer's Disease and Related Dementias Screening Trial. J Patient Exp 2022; 9:23743735221092573. [PMID: 35434299 PMCID: PMC9009139 DOI: 10.1177/23743735221092573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Given that participants' experiences in clinical trials include a variety of communication touchpoints with clinical trial staff, these communications should be designed in a way that enhances the participant experience by paying attention to the self-determination theoretical concepts of competence, autonomy, and relatedness. In this feature, we argue that clinical trial teams need to consider the importance of how they design their written participant communication materials, and we explain in detail the process our multidisciplinary team took to design written materials for the patient and family caregiver participants in our Alzheimer's disease and related dementias (ADRD) screening trial. This article concludes with suggested guidance and steps for other clinical trial teams.
Collapse
Affiliation(s)
- Katharine J Head
- Department of Communication Studies, Indiana University–Purdue University
Indianapolis, Indianapolis, IN, USA
| | - Jane A. Hartsock
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of
Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN,
USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational
Science Institute, USA
| | | | - Nicole R Fowler
- Department of Medicine, Indiana University School of
Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN,
USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational
Science Institute, USA
| |
Collapse
|
10
|
Schmidt K, Faerch K, Zoffmann V, Amadid H, Varming AR. The process of health behaviour change following participation in a randomised controlled trial targeting prediabetes: A qualitative study. Diabet Med 2022; 39:e14748. [PMID: 34806793 DOI: 10.1111/dme.14748] [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: 05/10/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
AIM To explore how participating in a randomised controlled trial affected motivation, barriers and strategies in the process of health behaviour change among individuals with prediabetes. METHODS An extension to the PRE-D trial, a qualitative study investigated the efficacy of glucose-lowering interventions (metformin, dapagliflozin or exercise) compared with a control group among individuals with prediabetes and overweight/obesity. Data were collected through separate focus group interviews with participants using semi-structured interview guides inspired by health behaviour change theories. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis with an inductive-deductive approach. RESULTS Four interrelated themes were generated from interviews: (1) 'self-construction of prediabetes', on how participants understood the term 'prediabetes', (2) 'altered health image', on how participants' health perceptions were affected, (3) 'personal strategies for health behaviour change', on different ways to attempt to implement behaviour changes and (4) 'the process of health behaviour change', on how participants progressed and relapsed while trying to change behaviour. Themes relate to the health belief model, self-determination theory, self-efficacy and the trans-theoretical model of change. Participants shared their experiences and thoughts during interviews and inspired each other, which led some participants to develop a new perspective on prediabetes severity and increased their motivation for behaviour change. CONCLUSIONS How participants perceived and accepted, rejected or neglected prediabetes appeared to affect their health images and whether they realised a need for behaviour change. Their achievements during interventions, health literacy, self-efficacy and perceived support from their social networks, professionals and technological aids influenced the maintenance of health behaviour changes.
Collapse
Affiliation(s)
- Kirstine Schmidt
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Kristine Faerch
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hanan Amadid
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Annemarie R Varming
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
11
|
Loizeau V, Morvillers JM, Bertrand DP, Kilpatrick K, Rothan-Tondeur M. Defining an enabling environment for those with chronic disease: an integrative review. BMC Nurs 2021; 20:252. [PMID: 34930230 PMCID: PMC8686648 DOI: 10.1186/s12912-021-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management. METHODS An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used. RESULTS A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment. CONCLUSION This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.
Collapse
Affiliation(s)
- Valérie Loizeau
- Centre Hospitalier Intercommunal Poissy Saint Germain, Université Sorbonne Paris Nord, Nursing Sciences Research Chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France.
| | - Jean-Manuel Morvillers
- Research in Nursing Sciences, Health Education and Practice Laboratory (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| | | | - Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke Street West, Office 1811, Montreal, Quebec, H3A 2M7, Canada
| | - Monique Rothan-Tondeur
- Research in Nursing Sciences Tondeur, Paris, France
- Laboratoire d'Enseignements et de Pratiques de Santé (LEPS), (EA 3412), UFR SMBH, F-93017, Bobigny, France
| |
Collapse
|
12
|
Kiss D, Pados E, Kovács A, Mádi P, Dervalics D, Bittermann É, Schmelowszky Á, Rácz J. "This is not life, this is just vegetation"-Lived experiences of long-term care in Europe's largest psychiatric home: An interpretative phenomenological analysis. Perspect Psychiatr Care 2021; 57:1981-1990. [PMID: 33811648 DOI: 10.1111/ppc.12777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/06/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Understanding the experiences of long-term care (LTC) may help to improve care by assisting mental health professionals and allowing mental health policies to be customized more effectively. DESIGN AND METHODS: Semistructured interviews were analyzed using interpretative phenomenological analysis (IPA). FINDINGS Three main themes emerged as a result: 1. Perception of selves, 2. Experience and representation of the institution, 3. Maintenance of safe spaces. PRACTICE IMPLICATIONS: Communication with patients, investigation of their identity processes, and relationship toward their past and present self during LTC might aid in well-being and sense of congruency in their identities. Nurses should encourage patients to keep connected with their memories and past selves through different activities.
Collapse
Affiliation(s)
- Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Pados
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Asztrik Kovács
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Péter Mádi
- Hungarian Rapid Response Police Unit, Budapest, Hungary
| | - Dóra Dervalics
- Kilátó Piarist Career Guidance and Labor Market Development Center, Budapest, Hungary
| | | | | | - József Rácz
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Department of Addictology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary
| |
Collapse
|
13
|
Haugstvedt A, Hernar I, Graue M, Strandberg RB, Stangeland Lie S, Sigurdardottir AK, Richards D, Kolltveit BCH. Nurses' and physicians' experiences with diabetes consultations and the use of dialogue tools in the DiaPROM pilot trial: A qualitative study. Diabet Med 2021; 38:e14419. [PMID: 33035378 DOI: 10.1111/dme.14419] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 01/11/2023]
Abstract
AIM To explore nurses' and physicians' experiences with diabetes consultations in general and the use of dialogue tools in the Diabetes Patient-Related Outcome Measures (DiaPROM) pilot trial. METHODS We used a qualitative explorative design by conducting semi-structured in-depth interviews with five nurses and nine physicians engaged in the DiaPROM pilot trial. The pilot trial aimed to test an intervention utilizing the patient-reported Problem Areas In Diabetes (PAID) scale and person-centred communication skills as dialogue tools in clinical consultations with adults with type 1 diabetes. We used thematic analysis to analyse the data. RESULTS We generated three themes (each including two subthemes) from the analysis of participants' experiences: (1) 'Conflicting demands and priorities' (subthemes: 'Balancing guideline recommendations with patients' main concerns' and 'Experiencing that patients need more support to disclose their emotional concerns'); (2) 'Insights about using dialogue tools' (subthemes: 'The benefits and challenges of using the PAID as a dialogue tool' and 'Communication techniques are helpful'); and (3) 'Facilitating new interventions is challenging' (subthemes: 'Unclear roles and responsibilities in the multidisciplinary teamwork' and 'The capacity sets the limit, not the willingness'). CONCLUSIONS Our findings indicate that the physicians and nurses experienced substantial challenges related to time and resources in the use of dialogue tools to support people's emotional concerns in clinical diabetes consultations. Thus, there is a need for healthcare organizations to adjust priorities to focus on the emotional burden of diabetes if the multidisciplinary diabetes teams are to successfully integrate psychosocial support into routine diabetes care.
Collapse
Affiliation(s)
- A Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - I Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - M Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - R B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - A K Sigurdardottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland
- Akureyri Hospital, Akureyri, Iceland
| | - D Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - B-C H Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
14
|
Brouwer-Goossensen D, Scheele M, van Genugten L, Lingsma HF, Dippel DWJ, Koudstaal PJ, den Hertog HM. Motivational interviewing in a nurse-led outpatient clinic to support lifestyle behaviour change after admission to a stroke unit: a randomized controlled trial. Eur J Cardiovasc Nurs 2021; 21:36-45. [PMID: 33824973 DOI: 10.1093/eurjcn/zvab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
AIMS Modification of health behaviour is an important part of stroke risk management. However, the majority of people with cardiovascular disease fail to sustain lifestyle modification in the long term. We aimed to evaluate the effectiveness of motivational interviewing to encourage lifestyle behaviour changes after transient ischaemic attack (TIA) or minor ischaemic stroke. METHODS AND RESULTS We performed a randomized controlled open-label phase II trial with blinded endpoint assessment. The intervention consisted of three 15-minute visits in 3 months by a motivational interviewing trained nurse practitioner. Patients in the control group received standard consultation after 1 and 3 months by a nurse practitioner. Primary outcome was lifestyle behaviour change, defined as smoking cessation and/or increased physical activity (30 min/day) and/or healthy diet improvement (5 points at the Food Frequency Questionnaire) at 6 months. We adjusted for age and sex with multivariable logistic regression. Between January 2014 and February 2016, we included 136 patients (of whom 68 were assigned to the intervention group). Twenty-five of 55 patients in the intervention group (45%) and 27 of 61 patients in the control group (44%) had changed their lifestyle at 6 months. We found no effect of motivational interviewing on lifestyle behaviour change after 6 months (aOR 0.99; 95% confidence interval: 0.44-2.26). CONCLUSION Our results do not support the effectiveness of motivational interviewing in supporting lifestyle behaviour change after TIA or ischaemic stroke. However, the overall lifestyle behaviour change was high and might be explained by the role of specialized nurses in both groups.
Collapse
Affiliation(s)
- Dorien Brouwer-Goossensen
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maaike Scheele
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lenneke van Genugten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | | |
Collapse
|
15
|
Thomsen TH, Jørgensen LB, Kjær TW, Winge K, Haahr A. Identification of Pre-Dominant Coping Types in Patients with Parkinson’s Disease: An Abductive Content Analysis of Video-Based Narratives. JOURNAL OF PARKINSONS DISEASE 2021; 11:349-361. [DOI: 10.3233/jpd-202217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: People with Parkinson’s disease suffer from a range of various symptoms. Altered movement patterns frequently represent the prevailing symptom experience and influence the everyday life of the affected persons. Objective: This qualitative study explores how persons with Parkinson‘s disease experience everyday life with a complex symptom profile and how they manage the consequential challenges in their daily life, as well as the motivation and consequences of these coping behaviours. Methods: Thirty-four patients with Parkinson’s disease were interviewed as an integrated part of the method Video-based Narrative. The interviews were analysed by means of qualitative content analysis according to Graneheim & Lundman. Results: The analysis identified six predominant coping types with different behavioural traits: The convincing behaviour, The economizing behaviour, The encapsulating behaviour, The evasive behaviour, The adaptable behaviour, and The dynamic behaviour. The strategies embedded in each of the six types are diverse, but all participants seek to maintain their integrity in different ways leading to the main motivation “To stay the same person”. Conclusion: Healthcare professionals should be aware of the patients‘ various coping behaviour in order to offer a person-centred approach. Psychoeducational interventions to promote coping skills may be essential in incorporating disease-related changes in the conduct of everyday life with Parkinson’s disease to maintain integrity.
Collapse
Affiliation(s)
- Trine Hørmann Thomsen
- Department of Clinical Neurophysiology and Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Bastrup Jørgensen
- Knowledge Centre for Neurorehabilitation, Hammel, Western Denmark
- Department of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Troels Wesenberg Kjær
- Department of Clinical Neurophysiology and Neurology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Winge
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Anita Haahr
- Centre for Health promotion and Rehabilitation, VIA University College, Aarhus N, Denmark
| |
Collapse
|
16
|
Mathiesen AS, Rothmann MJ, Zoffmann V, Jakobsen JC, Gluud C, Lindschou J, Due-Christensen M, Rasmussen B, Marqvorsen E, Thomsen T. Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and trial sequential analysis. Syst Rev 2021; 10:12. [PMID: 33413645 PMCID: PMC7791693 DOI: 10.1186/s13643-020-01566-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Existing self-management and behavioural interventions for diabetes vary widely in their content, and their sustained long-term effectiveness is uncertain. Autonomy supporting interventions may be a prerequisite to achieve 'real life' patient engagement and more long-term improvement through shared decision-making and collaborative goal setting. Autonomy supportive interventions aim to promote that the person with diabetes' motivation is autonomous meaning that the person strives for goals they themselves truly believe in and value. This is the goal of self-determination theory and guided self-determination interventions. Self-determination theory has been reviewed but without assessing both benefits and harms and accounting for the risk of random errors using trial sequential analysis. The guided self-determination has not yet been systematically reviewed. The aim of this protocol is to investigate the benefits and harms of self-determination theory-based interventions versus usual care in adults with diabetes. METHODS/DESIGN We will conduct the systematic review following The Cochrane Collaboration guidelines. This protocol is reported according to the PRISMA checklist. A comprehensive search will be undertaken in the CENTRAL, MEDLINE, EMBASE, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S and CPCI-SSH to identify relevant trials. We will include randomised clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory provided face-to-face or digitally by any healthcare professional in any setting. The primary outcomes will be quality of life, mortality, and serious adverse events. The secondary will be diabetes distress, depressive symptoms and adverse events not considered serious. Exploratory outcomes will be glycated haemoglobin and motivation. Outcomes will be assessed at the end of the intervention and at maximum follow-up. The analyses will be performed using Stata version 16 and trial sequential analysis. Two authors will independently screen, extract data from and perform risk of bias assessment of included studies using the Cochrane risk of bias tool. Certainty of the evidence will be assessed by GRADE. DISCUSSION Self-determination theory interventions aim to promote a more autonomous patient engagement and are commonly used. It is therefore needed to evaluate the benefit and harms according to existing trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020181144.
Collapse
Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia
| | - Vibeke Zoffmann
- The Research Unit Women's and Children's Health, The Julie Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Mette Due-Christensen
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Bodil Rasmussen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Marqvorsen
- The Research Unit Women's and Children's Health, The Julie Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
17
|
Botin L, Bertelsen PS, Kayser L, Turner P, Villumsen S, Nøhr C. People Centeredness, Chronic Conditions and Diversity Sensitive eHealth: Exploring Emancipation of the 'Health Care System' and the 'Patient' in Health Informatics. Life (Basel) 2020; 10:life10120329. [PMID: 33297318 PMCID: PMC7762218 DOI: 10.3390/life10120329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022] Open
Abstract
Health care systems struggle to consistently deliver integrated high-quality, safe, and patient-centered care to all in an economically sustainable manner. Inequity of access to health care services and variation in diagnostic and treatment outcomes are common. Further, as health care systems become ever more complex, iatrogenesis and counter productivity have emerged as real dangers. In exploring this paradox, this paper considers a subset of those in society living with chronic conditions. Their attributes and circumstances have led to them being marginalized or excluded from ‘end-user’ engagement and/or from their requirements being incorporated into technology supported chronic disease management initiatives. Significantly, these citizens are often the most vulnerable and socially disadvantaged and tend to achieve poorer results and cost more per capita than the ‘average patient’ in their interactions with the health care system. Critically, this paper argues that a truly people-centered technology supported chronic care system can only be designed by understanding and responding to the needs, attributes and capabilities of the most vulnerable in society. This paper suggests innovative ways of supporting interactions with these ‘end-users’ and highlights how reflection on these approaches can contribute to emancipating the health system to move towards more socially inclusive eHealth solutions.
Collapse
Affiliation(s)
- Lars Botin
- Danish Centre for Health Informatics, Techno-Anthropology & Participation, Aalborg University, DK-9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-51336604
| | - Pernille S. Bertelsen
- Danish Centre for Health Informatics, Techno-Anthropology & Participation, Aalborg University, DK-9000 Aalborg, Denmark;
| | - Lars Kayser
- Health Informatics & Innovation, University of Copenhagen, DK-1353 Copenhagen, Denmark;
| | - Paul Turner
- eHealth Services Research Group (eHSRG), University of Tasmania, Tasmania, TAS 7001, Australia;
| | - Sidsel Villumsen
- Human Resource Development, Central Denmark Region, DK-8200 Aarhus, Denmark;
| | - Christian Nøhr
- Maersk Mc-Kinney Møller Institute, University of Southern Denmark, DK-5230 Odense, Denmark;
| |
Collapse
|
18
|
Barenfeld E, Ali L, Wallström S, Fors A, Ekman I. Becoming more of an insider: A grounded theory study on patients' experience of a person-centred e-health intervention. PLoS One 2020; 15:e0241801. [PMID: 33226986 PMCID: PMC7682879 DOI: 10.1371/journal.pone.0241801] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim was to explore the experiences of a person-centred e-health intervention, in patients diagnosed with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF). DESIGN Grounded theory was applied to gather and analyse data. SETTING The study is part of a research project evaluating the effects of person-centred care (PCC) using a digital platform and structured telephone support for people with COPD or CHF recruited from nine primary care units in Sweden. PARTICIPANTS Twelve patients from the intervention group were purposefully selected in accordance with the initial sampling criteria. INTERVENTION The intervention was delivered through a digital platform and telephone support system for 6 months. The intervention relied on person-centred ethics operationalised through three core PCC components: patient narratives, partnership and shared documentation. RESULTS A core category was formulated: Being welcomed through the side door when lacking the front door keys. The core category reflects how a PCC intervention delivered remotely provides access to mutual and informal meetings at times when professional contacts were desired to support patient self-management goals. According to patients' wishes, family and friends were seldom invited as care partners in the e-health context. CONCLUSIONS A PCC intervention delivered remotely as a complement to standard care in a primary care setting for patients diagnosed with COPD or CHF is a viable approach to increase patients' access and involvement in preventive care. The e-health intervention seemed to facilitate PCC, strengthen patients' position in the health service system and support their self-management.
Collapse
Affiliation(s)
- Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
19
|
Buttigieg SC, Tomaselli G, Byers V, Cassar M, Tjerbo T, Rosano A. Corporate social responsibility and person-centered care: a scoping review. JOURNAL OF GLOBAL RESPONSIBILITY 2019. [DOI: 10.1108/jgr-01-2019-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe aim of this paper was to explore the linkage between corporate social responsibility (CSR) and person-centered care (PCC). The scope of the review was, therefore, to identify whether – as a result of such linkage – CSR may be a potential vehicle for delivering PCC within health-care organizations.Design/methodology/approachData were retrieved by searching multiple keywords on PubMed, Medline and Scopus databases with inclusion/exclusion criteria based on years of publication from 2001 to 2018, language, no geographic restrictions, paper focus, research and document types. A total of 56 articles (N = 56) were selected and reviewed. Thematic analysis was conducted to identify and compare the main features of PCC and CSR.FindingsThe findings revealed that while CSR and PCC are interrelated, CSR features are not being exploited in their entirety in formalizing PCC as part of the CSR strategy. In particular, the two salient CSR features explicitly referred to in conjunction with explicit PCC characteristics are quality of care and health communication. Furthermore, patients’ rights and dignity were the leading implicit CSR features mentioned in conjunction with both explicit and implicit PCC characteristics.Research limitations/implicationsSubjectivity of researchers, limited number of databases and publication types included are the main limitations of this research.Originality/valueTo the best of the authors’ knowledge, this is the first paper analyzing CSR and PCC in an interrelated way.
Collapse
|
20
|
Johansson K, Österberg SA, Leksell J, Berglund M. Supporting patients learning to live with diabetes: a phenomenological study. ACTA ACUST UNITED AC 2019; 27:697-704. [PMID: 29953270 DOI: 10.12968/bjon.2018.27.12.697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a study of the phenomenon of supporting patients who are learning to live with diabetes, from a diabetes specialist nurse (DSN) perspective. Guided by principles of reflective lifeworld research, data from six interviews (four in groups and two individual) with 16 DSNs were analysed. The results show that, in order to support learning, DSNs use a self-critical approach with the insight that they should not take over responsibility for their patients' diabetes. The DSNs support, encourage and challenge the patients to self-reflect and take responsibility based on patients' own goals and needs. To provide support, DSNs need to assume a tactful, critically challenging approach, dare to confront patients' fears and other emotions and have the insight to know that the responsibility for learning and integration of the condition lies with the patient. To be able to support patients in this way, it is necessary that the DSN is mentored and supported in this role.
Collapse
Affiliation(s)
- Karin Johansson
- Diabetes Specialist Nurse in Primary Health Care, Department of Administration/Primary Care, Region Kronoberg County Council, Växjö, Sweden
| | - Sofia Almerud Österberg
- Associate Professor, Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden
| | - Janeth Leksell
- Associate Professor, School of Health and Social Sciences, University Dalarna, Falun, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Berglund
- Associate Professor, School of Health and Education, University of Skövde, Skövde, Sweden
| |
Collapse
|
21
|
Ribu L, Rønnevig M, Corbin J. People with type 2 diabetes struggling for self-management: A part study from the randomized controlled trial in RENEWING HEALTH. Nurs Open 2019; 6:1088-1096. [PMID: 31367434 PMCID: PMC6650665 DOI: 10.1002/nop2.293] [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: 01/08/2019] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 01/04/2023] Open
Abstract
AIM To develop a theoretical explanation for the daily life problems and challenges perceived by those living with type 2 diabetes. DESIGN AND METHODS We used a grounded theory approach with a constant comparative method to discover a framework with the core concept of struggling between "ought to do" and "want to do" and related concepts. RESULTS The struggle to self-manage and maintain new habits can be more or less difficult depending on the patient's perceived conditions. We identified three situations illustrated in a diagram: one where there is less struggle to let go of old habits, a second where there is more of a struggle to balance between what individuals want to do and what they ought to do and a third where they are giving up struggling. Study findings show that healthcare personnel must consciously seek to understand how patients perceive their own situation.
Collapse
Affiliation(s)
- Lis Ribu
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet—Oslo Metropolitan UniversityOsloNorway
| | - Marit Rønnevig
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet—Oslo Metropolitan UniversityOsloNorway
| | - Juliet Corbin
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet—Oslo Metropolitan UniversityOsloNorway
| |
Collapse
|
22
|
Oftedal B, Kolltveit BH, Graue M, Zoffmann V, Karlsen B, Thorne S, Kristoffersen M. Reconfiguring clinical communication in the electronic counselling context: The nuances of disruption. Nurs Open 2019; 6:393-400. [PMID: 30918689 PMCID: PMC6419105 DOI: 10.1002/nop2.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
AIM This study expands on an earlier study about diabetes nurses' experiences of the Guided Self-Determination intervention in face-to-face consultations among people with type 2 diabetes. This current study investigates Guided Self-Determination in an electronic format with the aim to explore what can be learned about the written form for health communication from the perspectives of diabetes nurses in primary care. DESIGN The study has an explorative, qualitative design. METHOD Four diabetes nurses were individually interviewed after completing the electronic intervention. The analysis was guided by Interpretive Description. RESULTS Small sample size apart, the rich empirical data and quality of dialogue point to the interviewees' earlier contact, comfort and trust with the researcher. The written electronic communication could disrupt nurses' possibilities for using basic and advanced communication skills. Findings also indicate that written electronic communication can foster thoughtful responses to patients and increase possibilities for a transparent counselling delivery process.
Collapse
Affiliation(s)
- Bjørg Oftedal
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Beate‐Christin Hope Kolltveit
- Faculty of Health and Social Sciences, Centre for Evidence‐Based PracticeWestern Norway University of Applied SciencesBergenNorway
| | - Marit Graue
- Faculty of Health and Social Sciences, Centre for Evidence‐Based PracticeWestern Norway University of Applied SciencesBergenNorway
| | - Vibeke Zoffmann
- The Research Unit Women’s and Children’s HealthThe Juliane Marie CentreUniversity HospitalCopenhagenCopenhagenDenmark
| | - Bjørg Karlsen
- Faculty of Health SciencesUniversity of StavangerStavangerNorway
| | - Sally Thorne
- School of NursingUniversity of British ColumbiaVancouverBCCanada
| | | |
Collapse
|
23
|
Andersson S, Berglund M, Vestman C, Kjellsdotter A. Experiences of specially trained personnel of group education for patients with type 2 diabetes-A lifeworld approach. Nurs Open 2019; 6:635-641. [PMID: 30918714 PMCID: PMC6419299 DOI: 10.1002/nop2.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/03/2018] [Accepted: 01/09/2019] [Indexed: 11/29/2022] Open
Abstract
AIM To describe how the group education process for people with type 2 diabetes is experienced by diabetes nurses and dietitians who support the patients' learning, in a primary care setting. DESIGN The project took place at two primary care settings in the south of Sweden. METHODS Data collected from focus-group interviews and reflection notes were subjected to phenomenological analysis. RESULTS The specially trained personnel experienced that group education made it possible for the patients to learn through reflection concerning their own and others' experiences. Furthermore, group education entailed increased knowledge for the trained personnel. When the patients were challenged to make changes in their lives with the illness, the personnel experienced that both patients and personnel supported each other. The study concludes that the trained personnel person-centred approach, with help of the didactic model, get tools to support patients learning.
Collapse
Affiliation(s)
| | - Mia Berglund
- School of Health and EducationUniversity of SkövdeSkövdeSweden
| | | | - Anna Kjellsdotter
- School of Health and EducationUniversity of SkövdeSkövdeSweden
- Research and Development CentreSkaraborg Hospital SkövdeSkövdeSweden
| |
Collapse
|
24
|
Lie SS, Karlsen B, Graue M, Oftedal B. The influence of an eHealth intervention for adults with type 2 diabetes on the patient-nurse relationship: a qualitative study. Scand J Caring Sci 2019; 33:741-749. [PMID: 30866066 DOI: 10.1111/scs.12671] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND A constructive patient-nurse relationship is beneficial in self-management support approaches. Research indicates eHealth interventions hold a potential for self-management support for adults with type 2 diabetes. However, eHealth may change the patient-nurse relationship. No studies to date have addressed how eHealth self-management support interventions with written asynchronous communication can influence the relationship between patients and nurses. AIM The aim of this study was to explore how an eHealth intervention based on the Guided Self-Determination program (eGSD) influences the patient-nurse relationship from the perspective of patients participating and the nurses conducting the intervention. METHODS A qualitative approach with individual semi-structured interviews was used. Ten patients with type 2 diabetes who completed the eGSD and four nurses who delivered the intervention participated. The data were transcribed verbatim, and qualitative content analysis was used to analyse the text. RESULTS The findings revealed two themes: 'eGSD facilitates a reciprocal understanding and a flexibility in the relationship' and 'eGSD creates a more fragile relationship', reflecting ambiguous experiences with the eGSD. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE The findings indicate that eGSD influences the patient-nurse relationship by facilitating reciprocal understanding and flexibility. Both patients and RNs acknowledged these outcomes as beneficial. Nevertheless, familiar in-person consultations were expressed as integral for the patient-nurse relationship. As written communication in eHealth is a novelty, it demands new knowledge and expertise that RNs must master. Findings from this study may therefore be acknowledged when developing and implementing eHealth interventions. Education programs in written eHealth communication, as well as guidelines and frameworks on how to professionally and effectively conduct eHealth services while maintaining supportive patient-nurse relationships, should be a priority for institutions that educate healthcare personnel, health institutions and other stakeholders.
Collapse
Affiliation(s)
- Silje S Lie
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Faculty of Health Studies, VID Specialized University, Sandnes, Norway
| | - Bjørg Karlsen
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marit Graue
- Centre for Evidence-based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Oftedal
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
25
|
Haugstvedt A, Hernar I, Strandberg RB, Richards DA, Nilsen RM, Tell GS, Graue M. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: study protocol for the DiaPROM randomised controlled trial pilot study. BMJ Open 2019; 9:e024008. [PMID: 30782722 PMCID: PMC6340474 DOI: 10.1136/bmjopen-2018-024008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Although diabetes distress is found to be associated with decreased glycaemic control among adults with type 1 diabetes, the psychological and emotional impact of living with the condition is often not recognised and often under-reported in diabetes care. Therefore, regular assessment of diabetes distress is recommended. Assessment of diabetes distress using patient-reported outcome measures (PROMs) in clinical practice has the potential to enhance care for people with diabetes by identifying problems and improving patient-clinician communication. In this study protocol, we describe a pilot randomised controlled trial (RCT) aiming to test the feasibility of all components of an empowerment-based intervention using PROMs as dialogue support in clinical diabetes consultations, and to address the uncertainties associated with running a fully powered evaluation study. METHODS AND ANALYSIS We will undertake a two-arm pilot RCT of an intervention using the Problem Areas In Diabetes (PAID) scale in clinical diabetes consultations in order to conclude whether a fully powered trial is appropriate and/or feasible. The study will also include qualitative indepth interviews with participants and healthcare providers. Our objectives are to (1) evaluate the recruitment procedures and attrition rates; (2) evaluate the performance of the randomisation procedure; (3) evaluate the participants' mean scores on the outcome measures before and after the intervention; (4) evaluate if the intervention consultations are acceptable and feasible; and (5) explore patients' and healthcare providers' experiences with the use of PAID as dialogue support and empowerment-based communication skills in clinical diabetes consultations. The quantitative data analysis includes descriptive statistics (frequencies, percentages, means, SD and CI). For the qualitative data, we will perform thematic analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Western Norway Regional Committee for Medical and Health Research Ethics (2017/1506/REC west). We will present the findings from the study phases at national and international conferences and submit manuscripts to peer-reviewed journals and popular science journals. TRIAL REGISTRATION NUMBER NCT03471104; Pre-results.
Collapse
Affiliation(s)
- Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - David A Richards
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Roy Miodini Nilsen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
26
|
Mathiesen AS, Egerod I, Jensen T, Kaldan G, Langberg H, Thomsen T. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes 2019; 12:19-33. [PMID: 30588053 PMCID: PMC6301434 DOI: 10.2147/dmso.s179301] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Diabetes distress (DD) disproportionately affects vulnerable people with type 2 diabetes mellitus and interventions targeting this population are therefore relevant. A systematic review and meta-analysis was performed to assess the evidence for an effect of psychosocial interventions for reducing DD, and, secondly HbA1c, depression, and health-related quality of life in vulnerable people with type 2 diabetes mellitus. Vulnerability encompasses poor glycemic control (HbA1c >7.5%) and at least one additional risk factor for poor diabetes outcomes such as low educational level, comorbidity, and risky lifestyle behavior. The interventions should be theoretically founded and include cognition- or emotion-focused elements. We systematically searched four databases for articles published between January 1995 and March 2018. Eighteen studies testing a variety of psychosocial interventions in 4,066 patients were included. We adhered to the Cochrane methodology and PRISMA guidelines. Review Manager 5.3 was used for data extraction and risk of bias assessment, and Grades of Recommendation, Assessment, Development and Evaluation for assessing the quality of the evidence. Data were pooled using the fixed or random effects method as appropriate. We investigated effects of individual vs group, intensive vs brief interventions, and interventions with and without motivational interviewing in subgroup analyses. To assess the robustness of effect estimates, sensitivity analyses excluding studies with high risk of bias and attrition >20% were conducted. We found low to moderate quality evidence for a significant small effect of psychosocial interventions on DD, and very low to moderate quality evidence for no effect on HbA1c, both outcomes assessed at 3, 6, 12, and 24 months follow-up. The effect on depression was small, while there was no effect on health-related quality of life. Exploratory subgroup analyses suggested that interventions using motivational interviewing and individual interventions were associated with incremental effects on DD. Likewise, intensive interventions were associated with significant reductions in both DD and HbA1c.
Collapse
Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,
| | - Ingrid Egerod
- Intensive Care Unit 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tonny Jensen
- Department of Endocrinology, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark,
| | - Gudrun Kaldan
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Langberg
- CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
27
|
Theory and Practice in Digital Behaviour Change: A Matrix Framework for the Co-Production of Digital Services That Engage, Empower and Emancipate Marginalised People Living with Complex and Chronic Conditions. INFORMATICS-BASEL 2018. [DOI: 10.3390/informatics5040041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner’s Chronic Care Model (CCM); Valentijn’s Rainbow Model of Integrated Care (RMIC); and Phanareth’s et al.’s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice. Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.
Collapse
|
28
|
Coyne I, Holmström I, Söderbäck M. Centeredness in Healthcare: A Concept Synthesis of Family-centered Care, Person-centered Care and Child-centered Care. J Pediatr Nurs 2018; 42:45-56. [PMID: 30219299 DOI: 10.1016/j.pedn.2018.07.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Increasingly within healthcare, different kind of 'centeredness' are used to denote the focus of care which can create confusion for practitioners. METHODS A concept analysis was undertaken to identify the antecedents, attributes and relationship between family-, person-, and child-centered care. PubMed and CINAHL were searched from 2012 to 2017 and thirty-five papers were reviewed. RESULTS Both person- and child-centered care are focused on individuals, a symmetric relationship and the tailoring of care to individual needs while family- centered care is focused on the family as a unit of which the child is included. Person-centered care focuses on an adult person with autonomy, while the focus in child-centered care is the individual child as an own actor with rights but still close to a family. CONCLUSION It appears at a conceptual level that the concepts of centeredness contain both similarities and differences. Finding ways to structure nursing and focus the care that respects a person's dignity and humanity is essential in healthcare and should be a major goal of health policy and health systems worldwide. IMPLICATIONS The identification of the antecedents and attributes embedded in the concepts may help raise professionals' awareness of the different foci and how this will influence one's practice. There is a need to recognize strengths and weaknesses of the centeredness in different settings and environments. Furthermore, it is important to know which approach to apply within different situations so that quality care is enabled for every person, child and family.
Collapse
Affiliation(s)
- Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Inger Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden.
| | - Maja Söderbäck
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
| |
Collapse
|
29
|
Werbrouck A, Swinnen E, Kerckhofs E, Buyl R, Beckwée D, De Wit L. How to empower patients? A systematic review and meta-analysis. Transl Behav Med 2018; 8:660-674. [DOI: 10.1093/tbm/iby064] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Amber Werbrouck
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Eva Swinnen
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Eric Kerckhofs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Ronald Buyl
- Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Beckwée
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Rehabilitation Research (RERE), Vrije Universiteit Brussel, Brussel, Belgium
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Liesbet De Wit
- Department of Public Health, Vrije Universiteit Brussel, Brussel, Belgium
| |
Collapse
|
30
|
New Possibilities in Life with Type 2 Diabetes: Experiences from Participating in a Guided Self-Determination Programme in General Practice. Nurs Res Pract 2018; 2018:6137628. [PMID: 29755787 PMCID: PMC5884023 DOI: 10.1155/2018/6137628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/04/2018] [Indexed: 01/18/2023] Open
Abstract
Research suggests that guided self-determination programmes can support self-management of diabetes by empowering self-determined goal setting and competence building. As most research in this area has focused on people with type 1 diabetes, knowledge is lacking on how adults with type 2 diabetes mellitus experience participation in such programmes. This study reports the modelling phase of a complex intervention design that explored the experiences of adults with type 2 diabetes who participated in a nurse-led guided self-determination programme in general practice and examines how the programme affected patients' motivation to self-manage diabetes. The qualitative design with semistructured interviews included 9 adults with type 2 diabetes who participated in the programme. Qualitative content analysis was used to analyse the data. The findings indicate that the participants experienced new life possibilities after participating in the programme, which seemed to have a positive influence on their motivation for self-management. Through reflections about how to live with diabetes, the participants reinterpreted their life with diabetes by gradually developing a closer relationship with the disease, moving towards acceptance. The fact that dialogue with the nurses was seen to be on an equal footing helped support the participants to become more self-determined.
Collapse
|
31
|
Lie SS, Karlsen B, Niemiec CP, Graue M, Oftedal B. Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study. Patient Prefer Adherence 2018; 12. [PMID: 29535506 PMCID: PMC5836696 DOI: 10.2147/ppa.s154612] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. OBJECTIVE The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. METHODS We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. RESULTS The qualitative content analysis yielded 2 main themes. We labeled the first theme as "Written reflection affects awareness and commitment in diabetes self-management", which reflects 2 subthemes, namely, "Writing creates space and time for autonomous reflection" and "Writing influences individuals' focus in diabetes self-management". We labeled the second theme as "Written reflection is perceived as inapplicable in diabetes self-management", which reflects 2 subthemes, namely, "Responding in writing is difficult" and "The timing of the writing is inappropriate". CONCLUSION Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a "blended" approach, especially for those who consider written reflection to be difficult or unfamiliar.
Collapse
Affiliation(s)
- Silje S Lie
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Correspondence: Silje S Lie, Department of Public Health, Faculty of Health Sciences, University of Stavanger, N-4036 Stavanger, Norway, Tel +47 9750 6752, Email
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Christopher P Niemiec
- Department of Clinical and Social Sciences in Psychology, University of Rochester, Rochester, NY, USA
| | - Marit Graue
- Center for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Oftedal
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
32
|
Fall E, Izaute M, Chakroun-Baggioni N. How can the health belief model and self-determination theory predict both influenza vaccination and vaccination intention ? A longitudinal study among university students. Psychol Health 2017; 33:746-764. [PMID: 29132225 DOI: 10.1080/08870446.2017.1401623] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and objective Seasonal influenza is frequent among students and often responsible for impaired academic performance and lower levels of general health. However, the vaccination rate in this population is very low. As the seasonal influenza vaccine is not compulsory in France, it is important to improve the vaccination uptake by identifying predictors of both intention and behaviour. This study investigated the effect of decisional balance, motivation and self-efficacy on vaccination acceptance using the Extended Health Belief Model (HBM) and Self-Determination Theory (SDT). Design and Main Outcome Measures University students were invited to fill in an online survey to answer questions about their influenza vaccination intention, and HBM and SDT constructs. A one-year longitudinal follow-up study investigated vaccination behaviour. Results Autonomous motivation and self-efficacy significantly influenced the intention to have the influenza vaccine, and vaccine behaviour at one-year follow-up. Intention predicted a significant proportion of variation (51%) in behaviour, and mediated the effect of these predictors on vaccination behaviour. Conclusion These results suggest that motivation concepts of the Self-Determination Theory can be adequately combined with the Health Belief Model to understand vaccination behaviour.
Collapse
Affiliation(s)
- Estelle Fall
- a Université de Lorraine, EA 4360 APEMAC, équipe psychologie de la santé , Metz , France
| | - Marie Izaute
- b LAPSCO , Université Clermont Auvergne, CNRS , Clermont-Ferrand , France
| | | |
Collapse
|
33
|
Fisher L, Polonsky WH, Hessler D, Potter MB. A practical framework for encouraging and supporting positive behaviour change in diabetes. Diabet Med 2017; 34:1658-1666. [PMID: 28636745 PMCID: PMC5687986 DOI: 10.1111/dme.13414] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/30/2022]
Abstract
A wide range of diabetes-directed interventions - including novel medications, devices and comprehensive education programmes - have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed. Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.
Collapse
Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco
| | - W H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco
| | - M B Potter
- Department of Family & Community Medicine, University of California, San Francisco
| |
Collapse
|
34
|
Olesen ML, Hansen MK, Hansson H, Ottesen B, Andersen KK, Zoffmann V. The distress thermometer in survivors of gynaecological cancer: accuracy in screening and association with the need for person-centred support. Support Care Cancer 2017; 26:1143-1150. [PMID: 29058130 DOI: 10.1007/s00520-017-3935-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Unrecognised psychological distress among cancer survivors may be identified using short screening tools. We validated the accuracy of the distress thermometer (DT) to detect psychological distress on the Hospital Anxiety and Depression Scale (HADS) among early stage gynaecological cancer survivors and whether the women's DT and HADS scores were associated with the need of an individualised supportive intervention. METHODS One hundred sixty-five gynaecological cancer survivors answered DT and HADS before randomisation in a trial testing a nurse-led, person-centred intervention using supportive conversations. The number of conversations was decided in the woman-nurse dyad based on the woman's perceived need. Nurses were unaware of the women's DT and HADS scores. We validated DT's accuracy for screening using HADS as gold standard and receiver operating characteristic curves. Associations between DT and HADS scores and the number of conversations received were investigated. RESULTS For screening of distress (HADS ≥ 15), a DT score ≥ 2, had a sensitivity of 93% (95% CI 82-98%), a specificity of 40% (32-49%), and positive and negative predictive values of 36% (28-45%), and 94% (84-98%), respectively; area under curve was 0.73 (0.64-0.81). Higher DT and HADS scores were associated with more interventional conversations. CONCLUSIONS In gynaecological cancer survivors, DT may perform fairly well as a first stage screening tool for distress, but a second stage is likely needed due to a high number of false positives. DT and HADS scores may predict the number of supportive conversations needed in an individualised intervention in gynaecological cancer survivors.
Collapse
Affiliation(s)
- Mette L Olesen
- Juliane Marie Centre, Research Unit Women's and Children's Health Dept. 7821 and Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Merete K Hansen
- Statistics and Pharmacoepidemiology, The Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Helena Hansson
- Juliane Marie Centre, Research Unit Women's and Children's Health Dept. 7821 and Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ottesen
- Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus K Andersen
- Statistics and Pharmacoepidemiology, The Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Vibeke Zoffmann
- Juliane Marie Centre, Research Unit Women's and Children's Health Dept. 7821 and Department of Paediatric and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
35
|
Lie SS, Karlsen B, Oord ER, Graue M, Oftedal B. Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study. J Med Internet Res 2017; 19:e187. [PMID: 28559223 PMCID: PMC5470008 DOI: 10.2196/jmir.7479] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 01/17/2023] Open
Abstract
Background Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. Objective In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. Methods A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. Results We identified one overall theme: “Losing motivation for intervention participation.” This theme was illustrated by four categories related to the participants’ experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Conclusions Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants’ motivation for engagement in the intervention. To maintain motivation, our study points to the importance of combining eHealth with regular face-to-face consultations. Our study also shows that the perceived benefit of the GSD eHealth intervention intertwined with choosing to focus on other matters in complex daily lives are critical aspects in motivation for such interventions. This indicates the importance of giving potential participants tailored information about the aim, the content, and the effort needed to remain engaged in complex interventions so that eligible participants are recruited. Finally, motivation for engagement in the eHealth intervention was influenced by the technology used in this study. It seems important to facilitate more user-friendly but high-security eHealth technology. Our findings have implications for improving the eHealth intervention and to inform researchers and health care providers who are organizing eHealth interventions focusing on self-management support in order to reduce dropout rates.
Collapse
Affiliation(s)
| | - Bjørg Karlsen
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Marit Graue
- Centre for Evidence-based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Oftedal
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| |
Collapse
|
36
|
Thomsen TG, Soelver L, Hølge-Hazelton B. The influence of contextual factors on patient involvement during follow-up consultations after colorectal cancer surgery: a case study. J Clin Nurs 2017; 26:3688-3698. [PMID: 28122412 DOI: 10.1111/jocn.13741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To identify the contextual factors that influence individual patient involvement during colorectal cancer surgical follow-up consultations. BACKGROUND The healthcare system is subject to the requirement and expectation of greater involvement of patients and relatives. Increased patient involvement requires the development and implementation of new communication initiatives. Research shows that it is also necessary to consider the contextual circumstances surrounding patient involvement in specific situations. DESIGN Case study of a single Danish outpatient clinic, which allows the issues and circumstances involved in an everyday situation to be captured. METHOD 12 nonparticipative observations of outpatient visits and, subsequently, seven in-depth patient interviews. ANALYSIS Content analysis based on a dialogical, interactive framework, which underpinned the identification of current contextual factors. RESULTS The results showed five contextual factors that seemed to have an impact on patient involvement. The first, 'Two dimensions of patient involvement: treatment-oriented and person-oriented' highlighted a dual interpretation of patient involvement in the consultation situation. The two dimensions seemed to be influenced by four additional factors: 'Doctors leading the agenda', 'Traditional health professional roles', 'Unclear responsibilities' and 'Guidance primarily focused on treatment'. CONCLUSION The results showed how patient involvement in clinical practice could be understood as a two-way movement, in which patients are invited to participate in clinical practice, while health professionals are invited to participate in the patients' lives. The movement will change from situation to situation and is influenced by several contextual factors. RELEVANCE TO CLINICAL PRACTICE The results can help doctors and nurses to navigate using a goal-oriented approach towards patient involvement. The study makes visible the need for research-based development of the independent role of the nursing profession in cancer care follow-up, with a view to enhanced patient-centred care.
Collapse
Affiliation(s)
- Thora G Thomsen
- Research Unit, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| | - Lisbeth Soelver
- Bispebjerg and Frederiksberg Hospital, Digestive Center, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Research Unit, Zealand University Hospital, Roskilde, Denmark.,Institute of Regional Health Services Research, Faculty of Health Sciences, University of Southern Denmark, Odense M, Denmark
| |
Collapse
|
37
|
Oftedal B, Kolltveit BCH, Zoffmann V, Hörnsten Å, Graue M. Learning to practise the Guided Self-Determination approach in type 2 diabetes in primary care: A qualitative pilot study. Nurs Open 2017; 4:134-142. [PMID: 28694977 PMCID: PMC5500461 DOI: 10.1002/nop2.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/14/2016] [Indexed: 11/12/2022] Open
Abstract
Aim To describe how diabetes nurses in primary care experience the process of learning to practise the person‐centred counselling approach Guided Self‐Determination among adults with type 2 diabetes. Design A descriptive qualitative design. Method Data were collected in 2014–2015 by means of individual interviews with four diabetes nurses at two points in time. The data were analysed using qualitative content analysis. Results Three themes that reflect nurses’ processes in learning to use the Guided Self‐Determination approach were identified: (1) from an unfamiliar interaction to “cracking the code”; (2) from an unspecific approach to a structured, reflective, but demanding approach; and (3) from a nurse‐centred to a patient‐centred approach. The overall findings indicate that the process of learning to practise Guided Self‐Determination increased the nurses’ counselling competence. Moreover, the nurses perceived the approach to be generally helpful, as it stimulated reflections about diabetes management and about their own counselling practices.
Collapse
Affiliation(s)
- Bjørg Oftedal
- Department of Health Studies University of Stavanger Stavanger Norway
| | | | - Vibeke Zoffmann
- The Research Unit Women's and Children's Health The Juliane Marie Centre Copenhagen University Hospital Copenhagen Denmark
| | - Åsa Hörnsten
- Department of Nursing Umeå University Umeå Sweden
| | - Marit Graue
- Centre for Evidence-Based Practice Bergen University College Bergen Norway
| |
Collapse
|
38
|
Karlsen B, Oftedal B, Stangeland Lie S, Rokne B, Peyrot M, Zoffmann V, Graue M. Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol. BMJ Open 2016; 6:e013026. [PMID: 27965253 PMCID: PMC5168684 DOI: 10.1136/bmjopen-2016-013026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Self-management is deemed the cornerstone in overall diabetes management. Web-based self-management interventions have potential to support adults with type 2 diabetes (T2DM) in managing their disease. Owing to somewhat ambiguous results of such interventions, interventions should be theory-based and incorporate well-defined counselling methods and techniques for behavioural change. This study is designed to assess the effectiveness of a theory-driven web-based Guided Self-Determination (GSD) intervention among adults with T2DM in general practice to improve diabetes self-management behaviours and glycosylated haemoglobin (HbA1c). METHODS AND ANALYSIS A complex intervention design based on the framework of the UK Medical Research Council is employed as a guide for developing the intervention, assessing its feasibility and evaluating its effectiveness. The study consists of three phases: (1) the modelling phase adapting the original GSD programme for adults with T2DM, using a qualitative design, (2) feasibility assessment of the adapted intervention on the web, employing qualitative and quantitative methods and (3) evaluating the effectiveness of the intervention on diabetes self-management behaviours and HbA1c, using a quasi-experimental design. The first phase, which is completed, and the second phase, which is underway, will provide important information about the development of the intervention and its acceptability, whereas the third phase will assess the effectiveness of this systematically developed intervention. ETHICS AND DISSEMINATION The Norwegian Regional Committee for Medical and Health Research Ethics (REK west number 2015/60) has approved the study design. Patients recruited in the different phases will fill out an informed consent form prior to inclusion and will be guaranteed anonymity and the right to withdraw from the study at any time. The results of the study will be published in peer-reviewed journals, electronically and in print, and presented at research conferences. TRIAL REGISTRATION NUMBER NCT02575599.
Collapse
Affiliation(s)
- Bjørg Karlsen
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Bjørg Oftedal
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Berit Rokne
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mark Peyrot
- Sociology Department, Loyola University Maryland, Baltimore, Maryland, USA
| | - Vibeke Zoffmann
- Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marit Graue
- Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
| |
Collapse
|
39
|
Jutterström L, Hörnsten Å, Sandström H, Stenlund H, Isaksson U. Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes-A randomized study. PATIENT EDUCATION AND COUNSELING 2016; 99:1821-1829. [PMID: 27372525 DOI: 10.1016/j.pec.2016.06.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/11/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes. METHODS 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011. RESULTS HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group. CONCLUSION Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes. PRACTICE IMPLICATIONS It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.
Collapse
Affiliation(s)
- L Jutterström
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Å Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - H Sandström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
| | - H Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
| | - U Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden.
| |
Collapse
|
40
|
Johansson K, Österberg SA, Leksell J, Berglund M. Patients' experiences of support for learning to live with diabetes to promote health and well-being: A lifeworld phenomenological study. Int J Qual Stud Health Well-being 2016; 11:31330. [PMID: 27539956 PMCID: PMC4990532 DOI: 10.3402/qhw.v11.31330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/14/2022] Open
Abstract
Learning to live with diabetes in such a way that the new conditions will be a normal and natural part of life imposes requirements on the person living with diabetes. Previous studies have shown that there is no clear picture of what and how the learning that would allow persons to incorporate the illness into their everyday life will be supported. The aim of this study is to describe the phenomenon of support for learning to live with diabetes to promote health and well-being, from the patient’s perspective. Data were collected by interviews with patients living with type 1 or type 2 diabetes. The interviews were analysed using a reflective lifeworld approach. The results show that reflection plays a central role for patients with diabetes in achieving a new understanding of the health process, and awareness of their own responsibility was found to be the key factor for such a reflection. The constituents are responsibility creating curiosity and willpower, openness enabling support, technology verifying bodily feelings, a permissive climate providing for participation and exchanging experiences with others. The study concludes that the challenge for caregivers is to create interactions in an open learning climate that initiates and supports reflection to promote health and well-being.
Collapse
Affiliation(s)
- Karin Johansson
- Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden.,Department of Administration, Kronoberg County Council, Växjö, Sweden.,Primary Care, Region Kronoberg County Council, Växjö, Sweden;
| | - Sofia Almerud Österberg
- Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden
| | - Janeth Leksell
- School of Health and Social Sciences, University Dalarna, Falun, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Berglund
- School of Health and Education, University of Skövde, Skövde, Sweden
| |
Collapse
|
41
|
Guilcher SJT, Hamilton-Wright S, Skinner W, Woodhall-Melnik J, Ferentzy P, Wendaferew A, Hwang SW, Matheson FI. "Talk with me": perspectives on services for men with problem gambling and housing instability. BMC Health Serv Res 2016; 16:340. [PMID: 27485610 PMCID: PMC4971622 DOI: 10.1186/s12913-016-1583-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/27/2016] [Indexed: 01/25/2023] Open
Abstract
Background Problem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario. Methods We used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men’s perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services). Results The concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men’s experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support. Conclusions Our study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1583-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada. .,Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. .,Institute for Clinical Evaluative Sciences, 155 College Street, Suite 424, Toronto, M5T 3M6, Canada.
| | - Sarah Hamilton-Wright
- Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Wayne Skinner
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Julia Woodhall-Melnik
- Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Peter Ferentzy
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Aklilu Wendaferew
- Good Shepherd Ministries, 412 Queen Street East, Toronto, ON, M5A1T3, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada
| | - Flora I Matheson
- Centre for Urban Health Solutions, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada.,Institute for Clinical Evaluative Sciences, 155 College Street, Suite 424, Toronto, M5T 3M6, Canada.,Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada
| |
Collapse
|