Empowerment-oriented strategies to identify behavior change in patients with chronic diseases: An integrative review of the literature

Promoting the empowerment and emancipation of community-dwelling older adults with chronic multimorbidity through a home visiting programme: a hermeneutical study

INTRODUCTION

Nurse-led preventive home visiting programmes can improve health-related outcomes in community-dwelling older adults, but they have not proven to be cost-effective. Home visiting programmes led by nursing students could be a viable alternative. However, we do not know how community-dwelling older adults with chronic multimorbidity experience home visiting programmes in which nursing students carry out health promotion activities. The aim of the study is to understand how community-dwelling older adults with chronic multimorbidity experience a home visiting programme led by nursing students.

METHODS

A qualitative study based on Gadamer's hermeneutics. Thirty-one community-dwelling older adults with chronic multimorbidity were interviewed in-depth. Fleming's method for conducting hermeneutic, Gadamerian-based studies was followed and ATLAS.ti software was used for data analysis.

RESULTS

Two main themes were generated: (1) 'The empowering experience of a personalised health-promoting intervention', and (2) 'The emancipatory effect of going beyond standardised self-care education'.

CONCLUSIONS

The home visiting programme contributed to the community-dwelling older adults feeling more empowered to engage in health-promoting self-care behaviours. It also improved the older adults' sense of autonomy and self-efficacy, while reducing their loneliness and addressing some perceived shortcomings of the healthcare system.

CLINICAL RELEVANCE

Older adults participating in a home visiting programme led by nursing students feel empowered to implement self-care behaviours, which has a positive impact on their perceived health status. Nurse leaders and nursing regulatory bodies could collaborate with nursing faculties to integrate preventive home visiting programmes led by nursing students into the services offered to community-dwelling older adults with chronic multimorbidity.

Work participation, social roles, and empowerment of Q-fever fatigue syndrome patients ≥10 years after infection

OBJECTIVE

To determine work participation, social roles, and empowerment of QFS patients ≥10-year after infection.

METHODS

QFS patients ≥10-year after acute infection, who were of working age, participated in a cross-sectional survey study. Work participation, fulfilment of social roles, and empowerment outcomes were studied for the total population, as well as for subgroups based on employment type and current work status. Associations between empowerment, work and social roles were examined.

RESULTS

291 participants were included. Of the 250 participants who had paid work before Q-fever, 80.4% stopped working or worked less hours due to QFS. For each social role, more than half of the participants (56.6-87.8%) spent less time on the role compared to before Q-fever. The median empowerment score was 41.0 (IQR: 37.0-44.0) out of 60. A higher empowerment score was significantly associated with lower odds of performing all social roles less due to QFS (OR = 0.871-0.933; p<0.001-0.026), except for parenting and informal care provision (p = 0.070-0.460). No associations were found between empowerment and current work status.

CONCLUSION

Work participation and fulfilment of social roles is generally low in QFS patients. Many of the participants stopped working or are working less hours due to QFS, and most spent less time on social roles compared to before Q-fever. Minor variation was seen in total empowerment scores of participants; however, these slight differences were associated with the fulfilment of social roles, but not work participation. This new insight should be further explored in future studies.

Exploring Goal-Setting and Achievement Within Reablement: A Comparative Case Study of Three Countries

Purpose

Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequence, healthcare providers and organizations often lack knowledge to implement and align reablement to their national and local context. This study aimed to collect data on goal-setting and achievement, and multidisciplinary collaboration within reablement services to provide insight into how these processes inform reablement practice as well as to explore the experiences of healthcare professionals in Norway, New Zealand, and the Netherlands.

Material and Methods

A qualitative exploratory design was used comprising three focus group interviews with 20 healthcare professionals (nursing and allied health) involved in reablement programs from the three countries. Purposive sampling was employed considering a mix of gender, age and educational level.

Results

Findings reflected healthcare professionals' experiences and reablement processes in three main themes: (1) Goal-setting processes; clearly demonstrating goal-setting as an essential part of reablement and contributing to better understanding of users' motives; (2) Impact of goal-setting on multidisciplinary collaboration; promoting a sense of community, learning climate, job satisfaction and task-shifting; and (3) Behavior change techniques used to reach users' goals, promoting self-reflection and changing users' perspectives.

Conclusion

This study offers valuable insights from three countries. Goal-setting serves a crucial role enabling effective reablement implementation across diverse contexts. More specifically, to facilitate tailoring of reablement programs to the user's needs as well as establish more effective multidisciplinary collaboration by promoting trust, shared vision, and utilizing each other's expertise. However, despite the acknowledgement of the significance of reablement, it was reported by all that a cultural shift is necessary for users, informal caregivers as well as healthcare professionals.

Evaluation of Self-Management Behaviors and Its Correlation with the Metabolic Syndrome among the Type 2 Diabetes Mellitus Patients of Northern Saudi Arabia

Self-management behavior among diabetes patients is essential to monitor blood sugar levels, make necessary lifestyle changes, and help patients reduce their risk of complications from diabetes. We assessed the prevalence of metabolic syndrome (MS) and its association with self-management behavior and sociodemographic characteristics among 310 patients with type 2 diabetes mellitus (T2DM) attending different diabetes care centers in northern Saudi Arabia. We evaluated the self-management behaviors of patients with T2DM using a validated Arabic version of the Summary of Diabetes Self-Care Activities Scale. Regarding MS, we applied the National Cholesterol Education Program (NCEP) Adult Treatment Plan-3 (ATP-3) guidelines. A logistic regression analysis was used to identify the predictors of MS. We found that more than one-third (36.5%) of patients had MS according to the NCEP ATP-3 criteria. The prevalence of MS was significantly associated with unsatisfactory self-management behaviors. Regarding sociodemographic predictors for MS, we found a significant association between gender (ref: female: Adjusted OR (AOR) = 1.89, 95%CI = 1.17-2.95, p = 0.007) and body mass index (ref.: normal range: AOR = 2.98, 95%CI = 1.31-5.07, p = 0.003). Our findings suggest a tailor-made multifaceted intervention to improve the self-management behaviors of T2DM patients, which, in turn, can reduce MS.

The relationship between psychological resilience and quality of life among the Chinese diabetes patients: the mediating role of stigma and the moderating role of empowerment

BACKGROUND

Although some factors, such as stigma and empowerment, influence the complex relationship between psychological resilience and quality of life, few studies have explored similar psychological mechanisms among patients with diabetes. Therefore, this study explored the mediating role of stigma and the moderating role of empowerment in the psychological mechanisms by which psychological resilience affects quality of life.

METHODS

From June to September 2022, data were collected by multi-stage stratified sampling and random number table method. Firstly, six tertiary hospitals in Wuhu were numbered and then selected using the random number table method, resulting in the First Affiliated Hospital of Wannan Medical College being selected. Secondly, two departments were randomly selected from this hospital: endocrinology and geriatrics. Thirdly, survey points were set up in each department, and T2DM patients were randomly selected for questionnaire surveys. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure the psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma. Empowerment was measured by the Diabetes Empowerment Scale (DES). Quality of Life was assessed by the Diabetes Quality of Life Scale (DQoL). We used SPSS (version 21) and PROCESS (version 4.1) for data analysis.

RESULTS

(1) Psychological resilience was negatively correlated with stigma and quality of life, and positively correlated with empowerment. Stigma was positively associated with empowerment and quality of life. Empowerment was negatively correlated with quality of life. (2) The mediation analysis showed that psychological resilience had a direct predictive effect on the quality of life, and stigma partially mediated the relationship; Empowerment moderates the first half of "PR → stigma → quality of life"; Empowerment moderates the latter part of "PR → stigma → quality of life."

CONCLUSIONS

Under the mediating effect of stigma, psychological resilience can improve quality of life. Empowerment has a moderating effect on the relationship between psychological resilience and stigma, and it also has a moderating effect on the relationship between stigma and quality of life. These results facilitate the understanding of the relationship mechanisms between psychological resilience and quality of life.

Smartphone-based application to control and prevent overweight and obesity in children: design and evaluation

BACKGROUND

Obesity is a multifaceted condition that impacts individuals across various age, racial, and socioeconomic demographics, hence rendering them susceptible to a range of health complications and an increased risk of premature mortality. The frequency of obesity among adolescent females in Iran has exhibited an increase from 6 to 9%, while among boys, it has risen from 2 to 7%. Due to the increasing prevalence and advancements in technology, the primary objective of this study was to develop and evaluate a smartphone-based app that would serve as an educational tool for parents about the matter of childhood overweight and obesity. Additionally, the app aimed to enhance parents' capacity to effectively address and manage their children's weight-related concerns.

METHODS

The design of the present study is of an applied-developmental type. In the first phase, the content of related smartphone-based app was determined based on the needs identified in similar studies and the findings of a researcher-made questionnaire. The versions of the app were designed in the android studio 3 programming environment, using the Java 8 programming language and SQLite database. Then, in order to evaluate the app's usability, ease of access, and different features, the standard usability evaluation questionnaire and the user satisfaction questionnaire (QUIS) were completed by the users.

RESULTS

The developed app has five main sections: the main page, recommendation section (with eight parts), charts over the time, child psychology, and reminders for each user. The designed app was given to 20 people including nutritionists and parents with children under 18 years of age for conducting usability evaluation. According to the scores of participants about the usability evaluation of the app, it can be concluded that groups participating in the study could use the program, and they rated the app at a "good" level. Overall performance of the app, screen capabilities, terms and information of the program, learnability, and general features are scored higher than 7.5 out of 9.

CONCLUSION

By using this app, people can become familiar with the causes and symptoms of weight imbalance and manage their weight as best as possible. This app can be considered as a model for designing and creating similar broader systems and programs for the prevention, management, treatment and care of diseases, which aim to help control diseases as much as possible and increase the quality of life and reduce complications for be patients.

Experiences of stigma, psychological distress, and facilitative coping among pregnant people with gestational diabetes mellitus

BACKGROUND

Gestational diabetes mellitus (GDM) has been rising in the United States, and it poses significant health risks to pregnant individuals and their infants. Prior research has shown that individuals with GDM also experience prevalent stress and mental health issues, which can further contribute to glucose regulation difficulties. Stigma associated with GDM may contribute to these mental health challenges, yet there is a lack of focused research on GDM-related stigma, its impact on psychological health, and effective coping mechanisms. Thus, this qualitative study aims to understand individuals' experiences related to GDM stigma, mental health, and facilitative coping.

METHODS

In-depth, semi-structured interviews were conducted with 14 individuals with a current or recent (within the last year) diagnosis of GDM. Thematic analysis was employed to guide data analysis.

RESULTS

Four themes emerged from data analysis: (1) experience of distal GDM stigma including stigmatizing provider interactions, stigma from non-medical spaces, and intersecting stigma with weight, (2) internalized GDM stigma, such as shame, guilt, and self-blame, (3) psychological distress, which included experiences of stress and overwhelm, excessive worry and fear, and loneliness and isolation, and (4) facilitative coping mechanisms, which included diagnosis acceptance, internet-based GDM community, active participation in GDM management, social and familial support, and time for oneself.

CONCLUSIONS

Findings demonstrate the relevance of GDM stigma in mental health among people with GDM and the need for addressing GDM stigma and psychological health in this population. Interventions that can reduce GDM stigma, improve psychological wellness, and enhance positive coping may facilitate successful GDM management and healthy birth outcomes. Future quantitative, theory-driven research is needed to understand the prevalence of GDM stigma experiences and mechanisms identified in the current study, as well as among marginalized populations (e.g., individuals of color, sexual and gender minorities).

Empowerment interventions designed for persons living with chronic disease - a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes

BACKGROUND

Empowerment approaches are essential for building the capacity of individuals with chronic disease to be in control of their health. Reviews of empowerment interventions have been focused on specific chronic diseases, thereby limiting the scope of findings. This study had three aims: 1) to describe the characteristics of empowerment interventions covering a broad range of chronic diseases, 2) to clarify consistency with the World Health Organization`s (WHO) definition of empowerment as a process composed of four fundamental components and 3) to summarize outcome measures and estimate the effects in group and individual intervention formats.

METHODS

Systematic literature review and meta-analysis. CINAHL, Medline, Embase, PsycINFO, Web of Science, COCHRANE and Central Register of Controlled Trials were searched using Chronic Disease, NCD, Empowerment, as MeSH terms. Eligible randomized and quasi randomized controlled trials were included. Review Manager 5.4 was used to conduct the meta-analysis. Risk of bias was assessed with the Cochrane risk-of-bias tool (ROB 2).

RESULTS

Thirty-nine articles representing 8,011 participants were included in the review. A majority (82%) of studies reported robust evidence for changes on study-defined outcome measures in favor of interventions. Intervention content was assessed against WHO's four fundamental components of empowerment, showing that all studies incorporated one component, but none targeted all components. Components reflecting knowledge acquisition, patient engagement with their health care providers and facilitating environment were scarcely reported. Meta-analyses found evidence for positive effects of group-format interventions measuring empowerment, HbA1c, and self-efficacy. Effects on empowerment were also found in some individual-format interventions. High levels of heterogeneity and variability among the conceptual frameworks were identified.

CONCLUSION

Empowerment interventions in group-format were most efficient, however, considerable conceptual inconsistencies were identified. Future studies should consolidate conceptual understandings by using WHO's empowerment framework to ensure that fundamental components of empowerment are explicitly included in intervention design. Furthermore, there is a need to clarify the role of empowerment through pathways that include patient activation, self- management, and clinical outcomes. This systematic review will inform the clinicians and researchers who aim to develop novel empowerment interventions to assist patients in the process of gaining control of their health.

TRIAL REGISTRATION

PROSPERO: International Prospective register of systematic reviews ID=CRD42020178286.

Primary care-based models of care for osteoarthritis; a scoping review

OBJECTIVE

To identify and describe the extent, nature, characteristics, and impact of primary care-based models of care (MoCs) for osteoarthritis (OA) that have been developed and/or evaluated.

DESIGN

Six electronic databases were searched from 2010 to May 2022. Relevant data were extracted and collated for narrative synthesis.

RESULTS

Sixty-three studies pertaining to 37 discrete MoCs from 13 countries were included, of which 23 (62%) could be classified as OA management programmes (OAMPs) comprising a self-management intervention to be delivered as a discrete package. Four models (11%) focussed on enhancing the initial consultation between a patient presenting with OA at the first point of contact into a local health system and the clinician. Emphasis was placed on educational training for general practitioners (GPs) and allied healthcare professionals delivering this initial consultation. The remaining 10 MoCs (27%) detailed integrated care pathways of onward referral to specialist secondary orthopaedic and rheumatology care within local healthcare systems. The majority (35/37; 95%) were developed in high-income countries and 32/37 (87%) targeted hip/and or knee OA. Frequently identified model components included GP-led care, referral to primary care services and multidisciplinary care. The models were predominantly 'one-size fits all' and lacked individualised care approaches. A minority of MoCs, 5/37 (14%) were developed using underlying frameworks, three (8%) of which incorporated behaviour change theories, while 13/37 (35%) incorporated provider training. Thirty-four of the 37 models (92%) were evaluated. Outcome domains most frequently reported included clinical outcomes, followed by system- and provider-level outcomes. While there was evidence of improved quality of OA care associated with the models, effects on clinical outcomes were mixed.

CONCLUSION

There are emerging efforts internationally to develop evidence-based models focused on non-surgical primary care OA management. Notwithstanding variations in healthcare systems and resources, future research should focus on model development alignment with implementation science frameworks and theories, key stakeholder involvement including patient and public representation, provision of training and education for providers, treatment individualisation, integration and coordination of services across the care continuum and incorporation of behaviour change strategies to foster long-term adherence and self-management.

Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study

Background

Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated.

Methods

Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship.

Results

Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance.

Conclusion

This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.

Understanding health behavior change by motivation and reward mechanisms: a review of the literature

The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.

Construction and Validation of a Protocol Targeting Patients on Oral Anticoagulation with Warfarin

BACKGROUND

Warfarin is an oral anticoagulant that is very useful in preventing thromboembolism, though it is considered a drug with a high risk of causing adverse events. Considering the practical challenges in controlling oral anticoagulation, the patients on warfarin could benefit from educational strategies aimed at behavioral changes, active participation in self-care, and adherence to drug therapy.

OBJECTIVE

The aim was to construct and validate the EmpoderACO protocol for behavioral changes in warfarin patients.

METHODS

The methodological steps were: definition of concepts and domains of self-care, identification of objectives, construction and selection of items, assessment of content validity, and pre-test in the target population.

RESULTS

Relevance, adequacy, clarity, and internal reliability of the instrument's items were assessed by a multidisciplinary judges committee (JC) through the E-surv web platform, obtaining an average agreement of ≥0.91. The understanding of the instrument measured by the target population revealed adequate clarity with a coefficient average of 0.96.

CONCLUSION

EmpoderACO can aid in qualifying the communication process between medical professionals and patients, as well as in improving adherence to both treatment and clinical outcomes, and can be replicated in healthcare settings.

Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review

BACKGROUND

Care transitions across different settings necessitate careful decision-making for all parties involved, yet research indicates that older people and informal caregivers do not have a strong voice in such decisions.

OBJECTIVE

To provide a systematic overview of the literature about interventions designed to empower older people and informal caregivers in transitional care decision-making.

DESIGN

A systematic review (Prospero Protocol CRD42020167961; funded by the EU's Horizon 2020 program).

DATA SOURCES

Five databases were searched: PubMed, EMBASE, Web of Science, PsycINFO, and CINAHL.

REVIEW METHODS

The review included evaluations of empowerment in decision-making interventions for older people and informal caregivers facing care transitions, that were published from the inception of the databases up until April 2022. Data extractions were performed by two independent researchers and the quality of studies was assessed with the relevant JBI-critical appraisal tools. A narrative descriptive analysis of the results was performed.

FINDINGS

Ten studies, reporting on nine interventions, and including a total of 4642 participants, were included. Interventions included transition preparation tools, support from transition coaches, shared decision-making interventions, and advance care planning. Designs and outcomes assessed were highly diverse and showed a mix of positive and lacking effects.

CONCLUSIONS

There is a lack of research on how to empower older people and their informal caregivers in transitional care decision-making. Empowerment in decision-making is usually not central in transitional care interventions, and effects on actual empowerment are mostly not assessed. Conclusions on how to empower older people and informal caregivers in transitional care decision-making cannot be drawn.

The work of Chinese chronic conditions: adaptation and validation of the Distribution of Co-Care Activities Scale

Purpose

The Distribution of Co-Care Activities Scale was adapted into Chinese for the purposes of this study, and then the psychometric characteristics of the Chinese version of the DoCCA scale were confirmed in chronic conditions.

Methods

A total of 434 patients with chronic diseases were recruited from three Chinese cities. A cross-cultural adaptation procedure was used to translate the Distribution of Co-Care Activities Scale into Chinese. Cronbach's alpha coefficient, split-half reliability, and test-retest reliability were used to verify the scale's reliability. Content validity indices, exploratory factor analysis, and confirmatory factor analysis were used to confirm the scale's validity.

Results

The Chinese DoCCA scale includes five domains: demands, unnecessary tasks, role clarity, needs support, and goal orientation. The S-CVI was 0.964. Exploratory factor analysis yielded a five-factor structure that explained 74.952% of the total variance. According to the confirmatory factor analysis results, the fit indices were within the range of the reference values. Convergent and discriminant validity both met the criteria. Also, the scale's Cronbach's alpha coefficient is 0.936, and the five dimensions' values range from 0.818 to 0.909. The split-half reliability was 0.848, and the test-retest reliability was 0.832.

Conclusions

The Chinese version of the Distribution of Co-Care Activities Scale had high levels of validity and reliability for chronic conditions. The scale can assess how patients with chronic diseases feel about their service of care and provide data to optimize their personalized chronic disease self-management strategies.

The relationship between use of complementary and alternative medicine and health literacy in chronically ill outpatient cases: a cross-sectional study in southeastern Iran

Background

Chronically ill outpatient cases use a variety of complementary and alternative medicines due to their diseases and therapeutic complications. Chronic condition, quality of life, and health literacy all affect the use of complementary medicine among chronically ill outpatient cases. Health literacy helps patients make fully informed decisions about the use of complementary and alternative medicine. This study aimed to investigate the relationship between complementary and alternative medicine and health literacy in chronically ill outpatient cases.

Method

This cross-sectional analytical-descriptive study was conducted on 400 chronically ill outpatient cases referred to medical centers affiliated to Kerman University of Medical Sciences. Convenience sampling was used. Research tools included the complementary and alternative medicine questionnaire and the health literacy questionnaire. SPSS25 was used to analyze data.

Results

The mean use of complementary and alternative medicine in a recent year was 16.75 ± 7.89, which was lower than the mid-point of the questionnaire (84). Prayer, medicinal plants, vitamin supplements, music therapy, and art therapy were the mostly used complementary and alternative medicine methods. The most common reasons for using complementary medicine were to reduce physical complications and improve anxiety and stress. The mean satisfaction with the use of complementary and alternative medicine was 34.96 ± 6.69. The mean health literacy score was 67.13 ± 19.90. Decision-making and the use of health information had the highest mean score among the dimensions of health literacy, whereas reading skills received the lowest mean score. We found a significant and direct relationship between the use of complementary and alternative medicine, health literacy, and all its dimensions.

Conclusion

The study results showed that health literacy predicted the use of complementary and alternative medicine. Health education and promotion programs may be useful for improvement of health literacy in the community.

A multiple sclerosis lifestyle behavior online course: Qualitative analysis of participants' motivations, expectations and experiences

Background

Modification of lifestyle-related risk factors for multiple sclerosis (MS) has been associated with improved health outcomes when compared with standard medical management alone. Based on an existing lifestyle modification program offered as a residential workshop, the MS Online Course (MSOC) was developed to translate the workshop into an online intervention. We performed a pilot randomized controlled trial (RCT), to assess the feasibility concepts of accessibility, learnability and desirability through quantitative and qualitative analyzes. In the present study, we performed additional qualitative analyzes to explore participants' motivations, expectations, and experiences of the MSOC. This study aims to complement prior feasibility analyzes and inform recruitment strategies and course content redevelopment so that its effectiveness may be assessed by examining behavior change and health outcomes in a future larger RCT.

Methods

Participants were recruited via online advertisements and randomized to either: the standard care course, containing material sourced from public facing MS websites; or the intervention course, based on an evidence-based lifestyle modification program for people with MS. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, reflexive thematic analysis of interviews was undertaken.

Results

Of 31 eligible participants, 17 completed the MSOC and 14 agreed to be interviewed. Four themes were identified in this analysis: (1) "Wanting to help others" (helping through volunteering, contributing to knowledge base, spreading the word; (2) "Seeking knowledge" (confirmation of existing knowledge; obtaining new knowledge, relevant, credible information); (3) "Doing what I can to help myself" (understanding lifestyle modification, changing my lifestyle, remaining well); and (4) "Changing attitudes" (finding positivity, feeling more confident and in control).

Conclusions

Participants were motivated to help others through research, help themselves by improving knowledge and to find ways to better manage their MS. Expectations included obtaining credible, reliable information, to substantiate existing knowledge, and to further understand lifestyle modification. Participants' experiences included confirmation of and obtaining new knowledge, and early implementation of modified lifestyle behaviors. These insights surrounding participants' motivations, expectations and experiences will assist in recruitment strategies, course redevelopment and outcome measures for the future RCT to examine the effectiveness of the MSOC.

Acceptability, feasibility, and effectiveness of smartphone‐based delivery of written educational materials in Iranian patients with coronary artery disease: A randomized control trial study

Background and Aims

Providing education to patients with coronary artery disease (CAD) is one of the crucial roles of nurses and, there are various education methods for these patients. This study aimed to investigate the acceptability, feasibility, and effectiveness of smartphone‐based delivery (SPBD) of written educational materials in Iranian patients with CAD.

Methods

A total of 104 patients with CAD who were admitted to the cardiovascular unit of a large hospital in the northeast of Iran were randomly divided into control and intervention groups. When the standard educational content was provided, educational materials were delivered to the intervention group using a SPBD and to the control group using the routine print delivery (PD). The authors investigated the usability in the postintervention phase and information satisfaction and medication self‐efficacy in the pre‐ and postintervention phases.

Results

The mean age and the standard deviation of “patients” age in SPBD and PD groups was 51.8 ± 1.1 and 52.7 ± 1.3 years, respectively. No significant difference was observed between the two groups in terms of mean information satisfaction score (p = 0.726); however, the information satisfaction score was significantly higher in the SPBD group than PD group after the intervention (p = 0.012). The findings showed no statistically difference between two groups in terms of usability score (p > 0.05). The two groups were homogenous in terms of the mean medication self‐efficacy score in the preintervention phase (p = 0.987); however, it was significantly higher in SPBD group than PD group in the postintervention phase (p = 0.045).

Conclusion

The SPBD method had the same usability as the PD method and at the same time this method was more effective in promoting medication self‐efficacy. Therefore, SPBD could be used to educate patients with CAD and their caregivers and have appropriate effectiveness and acceptability among the Iranian population.

Telemedicine in Neurosurgical Trauma during the COVID-19 Pandemic: A Single-Center Experience

Telemedicine is a rapid tool that reduces the time until treatment for patients, which is especially useful for neurosurgical trauma. The aim of our study was to evaluate the use of telemedicine in neurosurgery during the COVID-19 pandemic compared with the pre-pandemic era. We assessed the utilization of telemedicine at the Department of Neurosurgery at University Hospital Center Osijek in Croatia over a timespan of one year prior to the COVID-19 pandemic and the first year of the pandemic, starting with the date of first lockdown in Croatia. For each time period, the total number of consults and specific clinical inquiries were recorded and adequately grouped as well as comprehensive patient characteristics. There were 336 consults in the pre-pandemic period and 504 in the pandemic period. The number of trauma-related consults during COVID-19 measures was significantly higher than the pre-pandemic era (288 and 138, respectively, p < 0.0001). Neurosurgical trauma patients requiring consults in the pandemic period were significantly older than before the pandemic (64.9 ± 18.5 and 60.6 ± 19.1, respectively, p = 0.03). Significantly, the number of admissions to our center and urgent surgeries did not significantly differ between these periods. Telemedicine is a cost-effective tool in the neurosurgical evaluation of patients, especially for trauma. The COVID-19 pandemic accelerated telemedicine implementation and improved neurosurgical trauma treatments.

Factors associated with non-adherence to the use of coumarin derivatives or direct oral anticoagulants: a systematic review of observational studies

Non-adherence to thromboprophylaxis treatment with oral anticoagulants (OAC) is a public health problem and may be associated with high mortality rates. We sought to synthesize the factors associated with non-adherence to therapy with coumarin derivatives or direct oral anticoagulants. A systematic review was performed at electronic databases Medline, Embase, CINAHL, Lilacs and grey literature (Google Scholar, MedNar, OpenGray, ProQuest Dissertations and Theses and hand search). This study was conducted according to Cochrane's method and PRISMA. The registration on PROSPERO is CRD42020223555. Overall, 1,270 studies were identified and nine studies were selected for this review. In hand search, 77 studies were found, but none included. The associated factors with non-adherence were heterogeneous, and some factors were described as both risk and protection for non-adherence, with few variables showing consistent results among the studies. Variables reported only as risk factors were "male sex"; "hospitalization"; "Charlson score" and "bleeding", while "white race"; CHA₂ DS₂ VASc (score range 2-9)" and "polypharmacy" were reported only as protective factors. Most studies did not present details in the description of concepts and methods to assess non-adherence. In clinical practice, the knowledge on factors associated with non-adherence is helpful to identifying patients at higher risk of complications that would benefit from individualized interventions.