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Pedersen LT, Ipsen JA, Bruun IH, Egebæk HK, Andersen PT, Viberg B. Association between patient activation level and functional outcomes in older adults with hip fractures. Arch Gerontol Geriatr 2024; 124:105472. [PMID: 38728823 DOI: 10.1016/j.archger.2024.105472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Hip fractures can significantly impact older adults' mobility and function. Effective rehabilitation is crucial to help them regain independence and quality of life. However, little is known about the association between patient activation and hip fracture rehabilitation. This study aims to assess the association between the PAM-13 scores and the level of physical function, mobility, and activities of daily living in older adults following a hip fracture rehabilitation program. METHOD An exploratory outcome study from a cluster-randomized stepped-wedge clinical controlled trial. Two hundred thirty-nine patients were classified into four Patient Activation Measure-Levels (PAM-13) according to their PAM-13 scores, reflecting their confidence and preparedness to manage their health. Level 1 represents the lowest level of confidence. The patient's mobility, function, and daily activities were evaluated at discharge and after 12 and 24 weeks. RESULTS The cohort had a median age of 78; 67% were female, and 50% lived alone. There were no significant differences in demographics between the PAM-Levels. PAM-Level 1 patients had longer hospital stays and lower mobility scores than PAM-Level 4 patients. However, all patients improved over time, and higher initial PAM levels resulted in better outcomes. PAM-Level 1 patients improved in Time Up and Go score from a median score of 54 seconds to 14 seconds at 24 weeks, while PAM-Level 4 patients improved from 26 to 9 seconds. CONCLUSION Our study found an association between PAM levels and functional outcomes in hip fracture rehabilitation. Patients with higher activation levels had better mobility and functional outcomes.
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Affiliation(s)
- Lars Tobiesen Pedersen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Health Education, University College South Denmark Esbjerg, Denmark.
| | - Jonas Ammundsen Ipsen
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Inge H Bruun
- Department of Physical Therapy and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Heidi Klakk Egebæk
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, The Capital Region, Denmark; Department of Exercise Epidemiology, Institute for Sports Science and Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion, University of Southern Denmark, Odense & Esbjerg, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
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Fusari G, Gibbs E, Hoskin L, Lawrence-Jones A, Dickens D, Fernandez Crespo R, Leis M, Crow J, Taylor E, Jones F, Darzi A. What is the feasibility and patient acceptability of a digital system for arm and hand rehabilitation after stroke? A mixed-methods, single-arm feasibility study of the 'OnTrack' intervention for hospital and home use. BMJ Open 2022; 12:e062042. [PMID: 36171046 PMCID: PMC9528675 DOI: 10.1136/bmjopen-2022-062042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Arm weakness is common after stroke; repetitive activity is critical for recovery but people struggle with knowing what to do, volume, and monitoring progress. We studied the feasibility and acceptability of OnTrack, a digital intervention supporting arm and hand rehabilitation in acute and home settings. DESIGN A mixed-method, single-arm study evaluating the feasibility of OnTrack for hospital and home use. An independent process evaluation assessed the intervention's fidelity, dose and reach. Amendments to the protocol were necessary after COVID-19. SETTING Acute stroke services and home settings in North West London. PARTICIPANTS 12 adults with a stroke diagnosis <6 months previously (first or recurrent) requiring arm rehabilitation in hospital and/or home. INTERVENTION 12 weeks using the OnTrack system comprising arm tracking and coaching support for self-management. PRIMARY AND SECONDARY OUTCOME MEASURES Recruitment, retention and completion rates; compliance and adherence to the intervention; reasons for study decline/withdrawal.Intervention fidelity and acceptability, evaluated through an independent process evaluation.Patient measures including activity baseline, healthcare activation, arm function and impairment collected at baseline, week 7 and week 14 of participation to assess suitability for a randomised controlled trial (RCT). RESULTS 181 individuals screened, 37 met eligibility criteria, 24 recruited (65%); of these, 15 (63%) were recruited before COVID-19, and 9 (37%) during. 12 completed the intervention (50%). Despite COVID-19 disruptions, recruitment, retention and completion were in line with prestudy expectations and acceptable for a definitive trial. Participants felt the study requirements were acceptable and the intervention usable. Fidelity of delivery was acceptable according to predetermined fidelity markers. Outcome measures collected helped determine sample size estimates and primary outcomes for an RCT. CONCLUSIONS The intervention was found to be usable and acceptable by participants; study feasibility objectives were met and demonstrated that a definitive RCT would be viable and acceptable. TRIAL REGISTRATION NUMBER NCT03944486.
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Affiliation(s)
| | - Ella Gibbs
- Helix Centre, Imperial College, London, UK
| | | | | | | | - Roberto Fernandez Crespo
- Big Data and Analytical Unit, Institute of Global Health Innovation, Imperial College, London, UK
| | - Melanie Leis
- Big Data and Analytical Unit, Institute of Global Health Innovation, Imperial College, London, UK
| | - Jennifer Crow
- Hyperacute Stroke Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Taylor
- Faculty of Health, Social Care and Education, Kingston University and St George's University, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's University, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College, London, UK
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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).
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Janamian T, Greco M, Cosgriff D, Baker L, Dawda P. Activating people to partner in health and self-care: use of the Patient Activation Measure. Med J Aust 2022; 216 Suppl 10:S5-S8. [PMID: 35665937 PMCID: PMC9328281 DOI: 10.5694/mja2.51535] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
Patient activation is a behavioural concept and is at the heart of personalised care. It is defined as an individual's knowledge, skill and confidence for managing their health and health care. Evidence indicates that patient activation scores can predict health behaviour and are closely linked to various clinical outcomes: reduced unnecessary emergency department visits, hospital admissions and re-admissions. Patients with lower activation levels (25-40% of the population) are less likely to adopt healthy behaviour, and more likely to have poorer clinical outcomes and higher rates of hospitalisation. Effective interventions can improve a patient's activation level, and positive change in activation equates to positive change in self-care behaviour. But to improve patient activation, we must first measure it using a robust evidence-based tool such as the Patient Activation Measure (PAM) survey. Armed with the patient's PAM score, providers can tailor their care and help patients achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation. The PAM is also useful for population segmentation and risk stratification - to target interventions and health strategies to meet the needs of patients who are at different points along the activation continuum, to measure the performance of health care systems, and to evaluate the effectiveness of health care interventions. The role of patient activation requires further serious consideration if we are to improve the long-term health and wellbeing of all Australians. The PAM tool is a feasible and cost-effective solution for achieving the Quadruple Aim - improving population health, the cost-efficiency of the health system, and patient and provider experience.
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Affiliation(s)
- Tina Janamian
- Client Focused Evaluation Program SurveysBrisbaneQLD
- University of QueenslandBrisbaneQLD
| | - Michael Greco
- Griffith UniversityBrisbaneQLD
- Care OpinionBrisbaneQLD
| | | | | | - Paresh Dawda
- University of CanberraCanberraACT
- Prestantia HealthCanberraACT
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Lightfoot CJ, Nair D, Bennett PN, Smith AC, Griffin AD, Warren M, Wilkinson TJ. Patient Activation: The Cornerstone of Effective Self-Management in Chronic Kidney Disease? KIDNEY AND DIALYSIS 2022; 2:91-105. [PMID: 37101653 PMCID: PMC10127536 DOI: 10.3390/kidneydial2010012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The importance of patient activation (i.e., the knowledge, skills, and confidence one has in managing one's own healthcare) in people with long-term conditions, including kidney disease, is growing. Enabling and empowering patients to take a more active role in their health and healthcare is the focus of person-centred care. Patient activation is recognised as a key construct of self-management, as to effectively self-manage a long-term condition, it is required to enable individuals to actively participate in treatment decisions, prevent complications, and manage risk factors. Identifying an individual's level of activation can help guide and tailor care, and interventions aimed at increasing patient activation may improve patient engagement and health outcomes. In this review, we explore the concepts of patient activation and self-management, the relationship between patient activation and self-management, interventions aimed at improving these, and what these mean to people living with kidney disease.
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Affiliation(s)
- Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester,Leicester LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester LE5 4PW, UK
- Correspondence: ; Tel.: +44-116-252-3211
| | - Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN 37232, USA
| | - Paul N. Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester,Leicester LE1 7RH, UK
- Leicester NIHR Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Anthony D. Griffin
- Leicester Kidney Lifestyle Team, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Madeleine Warren
- Leicester Kidney Lifestyle Team, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Thomas J. Wilkinson
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
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Orlowski A, Snow S, Humphreys H, Smith W, Jones RS, Ashton R, Buck J, Bottle A. Bridging the impactibility gap in population health management: a systematic review. BMJ Open 2021; 11:e052455. [PMID: 34930736 PMCID: PMC8689179 DOI: 10.1136/bmjopen-2021-052455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Assess whether impactibility modelling is being used to refine risk stratification for preventive health interventions. DESIGN Systematic review. SETTING Primary and secondary healthcare populations. PAPERS Articles published from 2010 to 2020 on the use or implementation of impactibility modelling in population health management, reported with the terms 'intervenability', 'amenability', and 'propensity to succeed' (PTS) and associated with the themes 'care sensitivity', 'characteristic responders', 'needs gap', 'case finding', 'patient selection' and 'risk stratification'. INTERVENTIONS Qualitative synthesis to identify themes for approaches to impactibility modelling. RESULTS Of 1244 records identified, 20 were eligible for inclusion. Identified themes were 'health conditions amenable to care' (n=6), 'PTS modelling' (n=8) and 'comparison or combination with clinical judgement' (n=6). For the theme 'health conditions amenable to care', changes in practice did not reduce admissions, particularly for ambulatory care sensitive conditions, and sometimes increased them, with implementation noted as a possible issue. For 'PTS modelling', high costs and needs did not necessarily equate to high impactibility and targeting a larger number of individuals with disorders associated with lower costs had more potential. PTS modelling seemed to improve accuracy in care planning, estimation of cost savings, engagement and/or care quality. The 'comparison or combination with clinical judgement' theme suggested that models can reach reasonable to good discriminatory power to detect impactable patients. For instance, a model used to identify patients appropriate for proactive multimorbid care management showed good concordance with physicians (c-statistic 0.75). Another model employing electronic health record scores reached 65% concordance with nurse and physician decisions when referring elderly hospitalised patients to a readmission prevention programme. However, healthcare professionals consider much wider information that might improve or impede the likelihood of treatment impact, suggesting that complementary use of models might be optimum. CONCLUSIONS The efficiency and equity of targeted preventive care guided by risk stratification could be augmented and personalised by impactibility modelling.
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Affiliation(s)
- Andi Orlowski
- Health Economics Unit, Stoke on Trent, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sally Snow
- Health Economics Unit, Stoke on Trent, UK
| | | | | | | | | | - Jackie Buck
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Jones B, Ndosi M, Hunt A, Harcourt D, Dures E. Factors associated with patient activation in inflammatory arthritis: a multisite cross-sectional study. Rheumatol Adv Pract 2021; 5:ii35-ii44. [PMID: 34755027 PMCID: PMC8570153 DOI: 10.1093/rap/rkab053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/05/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives Patient activation covers the skills, abilities and behaviour that impact how able and willing someone is to take an active role in self-managing their health. This study explored clinical and psychosocial factors associated with patient activation in rheumatology patients. Methods This was a cross-sectional study using postal survey methods. Participants with inflammatory rheumatic conditions were from six rheumatology centres in England. Patient activation was captured using the Patient Activation Measure (PAM). Twenty-nine explanatory factors were tested for potential association with patient activation in univariable and multivariable analyses. In preliminary multivariable analyses, factors found to have an association with patient activation at a P < 0.1 level were entered into the final multivariable model. Those that remained significant at a P < 0.05 level were considered associated with patient activation. Results The sample comprised 251 participants (74% female) with a mean age of 59.31 years (s.d. 12.69), disease duration of 14.48 years (s.d. 12.52) and a PAM score of 58.3 (s.d. 11.46). Of the 29 candidate factors, 25 were entered into a preliminary multivariable analysis. In the final multivariable analysis, four factors (self-efficacy, the illness belief that treatment will control participants’ condition and two dimensions of health literacy) were significantly associated with patient activation. This final model accounted for 40.4% of the variance in PAM scores [F(4, 246) = 41.66, P < 0.001]. Conclusions Patient activation is important in managing rheumatic conditions. Our data confirm that self-efficacy and health literacy are particular targets for patient activation interventions.
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Affiliation(s)
- Bethan Jones
- School of Healthcare Sciences, Cardiff University, Cardiff
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary
| | - Andrew Hunt
- Academic Rheumatology, Bristol Royal Infirmary
| | - Diana Harcourt
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emma Dures
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England.,Academic Rheumatology, Bristol Royal Infirmary
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Yakubu A, Paloji F, Bonnet JPG, Wetter T. Development of an Instrument for Assessing the Maturity of Citizens for Consumer Health Informatics in Developing Countries: The Case of Chile, Ghana, and Kosovo. Methods Inf Med 2021; 60:62-70. [PMID: 34237785 DOI: 10.1055/s-0041-1731389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We aimed to develop a survey instrument to assess the maturity level of consumer health informatics (ConsHI) in low-middle income countries (LMIC). METHODS We deduced items from unified theory of acceptance and use of technology (UTAUT), UTAUT2, patient activation measure (PAM), and ConsHI levels to constitute a pilot instrument. We proposed a total of 78 questions consisting of 14 demographic and 64 related maturity variables using an iterative process. We used a multistage convenient sampling approach to select 351 respondents from all three countries. RESULTS Our results supported the earlier assertion that mobile devices and technology are standard today than ever, thus confirming that mobile devices have become an essential part of human activities. We used the Wilcoxon Signed-Rank Test (WSRT) and item response theory (IRT) to reduce the ConsHI-related items from 64 to 43. The questionnaire consisted of 10 demographic questions and 43 ConsHI relevant questions on the maturity of citizens for ConsHI in LMIC. Also, the results supported some moderators such as age and gender. Additionally, more demographic items such as marital status, educational level, and location of respondents were validated using IRT and WSRT. CONCLUSION We contend that this is the first composite instrument for assessing the maturity of citizens for ConsHI in LMIC. Specifically, it aggregates multiple theoretical models from information systems (UTAUT and UTAUT2) and health (PAM) and the ConsHI level.
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Affiliation(s)
- Abubakari Yakubu
- Institute for Medical Informatics, Section of Medical Informatics, Heidelberg University, Heidelberg, Germany.,Department of Operations, Postal and Courier Services Regulatory Commission, Accra, Ghana
| | - Fortuna Paloji
- Institute for Medical Informatics, Section of Medical Informatics, Heidelberg University, Heidelberg, Germany
| | - Juan Pablo Guerrero Bonnet
- Institute for Medical Informatics, Section of Medical Informatics, Heidelberg University, Heidelberg, Germany.,Centro de Informática Médica Telemedicina, Facultad de medicina, Universidad de Chile, Chile
| | - Thomas Wetter
- Institute for Medical Informatics, Section of Medical Informatics, Heidelberg University, Heidelberg, Germany.,Department of Biomedical, Informatics and Medical Education, University of Washington, Seattle, United States
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Lightfoot CJ, Wilkinson TJ, Memory KE, Palmer J, Smith AC. Reliability and Validity of the Patient Activation Measure in Kidney Disease: Results of Rasch Analysis. Clin J Am Soc Nephrol 2021; 16:880-888. [PMID: 34117081 PMCID: PMC8216620 DOI: 10.2215/cjn.19611220] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing prioritization of the promotion of patient activation in nephrology, its applicability to people with CKD is not well established. Before the Patient Activation Measure is universally adopted for use in CKD, it is important to critically evaluate this measure. The aim of this study was to describe the psychometric properties of the Patient Activation Measure in CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A survey containing the 13-item Patient Activation Measure was completed by 942 patients with CKD, not treated with dialysis. Data quality was assessed by mean, item response, missing values, floor and ceiling effects, internal consistency (Cronbach's alpha and average interitem correlation), and item-rest correlations. Rasch modeling was used to assess item performance and scaling (item statistics, person and item reliability, rating scale diagnostics, factorial test of residuals, and differential item functioning). RESULTS The item response was high, with a small number of missing values (<1%). Floor effect was small (range 1%-5%), but the ceiling effect was above 15% for nine items (range 15%-38%). The Patient Activation Measure demonstrated good internal consistency overall (Cronbach α=0.925, and average interitem correlation 0.502). The difficulty of the Patient Activation Measure items ranged from -0.90 to 0.86. Differential item functioning was found for disease type (item 3) and age (item 12). The person separation index was 9.48 and item separation index was 3.21. CONCLUSIONS The 13-item Patient Activation Measure appears to be a suitably reliable and valid instrument for assessing patient activation in CKD. In the absence of a kidney-specific instrument, our results support the 13-item Patient Activation Measure as a promising measure to assess activation in those with CKD, although consideration for several items is warranted. The high ceiling effect may be a problem when using the 13-item Patient Activation Measure to measure changes over time.
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Affiliation(s)
- Courtney J Lightfoot
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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10
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Moreno-Chico C, Roy C, Monforte-Royo C, González-De Paz L, Navarro-Rubio MD, Gallart Fernández-Puebla A. Effectiveness of a nurse-led, face-to-face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions. Res Nurs Health 2021; 44:458-472. [PMID: 33834505 DOI: 10.1002/nur.22132] [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: 07/19/2020] [Revised: 02/16/2021] [Indexed: 11/08/2022]
Abstract
Prevalence of chronic diseases and multimorbidity is rising, and it remains unclear what the best strategy is for activating people with chronic conditions in their self-care. We designed a two-group quasi-experimental time series trial to examine the effectiveness of a nurse-led, face-to-face, individually-tailored health coaching (HC) intervention in improving patient activation and secondary outcomes (self-efficacy, quality of life, anxiety and depression symptoms, medication adherence, hospitalization and emergency visits) among primary care users with chronic conditions. A total of 118 people with chronic conditions were recruited through a primary care center and allocated to either the intervention group (IG) (n = 58) or control group (CG) (n = 60). The IG received a nurse-led individually-tailored HC intervention involving 4-6 face-to-face multicomponent sessions covering six core activation topics. The CG received usual primary care. Data were collected at baseline, after the intervention (6 weeks after baseline for controls) and at 6 and 12 months from baseline. Compared with controls, the IG had significantly higher patient activation scores after the intervention (73.29 vs. 66.51, p = .006). However, this improvement was not maintained at follow-up and there were no significant differences in secondary outcomes across the study period. HC may be an effective strategy for achieving short-term improvements in the activation of primary care users with chronic conditions. Further studies with different methodological approaches are needed to elucidate how HC may improve and sustain changes in patient activation.
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Affiliation(s)
- Cibeles Moreno-Chico
- Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain.,Rambla Mutua de Terrassa Primary Healthcare Center, Terrassa, Barcelona, Spain
| | - Callista Roy
- Mount Saint Mary's University Los Angeles, Los Angeles, California, USA.,Boston College School of Nursing, Boston, Massachusetts, USA
| | - Cristina Monforte-Royo
- Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - Luis González-De Paz
- Les Corts Primary Healthcare Center, Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.,Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria D Navarro-Rubio
- Patient and Family Empowerment, Sant Joan de Deu Children's Hospital, Barcelona, Spain
| | - Alberto Gallart Fernández-Puebla
- Department of Nursing, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
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Jones B, Hunt A, Hewlett S, Harcourt D, Dures E. Rheumatology patients' perceptions of patient activation and the Patient Activation Measure: A qualitative interview study. Musculoskeletal Care 2021; 20:74-85. [PMID: 33826238 DOI: 10.1002/msc.1555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/05/2021] [Accepted: 03/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION An important aspect of self-management is patient activation (the skills, abilities and confidence someone uses to actively manage their health). The dominant method of capturing patient activation is the Patient Activation Measure (PAM) which has been integrated into many aspects of clinical practice in musculoskeletal care. However, limited research has investigated how rheumatology patients understand and perform patient activation, and how closely their perceptions align with the PAM. METHODS Seventeen patients from two rheumatology departments in South West England participated in semi-structured interviews at two timepoints. They discussed how they actively managed their health and their views on the PAM. Data on activation were analysed using framework analysis and data on the PAM were analysed using content analysis. RESULTS Participants self-managed with determination, finding ways to make small, sustainable behaviour changes and effectively navigate the healthcare system. They reported the value of knowing what self-management techniques suited them individually and reported benefitting from positive perceptions of their own health and good social support. Participants noted that the PAM did not always capture the fluctuating nature of their inflammatory arthritis and the collaborative nature of healthcare. CONCLUSIONS Patients' perceptions and experiences of patient activation covered a wide range of skills, behaviours and beliefs. However, these are not always captured by the PAM. Therefore, its use as a clinical tool is best accompanied by dialogue with patients to understand their self-management.
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Affiliation(s)
- Bethan Jones
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Andrew Hunt
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
| | - Sarah Hewlett
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Emma Dures
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
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Verot E, Bouleftour W, Macron C, Rivoirard R, Chauvin F. Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version. JMIR Res Protoc 2020; 9:e17485. [PMID: 33289495 PMCID: PMC7755534 DOI: 10.2196/17485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient's needs, with nursing care adapting accordingly. OBJECTIVE The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. METHODS This study will follow the "Reach, Effectiveness, Adoption, Implementation, and Maintenance" framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the "Capability, Opportunity, Motivation, and Behavior" model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient's anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient's enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. RESULTS This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. CONCLUSIONS This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. TRIAL REGISTRATION ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17485.
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Affiliation(s)
- Elise Verot
- Centre Hygée, University of Saint-Etienne, University of Lyon, Saint-Priest-en-Jarez, France
| | - Wafa Bouleftour
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Corinne Macron
- Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Romain Rivoirard
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Priest-en-Jarez, France
| | - Franck Chauvin
- Centre Hygée, University of Saint-Etienne, University of Lyon, Saint-Priest-en-Jarez, France
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13
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Cooper-Stanton G. Best practice for chronic oedema in community settings: what can we learn? Br J Community Nurs 2020; 25:610-614. [PMID: 33275509 DOI: 10.12968/bjcn.2020.25.12.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.
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Affiliation(s)
- Garry Cooper-Stanton
- Clinical Nurse Specialist, Walsall Lymphoedema Service; Queen's Nurse; Adult Nurse Lecturer, University of Birmingham
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14
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Hamilton CB, Li LC. Measures of Patient Activation and Self-Efficacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:645-659. [PMID: 33091240 DOI: 10.1002/acr.24350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Clayon B Hamilton
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Linda C Li
- The University of British Columbia, Vancouver, British Columbia, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada
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15
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Eyles JP, Ferreira M, Mills K, Lucas BR, Robbins SR, Williams M, Lee H, Appleton S, Hunter DJ. Is the Patient Activation Measure a valid measure of osteoarthritis self-management attitudes and capabilities? Results of a Rasch analysis. Health Qual Life Outcomes 2020; 18:121. [PMID: 32370751 PMCID: PMC7201682 DOI: 10.1186/s12955-020-01364-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one's health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA. METHODS Item response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes. RESULTS Two-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores. CONCLUSIONS This study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.
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Affiliation(s)
- J P Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia. .,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - M Ferreira
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - B R Lucas
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - S R Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - M Williams
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - H Lee
- Rehabilitation Department, Hunters Hill Private Hospital, Sydney, Australia
| | - S Appleton
- Physiotherapy Department, Mount Wilga Private Hospital, Sydney, Australia
| | - D J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
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16
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Fusari G, Gibbs E, Hoskin L, Dickens D, Leis M, Taylor E, Jones F, Darzi A. Protocol for a feasibility study of OnTrack: a digital system for upper limb rehabilitation after stroke. BMJ Open 2020; 10:e034936. [PMID: 32205375 PMCID: PMC7103844 DOI: 10.1136/bmjopen-2019-034936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Arm weakness is a common problem after stroke (affecting 450 000 people in the UK) leading to loss of independence. Repetitive activity is critical for recovery but research shows people struggle with knowing what or how much to do, and keeping track of progress. Working with more than 100 therapists (occupational therapists and physiotherapists) and patients with stroke, we codeveloped the OnTrack intervention-consisting of software for smart devices and coaching support-that has the potential to address this problem. This is a protocol to assess the feasibility of OnTrack for evaluation in a randomised control trial. METHODS AND ANALYSIS A mixed-method, single-arm study design will be used to evaluate the feasibility of OnTrack for hospital and community use. A minimum sample of 12 participants from a stroke unit will be involved in the study for 14 weeks. During week 1, 8 and 14 participants will complete assessments relating to their arm function, arm impairment and activation. During weeks 2-13, participants will use OnTrack to track their arm movement in real time, receive motivational messages and face-to-face sessions to address problems, gain feedback on activity and receive self-management skills coaching. All equipment will be loaned to study participants. A parallel process evaluation will be conducted to assess the intervention's fidelity, dose and reach, using a mixed-method approach. A public and patient involvement group will oversee the study and help with interpretation and dissemination of qualitative and quantitative data findings. ETHICS AND DISSEMINATION Ethical approval granted by the National Health Service Health Research Authority, Health and Care Research Wales, and the London-Surrey Research Ethics Committee (ref. 19/LO/0881). Trial results will be submitted for publication in peer review journals, presented at international conferences and disseminated among stroke communities. The results of this trial will inform development of a definitive trial. TRIAL REGISTRATION NUMBER NCT03944486.
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Affiliation(s)
- Gianpaolo Fusari
- Helix Centre, Royal College of Art, London, UK
- Helix Centre, Imperial College London, London, UK
| | - Ella Gibbs
- Helix Centre, Imperial College London, London, UK
| | - Lily Hoskin
- Helix Centre, Imperial College London, London, UK
| | | | - Melanie Leis
- Big Data and Analytical Unit, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Elizabeth Taylor
- Faculty of Health Social Care and Education, Kingston and St George's University of London, London, UK
| | - Fiona Jones
- Faculty of Health Social Care and Education, Kingston and St George's University of London, London, UK
| | - Ara Darzi
- Helix Centre, Imperial College London, London, UK
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17
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Lidington E, McGrath SE, Noble J, Stanway S, Lucas A, Mohammed K, van der Graaf W, Husson O. Evaluating a digital tool for supporting breast cancer patients: a randomized controlled trial protocol (ADAPT). Trials 2020; 21:86. [PMID: 31941539 PMCID: PMC6961395 DOI: 10.1186/s13063-019-3971-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/06/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are a growing number of mHealth tools for breast cancer patients but a lack of scientific evidence for their effects. Recent studies have shown a mix of positive and negative impacts on users. Here we will assess the impact of OWise Breast Cancer, a mobile application for self-monitoring symptoms and managing care, on the process of self-management. METHODS This randomized controlled trial with early stage breast cancer patients will assess the effect of OWise use on patient activation at 3 months from diagnosis measured by the PAM-13 questionnaire. We will also assess differences in changes in health-related quality of life, psychological distress, health status, and National Health Service (NHS) health resource utilization over the first year from diagnosis. Participants will be randomly allocated (1:1) to standard care or standard care plus OWise. Participants will complete questionnaires before starting anti-cancer treatment and at 3, 6, and 12 months from diagnosis. Clinical and patient-reported outcome data will be linked to health resource utilization data from Discover, an integrated care record of primary, secondary, and social care in North West London. We will measure contamination in the control group and adjust the sample size to mitigate the dilution of effect estimates. A per-protocol analysis will be conducted as a sensitivity analysis to assess robustness of the primary results. DISCUSSION This study aims to generate evidence for the effectiveness of OWise at improving patient activation for women with early-stage breast cancer. The results will show the impact of using the tool at the patient level and the NHS health system level. The outcomes of the study will have implications for the application of OWise across the NHS for breast cancer patients and expansion into other tumor types. Assessing publicly available mHealth tools poses a challenge to trialists due to the risk of contamination. Here we apply various methods to measure, mitigate, and assess the effects of contamination. TRIAL REGISTRATION The study was registered at clincaltrials.gov (NCT03866655) on 7 March 2019.
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Affiliation(s)
| | | | | | | | - Amanda Lucas
- Discover at Imperial College Health Partners, London, United Kingdom
| | - Kabir Mohammed
- Discover at Imperial College Health Partners, London, United Kingdom
| | - Winette van der Graaf
- The Royal Marsden Hospital, London, United Kingdom
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Olga Husson
- Netherlands Cancer Institute, Amsterdam, Netherlands
- Institute of Cancer Research, Sutton, United Kingdom
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18
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Knudsen MV, Petersen AK, Angel S, Hjortdal VE, Maindal HT, Laustsen S. Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study. Eur J Cardiovasc Nurs 2019; 19:376-385. [PMID: 31702397 DOI: 10.1177/1474515119885325] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cardiac tele-rehabilitation is defined as using information and communication technology to support rehabilitation services. However, it requires a high level of patient activation and health literacy; this has not yet been explored. AIMS The purpose of this study was to evaluate patient activation and health literacy in tele-rehabilitation compared to hospital-based cardiac rehabilitation. METHODS We conducted a pilot study in patients with ischaemic or heart valve disease. In a non-randomised design, 24 patients attended a 12-week tele-rehabilitation programme, and 53 matched controls a 12-week hospital-based cardiac rehabilitation programme. The primary outcome was patient activation, which was assessed using the Patient Activation Measure before the intervention, at the end of the intervention and at follow-up six months after the intervention. The secondary outcome was health literacy, assessed using three dimensions from the Health Literacy Questionnaire before rehabilitation and at six-month follow-up: actively manage my health (HLQ3), ability to engage with healthcare providers (HLQ6) and understanding health information (HLQ9). RESULTS Patient activation improved similarly in tele-rehabilitation and hospital-based cardiac rehabilitation at all time points. Six months after the intervention, patients in tele-rehabilitation significantly improved on the dimension HLQ6 compared to patients in hospital-based cardiac rehabilitation. No significant between-group differences were found in HLQ3 or HLQ9. CONCLUSION Tele-rehabilitation and hospital-based cardiac rehabilitation seemed to be equally successful in improving patient activation and health literacy. Tele-rehabilitation should be further tested in a randomised controlled trial, with a focus on whether patient levels of education and self-management at the initiation of rehabilitation are decisive factors for tele-rehabilitation participation.
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Affiliation(s)
- Marie V Knudsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark.,Centre of Research in Rehabilitation, Aarhus University, Denmark
| | - Annemette K Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Denmark.,Centre of Research in Rehabilitation, Aarhus University, Denmark
| | - Sanne Angel
- Nursing and Health Care, Aarhus University, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark.,Department of Clinical Medicine, Aarhus University, Denmark
| | - Helle T Maindal
- Health Promotion and Population Health, Aarhus University, Denmark
| | - Sussie Laustsen
- Centre of Research in Rehabilitation, Aarhus University, Denmark.,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark.,Faculty of Health Sciences (Nursing), VIA University College, Denmark
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19
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Skovlund SE, Lichtenberg TH, Hessler D, Ejskjaer N. Can the Routine Use of Patient-Reported Outcome Measures Improve the Delivery of Person-Centered Diabetes Care? A Review of Recent Developments and a Case Study. Curr Diab Rep 2019; 19:84. [PMID: 31420754 DOI: 10.1007/s11892-019-1190-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW In recent years, the recommendation for and use of patient-reported outcome measures (PROMs) in routine diabetes care has significantly increased. We review recent evidence and highlight key opportunities and challenges related to the active clinical use of PROMs to support person-centered diabetes care and focus areas for future research in the area. RECENT FINDINGS Recent pragmatic studies support that integration of multi-dimensional PROMs for diabetes in clinical care as part of a care improvement strategy can be acceptable for and valued by people with diabetes (PWD) and healthcare professionals (HCPs) and may improve multiple aspects of quality of care, including screening, medical care monitoring and decision support, individualization of self-management support and goal-setting, and broader benefits related to active patient participation and person-centred diabetes care. We identify multiple intervention, individual, and care setting characteristics, which influence acceptability, feasibility, implementation, and effectiveness of PROMs in routine care. Recent clinical PROM studies highlight the value of mixed methods research and systematic involvement of PWD, clinicians, and other stakeholders in the design and implementation of questionnaires for patient input in routine diabetes care. We identified a new significant trend towards participatory development of multi-dimensional PROMs with the aim of IT-enabled integration into routine diabetes care to facilitate multiple components of person-centered diabetes care and better clinical, quality of life, and cost outcomes. While results from large-scale randomized controlled studies are still limited, a growing number of pragmatic implementation studies support that user-centric PROM interventions have the potential to facilitate significant improvements in care for PWD.
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Affiliation(s)
- Soren E Skovlund
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark.
| | | | - D Hessler
- Family & Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - N Ejskjaer
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark
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20
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Gao J, Arden M, Hoo ZH, Wildman M. Understanding patient activation and adherence to nebuliser treatment in adults with cystic fibrosis: responses to the UK version of PAM-13 and a think aloud study. BMC Health Serv Res 2019; 19:420. [PMID: 31234848 PMCID: PMC6591841 DOI: 10.1186/s12913-019-4260-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient activation refers to patients' knowledge, skills, and confidence in self-managing health conditions. In large cross-sectional studies, individuals with higher patient activation are observed to have better health outcomes with the assumption that they are more engaged in health self-management. However, the association between patient activation and objectively measured self-care indicators in individuals can be inconsistent. This research investigated the role of patient activation as measured by the UK Patient Activation Measure (PAM-13) in adults with Cystic Fibrosis (CF). The aims were twofold: to explore how adults with CF interpret and respond to the PAM-13; and to investigate the association between PAM-13 and objectively measured nebuliser adherence in UK adults with CF. METHODS This article describes two studies which examined the PAM-13 from different perspectives. Study 1 comprised 'think aloud' interviews with 15 adults with CF. The data were analysed using an a priori coding framework. Study 2 examined the association between PAM-13 and objectively measured nebuliser adherence in 57 adults with CF. RESULTS Study 1 showed that adults with CF encountered several difficulties while completing the PAM-13. The difficulties were related to understanding how to interpret aspects of CF in order to respond (i.e., control over the condition, ability to exercise) and item wording. Some adults with CF responded to the PAM-13 in an optimistic way in relation to what they thought they should do rather than what they actually do. These findings were echoed by the results of Study 2, which showed that PAM-13 scores were not significantly correlated with objective medication adherence in a different sample. This article synthesises the results of both studies, providing insights into influences and associations of patient activation as measured by the UK PAM-13 in adults with CF. CONCLUSIONS There were some significant difficulties created by the wording of the UK PAM-13 for adults with CF. This may partly explain the finding that PAM-13 scores were not related to objectively measured nebuliser adherence in this study. The UK PAM-13 would benefit from further research to verify its validity and reliability in different patient populations against objective measures of behaviour rather than simply self-report.
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Affiliation(s)
- Jie Gao
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK.
| | - Madelynne Arden
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, UK
| | - Zhe Hui Hoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield, UK
| | - Martin Wildman
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.,Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield, UK
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21
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Lewis A, Dullaghan D, Townes H, Green A, Potts J, Quint JK. An observational cohort study of exercise and education for people with chronic obstructive pulmonary disease not meeting criteria for formal pulmonary rehabilitation programmes. Chron Respir Dis 2019; 16:1479973119838283. [PMID: 30991841 PMCID: PMC6472173 DOI: 10.1177/1479973119838283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Pulmonary rehabilitation (PR) is offered to patients with functional breathlessness. However, access to PR is limited. The objective of this study was to evaluate whether a 4-week education and exercise programme offered to COPD patients with Medical Research Council (MRC) dyspnoea 1-2 improves disease self-management. Patients were recruited by their GP to attend four weekly 2-h sessions provided by a multidisciplinary team. Patients completed outcome measures before and after the program. Forty-two patients entered the programme and 26 out of 42 (61.9%) completed all sessions. The Bristol COPD Knowledge Questionnaire and Patient Activation Measure improved (both p ≤ 0.001). Disease burden was not reduced according to the COPD assessment test. All patients accepted a referral for ongoing exercise. Fourteen current smokers (81.3%) accepted a referral for smoking cessation, three patients with anxiety or depression (37.5%) accepted a psychological therapies referral. The programme improved COPD disease knowledge, patient activation and stimulated referrals to further services supporting disease management. Randomised controlled trials are warranted for similar interventions for COPD patients with early stage disease.
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Affiliation(s)
- A Lewis
- 1 National Heart and Lung Institute, Imperial College London, London, UK
| | - D Dullaghan
- 2 Wandsworth Community Healthcare, Central London Community Healthcare NHS Trust, Battersea Studios, London, UK
| | - H Townes
- 3 Harringey Community Respiratory Team, Whittington Health NHS, Magdala Avenue, London, UK
| | - A Green
- 4 British Lung Foundation, London, UK
| | - J Potts
- 1 National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer K Quint
- 1 National Heart and Lung Institute, Imperial College London, London, UK
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The structural and convergent validity of three commonly used measures of self-management in persons with neurological conditions. Qual Life Res 2018; 28:545-556. [PMID: 30390217 DOI: 10.1007/s11136-018-2036-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Self-management ability is commonly assessed in chronic disease research and clinical practice. The purpose of this study was to assess the structural and convergent validity of three commonly used self-management outcome measures in a sample of persons with neurological conditions. METHODS We used data from a Canadian survey of persons with neurological conditions, which included three commonly used self-management measures: the Partners in Health Scale (PIH), the Patient Activation Measure (PAM), and the Self-Efficacy for Managing a Chronic Disease Scale (SEMCD). Confirmatory factor analysis was used to assess the structural and convergent validity of the three measures. RESULTS When treated as single-factor constructs, none of the measurement models provided a good fit to the data. A four-domain version of the PIH was the best fitting model. Confirmatory factor analysis suggests that the three tools measure different, but correlated constructs. CONCLUSIONS While the PAM, PIH and SEMCD scales are all used as measures of patient self-management, our study indicates that they measure different, but correlated latent variables. None, when treated as single, uni-dimensional construct, provides an acceptable fit to our data. This is probably because self-management is multi-dimensional, as is consistently shown by qualitative evidence. While these measures may provide reliable summative measures, multi-dimensional scales are needed for clinical use and more detailed research on self-management.
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23
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Bourbeau J, Farias R, Li PZ, Gauthier G, Battisti L, Chabot V, Beauchesne MF, Villeneuve D, Côté P, Boulet LP. The Quebec Respiratory Health Education Network: Integrating a model of self-management education in COPD primary care. Chron Respir Dis 2018; 15:103-113. [PMID: 28750556 PMCID: PMC5958467 DOI: 10.1177/1479972317723237] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/19/2017] [Accepted: 05/10/2017] [Indexed: 11/26/2022] Open
Abstract
The objective of this study is to evaluate whether a chronic obstructive pulmonary disease (COPD) self-management education program with coaching of a case manager improves patient-related outcomes and leads to practice changes in primary care. COPD patients from six family medicine clinics (FMCs) participated in a 1-year educational program offered by trained case managers who focused on treatment adherence, inhaler techniques, smoking cessation, and the use of an action plan for exacerbations. Health-care utilization, health-related quality of life (HRQL), treatment adherence, inhaler technique, and COPD knowledge were assessed at each visit with validated questionnaires. We also evaluated whether the use of spirometry and the assessment of individual patient needs led to a more COPD-targeted treatment by primary care physicians, based on changes in prescriptions for COPD (medication, immunization, and written action plan). Fifty-four patients completed the follow-up visits and were included in the analysis. The number of unscheduled physician visits went from 40 the year before intervention to 17 after 1 year of educational intervention ( p = 0.033). Emergency room visits went from five to two and hospitalizations from two to three (NS). Significant improvements were observed in HRQL ( p = 0.0001), treatment adherence ( p = 0.025), adequate inhaler technique ( p < 0.0001), and COPD knowledge ( p < 0.001). Primary care physicians increased their prescriptions for long-acting bronchodilators with/without inhaled corticosteroid, flu immunizations, and COPD action plans in the event patient had an exacerbation. The COPD self-management educational intervention in FMCs reduced unscheduled visits to the clinic and improved patients' quality of life, self-management skills, and knowledge. The program had a positive impact on COPD-related practices by primary care physicians in the FMCs.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Québec, Canada
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
| | - Raquel Farias
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Québec, Canada
| | - Pei Zhi Li
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Québec, Canada
| | - Guylaine Gauthier
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
| | - Livia Battisti
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
- Hôpital St-François d’Assise, Québec, Canada
| | - Valérie Chabot
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
| | | | - Denis Villeneuve
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
| | - Patricia Côté
- Quebec Respiratory Health Education Network/Réseau Québécois d’Éducation en Santé Respiratoire (QRHEN/RQESR), Québec, Canada
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Canada
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Carey SA, Tecson KM, Bass K, Felius J, Hall SA. Patient activation with respect to advanced heart failure therapy in patients over age 65 years. Heart Lung 2018; 47:285-289. [PMID: 29685331 DOI: 10.1016/j.hrtlng.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/23/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including "activation" (engagement and ability to self-manage). OBJECTIVE To investigate effects of age, activation, and depression/anxiety on selection and 6-month survival of participants considered for therapy. METHODS Consecutive people referred for advanced HF therapy completed the Patient Activation Measure and Hospital Anxiety and Depression Scale. We analyzed data from participants by age (≥65 vs. <65 years), stratified by approval for therapy. RESULTS Among 168 referred, 109 were approved, with no difference in activation between age groups (88% highly activated). Similarly, activation was not associated with age among those not approved. Activation was related to anxiety in older, approved participants, but not to depression. CONCLUSIONS Concerns regarding reduced self-management in the elderly may not be valid. Age alone should not disqualify a candidate for advanced HF therapy.
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Affiliation(s)
- Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, 3410 Worth Street, Suite 250, Dallas, TX 75246, USA; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, 3410 Worth Street, Suite 560, Dallas, TX 75246, USA
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Scott & White Research Institute, 621 N. Hall Street, Suite H-030, Dallas, TX 75226, USA
| | - Kyle Bass
- Soltero Cardiovascular Research Center, Baylor University Medical Center, 621 N. Hall Street, Suite 530, Dallas, TX 75226, USA.
| | - Joost Felius
- Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, 3410 Worth Street, Suite 560, Dallas, TX 75246, USA
| | - Shelley A Hall
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, 3410 Worth Street, Suite 250, Dallas, TX 75246, USA; Annette C. and Harold C. Simmons Transplant Institute, Baylor Scott & White Research Institute, 3410 Worth Street, Suite 560, Dallas, TX 75246, USA
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Griauzde DH, Kullgren JT, Liestenfeltz B, Richardson C, Heisler M. A mobile phone-based program to promote healthy behaviors among adults with prediabetes: study protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:48. [PMID: 29449958 PMCID: PMC5810019 DOI: 10.1186/s40814-018-0246-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/02/2018] [Indexed: 11/10/2022] Open
Abstract
Background Rates of participation in Diabetes Prevention Programs (DPPs) are low. This may be due, in part, to low levels of autonomous motivation (i.e., motivation that arises from internal sources and sustains healthy behaviors over time) to prevent type 2 diabetes (T2DM) among many individuals with prediabetes. Mobile health (mHealth) technologies that incorporate principles from the Self-Determination Theory offer an effective and scalable approach to increase autonomous motivation levels. One promising mobile phone-based application is JOOL Health, which aims to help users connect certain health behaviors (e.g., sleep and diet) with personal values in specific life domains (e.g., family and work). The first aim of this study is to estimate whether JOOL Health can increase autonomous motivation to prevent T2DM among individuals with prediabetes who declined DPP participation. The second aim of this pilot study is to examine the intervention’s feasibility and acceptability. Methods This is a 12-week, three-arm pilot randomized controlled trial. We will recruit 105 individuals with prediabetes who did not engage in a DPP despite invitation from their health plan to participate in face-to-face or web-based programs at no out-of-pocket-cost. Participants will be randomized to one of three study arms: (1) a group that receives information on prediabetes, evidence-based strategies to decrease progression to T2DM, and a list of resources for mHealth tools for monitoring diet, physical activity, and weight (comparison group); (2) a group that receives the JOOL Health application; and (3) a group that receives the JOOL Health application as well as a Fitbit activity tracker and wireless-enabled scale. Our primary outcome is change in autonomous motivation to prevent T2DM (measured using the Treatment Self-Regulation Questionnaire). We will also collect data related to the intervention’s feasibility (recruitment and retention rates) and acceptability (adherence and qualitative experience) as well as changes in psychosocial outcomes, hemoglobin A1c, and weight. Discussion To our knowledge, this is the first study that aims to promote positive health behaviors among individuals with prediabetes who previously declined to participate in a DPP. Our results will inform a larger trial to test the effect of JOOL Health on clinically relevant outcomes, including weight loss, physical activity, and DPP engagement. Trial registration NCT03025607. Registered February 2017. Electronic supplementary material The online version of this article (10.1186/s40814-018-0246-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dina H Griauzde
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA
| | - Jeffrey T Kullgren
- 2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
| | | | - Caroline Richardson
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
| | - Michele Heisler
- 1Robert Wood Johnson Foundation Clinical Scholars Program, University of Michigan, Ann Arbor, MI USA.,2VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2800 Plymouth Road, Building 14, Room G100-36, Ann Arbor, MI 48109-2800 USA.,3University of Michigan Medical School, Ann Arbor, MI USA.,4University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
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McCarthy MC, McNeil R, Drew S, Orme L, Sawyer SM. Information needs of adolescent and young adult cancer patients and their parent-carers. Support Care Cancer 2017; 26:1655-1664. [PMID: 29222598 DOI: 10.1007/s00520-017-3984-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 11/15/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aimed to explore health-related information needs of adolescent and young adults (AYAs) and their parent-carers and to examine demographic and clinical variables associated with unmet information needs, including patient activation. METHODS In a national cross-sectional study, 196 Australian AYAs diagnosed with cancer between 15 and 25 years and within 24 months of diagnosis and 204 parent-carers reported on total and unmet needs for cancer and health-related information. Fifty-one percent of AYAs were male, 81% had completed treatment and 86% were treated in adult hospitals. RESULTS AYAs and parents reported high levels of total need for information. The mean number of unmet needs was 5.63 and 6.82 for AYAs and parents, respectively. AYAs reported the highest unmet needs in relation to their cancer (e.g. late effects and cancer recurrence, and having children in the future). The highest unmet parent information needs were related to medical information about their child as well as information on financial issues for their children and themselves. Unmet information need was associated with psychological distress (posttraumatic stress symptoms) for AYAs and parents. Patient activation was negatively associated with unmet information needs for AYAs. Demographic and treatment variables were not significantly associated with information needs. CONCLUSION These findings indicate the importance of information needs for AYAs and their carers. The association between patient activation and information needs suggests that promoting young people's engagement with healthcare is a key opportunity within AYA care. Parent information needs and associated emotional distress additionally highlight the importance of family-centered care.
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Affiliation(s)
- Maria C McCarthy
- Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia. .,Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, 3052, Australia.
| | - Robyn McNeil
- Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, 2052, Australia
| | - Sarah Drew
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, 2052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, 3052, Australia.,ONTrac at Peter Mac Victorian Adolescent & Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, 3002, Australia
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, 2052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
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27
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Zimbudzi E, Lo C, Ranasinha S, Kerr PG, Polkinghorne KR, Teede H, Usherwood T, Walker RG, Johnson G, Fulcher G, Zoungas S. The association between patient activation and self-care practices: A cross-sectional study of an Australian population with comorbid diabetes and chronic kidney disease. Health Expect 2017; 20:1375-1384. [PMID: 28675539 PMCID: PMC5689227 DOI: 10.1111/hex.12577] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/28/2022] Open
Abstract
Objective This study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia. Methods A cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities. Results A total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking. Conclusion In people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Clayton, Vic, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Vic, Australia
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia
| | - Timothy Usherwood
- Department of General Practice, Sydney Medical School Westmead, University of Sydney, Sydney, NSW, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia
| | - Rowan G Walker
- Department of Renal Medicine, Alfred Health, Prahran, Vic, Australia
| | | | - Greg Fulcher
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Vic, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Vic, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia
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28
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Houlihan BV, Brody M, Everhart-Skeels S, Pernigotti D, Burnett S, Zazula J, Green C, Hasiotis S, Belliveau T, Seetharama S, Rosenblum D, Jette A. Randomized Trial of a Peer-Led, Telephone-Based Empowerment Intervention for Persons With Chronic Spinal Cord Injury Improves Health Self-Management. Arch Phys Med Rehabil 2017; 98:1067-1076.e1. [PMID: 28284835 DOI: 10.1016/j.apmr.2017.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the impact of "My Care My Call" (MCMC), a peer-led, telephone-based health self-management intervention in adults with chronic spinal cord injury (SCI). DESIGN Single-blinded randomized controlled trial. SETTING General community. PARTICIPANTS Convenience sample of adults with SCI (N=84; mean time post-SCI, 9.9y; mean age, 46y; 73.8% men; 44% with paraplegia; 58% white). INTERVENTIONS Trained peer health coaches applied the person-centered health self-management intervention with 42 experimental subjects over 6 months on a tapered call schedule. The 42 control subjects received usual care. Both groups received the MCMC Resource Guide. MAIN OUTCOME MEASURES Primary outcome-health self-management as measured by the Patient Activation Measure (PAM). Secondary outcomes-global ratings of service/resource use, health-related quality of life, and quality of primary care. RESULTS Intervention participants averaged 12 calls over 6 months (averaging 21.8min each), with distinct variation. At 6 months, intervention participants reported a significantly greater change in PAM scores (6mo: estimate, 7.029; 95% confidence interval, .1018-13.956; P=.0468) compared with controls, with a trend toward significance at 4 months. At 6 months, intervention participants reported a significantly greater decrease in social/role activity limitations (estimate, -.443; P=.0389), greater life satisfaction (estimate, 1.0091; P=.0522), greater services/resources awareness (estimate, 1.678; P=.0253), greater overall service use (estimate, 1.069; P=.0240), and a greater number of services used (estimate, 1.542; P=.0077). Subgroups most impacted by MCMC on PAM change scores included the following: high social support, white persons, men, 1 to 6 years postinjury, and tetraplegic. CONCLUSIONS This trial demonstrates that the MCMC peer-led, health self-management intervention achieved a positive impact on self-management to prevent secondary conditions in adults with SCI. These results warrant a larger, multisite trial of its efficacy and cost-effectiveness.
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Affiliation(s)
- Bethlyn Vergo Houlihan
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
| | - Miriam Brody
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Sarah Everhart-Skeels
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Diana Pernigotti
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Sam Burnett
- Centre for Collaboration, Motivation and Innovation, Hope, British Columbia, Canada
| | - Judi Zazula
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Christa Green
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT
| | - Stathis Hasiotis
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Timothy Belliveau
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT
| | - Subramani Seetharama
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hartford Hospital, Hartford, CT
| | - David Rosenblum
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Alan Jette
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
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Barello S, Graffigna G, Pitacco G, Mislej M, Cortale M, Provenzi L. An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study. Front Psychol 2017; 7:2020. [PMID: 28119644 PMCID: PMC5222845 DOI: 10.3389/fpsyg.2016.02020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES. Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice. Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process. Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design.
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Affiliation(s)
- Serena Barello
- Department of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
| | | | - Giuliana Pitacco
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Maila Mislej
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Maurizio Cortale
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Livio Provenzi
- 0-3 Center for the at-Risk Infant - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio MedeaBosisio Parini, Italy
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30
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Blakemore A, Hann M, Howells K, Panagioti M, Sidaway M, Reeves D, Bower P. Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom. BMC Health Serv Res 2016; 16:582. [PMID: 27756341 PMCID: PMC5069882 DOI: 10.1186/s12913-016-1843-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient Activation is defined as the knowledge, skill, and confidence a patient has in managing their health. Higher levels of patient activation are associated with better self-management, better health outcomes, and lower healthcare costs. Understanding the drivers of patient activation can allow better tailoring of patient support and interventions. There are few data on patient activation in UK patients with long-term conditions. METHODS A prospective cohort design was used. Questionnaires were mailed to 12,989 patients over the age of 65 years with at least one long-term condition in Salford, UK. They completed the Patient Activation Measure and self-report measures of: depression, health literacy, social support, health-related quality of life, and impact of multimorbidity. We report descriptive data on baseline activation and change over time, and use multivariate regression to model associations with patient activation at baseline and predictors of change in Activation over 6 months. RESULTS The cohort included 4377 (33.6 %) older people, of whom 4225 were mailed a further questionnaire at 6 months; 3390 returned it complete (80.2 %). At baseline, 15 % self-reported PAM level 1, 16 % level 2, 45 % level 3, and 25 % level 4. Across all patients, depression had the strongest association with patient activation. Other important factors were: older age, being retired, poor health literacy, health-related quality of life, and social support. Total number of self-reported comorbidities and the perceived impact of comorbidities were also important for patients with more than one long-term condition. Patient activation scores were reasonably enduring over time (r = 0.43 between baseline and at six months), although nearly half changed 'levels' of activation over that time. Few variables predicted change in activation over 6 months. CONCLUSIONS This is the first large scale assessment of patient activation in the UK. Our data may be useful in identifying patients who need support with patient activation, and allow interventions (such as health coaching) to be tailored to better support older patients with long-term conditions who have symptoms of depression, poor social support and impaired health literacy. Further analyses of longitudinal studies will be necessary to better understand the causal relationships between patient activation and variables such as depression.
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Affiliation(s)
- Amy Blakemore
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Hann
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kelly Howells
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Sidaway
- Salford Royal NHS Foundation Trust, Salford Royal Foundation Trust, Stott Lane, Salford, M6 8HD UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
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