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García-Ovejero E, Pisano-González M, Salcedo-Diego I, Serrano-Gallardo P. Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain. Healthcare (Basel) 2024; 12:811. [PMID: 38667573 PMCID: PMC11049834 DOI: 10.3390/healthcare12080811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.
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Affiliation(s)
- Ester García-Ovejero
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Pisano-González
- General Directorate of Social and Health Care and Coordination, Ministry of Health of the Principality of Asturias, 33005 Asturias, Spain
- Research Group “Person-Centered Care” of the Research Institute of Asturias (ISPA), 33005 Asturias, Spain
| | - Isabel Salcedo-Diego
- Puerta de Hierro Majadahonda University Hospital, 28222 Majadahonda, Spain
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Pilar Serrano-Gallardo
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- Interuniversity Institute “Advanced Research on Evaluation of Science and the University” (INAECU), 28029 Madrid, Spain
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Senanayake S, Barnett A, Brain D, Allen M, Powell EE, O'Beirne J, Valery P, Hickman IJ, Kularatna S. A discrete choice experiment to elicit preferences for a chronic disease screening programme in Queensland, Australia. Public Health 2024; 228:105-111. [PMID: 38354579 DOI: 10.1016/j.puhe.2024.01.007] [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: 07/11/2023] [Revised: 12/25/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Patient-centred care, increasingly highlighted in healthcare strategies, necessitates understanding public preferences for healthcare service attributes. We aimed to understand the preferences of the Australian population regarding the attributes of chronic disease screening programmes. STUDY DESIGN The preferences were elicited using the discrete choice experiment (DCE) methodology. METHODS A DCE was administered to a sample of the Australian general population. Respondents were asked to make choices, each offering two hypothetical screening scenarios defined by screening conduct, quality and accuracy of the test results, cost to the patient, wait time and source of information. Data were analysed using a panel mixed multinomial logit model. RESULTS A strong preference for highly accurate screening tests and nurse-led screenings at local health clinics was evident. They expressed disutility for waiting time and out-of-pocket costs but were indifferent about the source of information. Their preference for a nurse-led programme was highlighted by the fact that they were willing to pay $81 and $88 to get a nurse-led programme when they were offered a general practitioner-led and a specialist-led programme, respectively. Furthermore, they were willing to pay $32 to reduce a week of waiting time and $205 for a 95% accurate test compared to a 75% accurate test. Preferences remained consistent irrespective of the respondent's place of residence. CONCLUSIONS Our findings highlight the importance of diagnostic test accuracy and nurse-led service delivery in chronic disease screening programmes. These insights could guide the development of patient-centric services by enhancing test accuracy, reducing waiting times and promoting nurse-led care models.
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Affiliation(s)
- S Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001, Australia; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - A Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - D Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001, Australia.
| | - M Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - E E Powell
- The University of Queensland, St Lucia, QLD 4072, Australia; Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - J O'Beirne
- University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, QLD 4558, Australia
| | - P Valery
- QIMR Berghofer Medical Research Institute, Royal Brisbane Hospital, Herston, QLD 4029, Australia
| | - I J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia; The University of Queensland, St Lucia, QLD 4072, Australia
| | - S Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4001, Australia; Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Reistetter T, Hreha K, Dean JM, Pappadis MR, Deer RR, Li CY, Hong I, Na A, Nowakowski S, Shaltoni HM, Bhavnani SK. The Pre-Adaptation of a Stroke-Specific Self-Management Program Among Older Adults. J Aging Health 2023; 35:632-642. [PMID: 36719035 PMCID: PMC10387498 DOI: 10.1177/08982643231152520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives: Managing multimorbidity as aging stroke patients is complex; standard self-management programs necessitate adaptations. We used visual analytics to examine complex relationships among aging stroke survivors' comorbidities. These findings informed pre-adaptation of a component of the Chronic Disease Self-Management Program. Methods: Secondary analysis of 2013-2014 Medicare claims with stroke as an index condition, hospital readmission within 90 days (n = 42,938), and 72 comorbidities. Visual analytics identified patient subgroups and co-occurring comorbidities. Guided by the framework for reporting adaptations and modifications to evidence-based interventions, an interdisciplinary team developed vignettes that highlighted multimorbidity to customize the self-management program. Results: There were five significant subgroups (z = 6.19, p < .001) of comorbidities such as obesity and cancer. We constructed 6 vignettes based on the 5 subgroups. Discussion: Aging stroke patients often face substantial disease-management hurdles. We used visual analytics to inform pre-adaptation of a self-management program to fit the needs of older adult stroke survivors.
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Affiliation(s)
- Timothy Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710
| | - Julianna M. Dean
- Department of Clinical, Health, and Applied Sciences, College of Human Sciences and Humanities, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058
| | - Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Rachel R. Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, 135 Backun Hall, Yonsei Univroad 1, Wonju, Gangwon-do, Republic of Korea, 26493
| | - Annalisa Na
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Hashem M. Shaltoni
- Department of Neurology, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Suresh K. Bhavnani
- Department of Population Health and Health Disparities, School of Public and Population Health, 300 University Blvd, Galveston, TX 77555
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Pellegrini CA, Wilcox S, DeVivo KE, Jamieson S. Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:1996-2010. [PMID: 36752353 DOI: 10.1002/acr.25098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/06/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management. METHODS Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles. RESULTS Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies. CONCLUSION This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.
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Falasinnu T, Bao G, Brady TJ, Lim SS, Drenkard C. Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self-Management Program. Arthritis Care Res (Hoboken) 2023; 75:519-528. [PMID: 34738339 PMCID: PMC9065209 DOI: 10.1002/acr.24811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus erythematosus (SLE); however, little is known about predictors of participation among Black women with SLE. We examined factors associated with CDSMP initiation and completion in this population. METHODS We studied 228 Black women with SLE who consented to attend a CDSMP workshop. We used logistic regression to calculate unadjusted and adjusted odds ratios (ORs) for being a CDSMP initiator (a participant registered into the CDSMP who attended at least 1 of the first 2 weekly classes) and a CDSMP completer (a participant who completed at least 4 of 6 weekly classes). RESULTS The majority of participants were CDSMP initiators (74% [n = 168]). Of those, 126 (75%) were CDSMP completers. Older age (adjusted OR [ORadj ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) and unemployment/disability (ORadj 2.05 [95% CI 1.05-4.14]) increased the odds of being a CDSMP initiator. The odds of initiating the CDSMP decreased by 22% for each additional child in the household (OR 0.78 [95% CI 0.62-0.98]), but this association became nonsignificant in the adjusted model (ORadj 0.89 [95% CI 0.68-1.18]). The only factor that differed significantly between CDSMP completers and noncompleters was age, with 4% higher odds of being a completer for each additional year of age (ORadj 1.04 [95% CI 1.00-1.07]). CONCLUSION Our findings suggest that young Black women with SLE face barriers to attend and complete in-person CDSMP workshops, possibly in relation to work and child care demands.
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Affiliation(s)
| | | | | | - S Sam Lim
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cristina Drenkard
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
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Johnson VL, Apps L, Kreit E, Mullis R, Mant J, Davies MJ. The feasibility of a self-management programme (My Life After Stroke; MLAS) for stroke survivors. Disabil Rehabil 2023; 45:235-243. [PMID: 35104171 DOI: 10.1080/09638288.2022.2029960] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE An evidence-based, theory-driven self-management programme "My Life After Stroke" (MLAS) was developed to address the longer-term unmet needs of stroke survivors.This study's aim was to test the acceptability and feasibility of MLAS as well as exploring what outcomes measures to include as part of further testing. METHODS Stroke registers in four GP practices across Leicester and Cambridge were screened, invite letters sent to eligible stroke survivors and written, informed consent gained. Questionnaires including Southampton Stroke Self-Management Questionnaire (SSSMQ) were completed before and after MLAS.Participants (and carers) attended MLAS (consisting of two individual appointments and four group sessions) over nine weeks, delivered by two trained facilitators. Feedback was gained from participants (after the final group session and final individual appointment) and facilitators. RESULTS Seventeen of 36 interested stroke survivors participated alongside seven associated carers. 15/17 completed the programme and attendance ranged from 13-17 per session. A positive change of 3.5 of the SSSMQ was observed. Positive feedback was gained from facilitators and 14/15 participants recommended MLAS (one did not respond). CONCLUSIONS MLAS was a feasible self-management programme for stroke survivors and warrants further testing as part of the Improving Primary Care After Stroke (IPCAS) cluster randomised controlled trial.IMPLICATIONS FOR REHABILITATIONMy Life After Stroke is a self-management programme developed for stroke survivors living in the community.MLAS is feasible and acceptable to stroke survivors.MLAS could be considered to help address the unmet educational and psychological needs of stroke survivors.
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Affiliation(s)
- V L Johnson
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L Apps
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- De Montfort University, Leicester, UK
| | - E Kreit
- University of Cambridge, Cambridge, UK
| | - R Mullis
- University of Cambridge, Cambridge, UK
| | - J Mant
- University of Cambridge, Cambridge, UK
| | - M J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Biomedical Research Centre, NIHR, Leicester, UK
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Pullyblank K, Brunner W, Scribani M, Krupa N, Ory MG, Smith ML. Recruitment and engagement in disease self-management programs: Special concerns for rural residents reporting depression and/or anxiety. Prev Med Rep 2022; 26:101761. [PMID: 35299592 PMCID: PMC8921301 DOI: 10.1016/j.pmedr.2022.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/07/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Poorer health outcomes are correlated with depression/anxiety in a rural population. Electronic modes of recruitment engage those reporting depression/anxiety into CDSME. CDSME increases patient activation regardless of history of depression/anxiety.
Chronic disease self-management education (CDSME) programs benefit individuals with chronic diseases, including mental health conditions, by improving health-related outcomes and increasing engagement with the health care system. Recruiting individuals with a history of mental health conditions to participate in CDSME is challenging, particularly in rural, underserved areas. Hence, it is important to understand factors associated with the presence of mental health conditions, and impacts of CDSME on patient engagement. This project identifies individual and program-level characteristics, as well as recruitment characteristics, associated with reporting a history of depression and/or anxiety. It also assesses factors related to program engagement and the relationship between completing CDSME and patient activation. Data were collected during CDSME workshops offered in 2019 in a rural region of New York. Of the 421 enrollees who completed survey instruments, 162 reported a history of depression and/or anxiety. Univariate analyses indicated that those reporting a history of depression and/or anxiety were younger, female, in poorer health, had more comorbidities, were Medicaid beneficiaries, and had lower patient activation scores. They also heard about and signed up for the workshop through the internet at higher rates than those not reporting a history of depression and/or anxiety. Multivariable logistic regression modeling indicated age, self-rated health, and number of comorbidities were independent predictors of reporting a history of depression and/or anxiety. Among CDSME completers, patient activation significantly improved regardless of history of depression and/or anxiety. Engaging individuals with mental health conditions in CDSME requires a multimodal recruitment strategy incorporating electronic marketing and registration.
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Affiliation(s)
- Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA.,Decker College of Nursing and Health Sciences, Binghamton University, PO Box 6000, Binghamton, NY 13902, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Melissa Scribani
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Nicole Krupa
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
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Zaman MS, Ghahari S, McColl MA. Empowered patient: A program to improve people with Parkinson’s communication with health care professionals. Clin Park Relat Disord 2022; 7:100156. [PMID: 35898797 PMCID: PMC9310115 DOI: 10.1016/j.prdoa.2022.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Communication breakdown between patients and health care professionals poses an accessibility gap preventing adequate health care. The Empowered Patient Program was developed to support people with Parkinson’s in improving their health communication skills/strategies and thus facilitate the accessibility gap in their care. Objective Our pilot study aimed to test the feasibility and preliminary effect of the Empowered Patient Program within a small cohort of individuals with Parkinson’s disease. Methods We completed a pre-test-post-test pilot study. Eight participants completed the Empowered Patient Program for this pilot study. Data collection was completed by administering a questionnaire prior to the program, immediately after program completion, and three months post-completion. We additionally conducted two telephone interviews with the participants to qualitatively gather feedback on the program. Results The program elucidated statistically significant improvement across domains/areas of knowledge (p = 0.01) and self-perceived communication skills (p = 0.04) among the participants. Through feedback from the patient interviews, it was confirmed that these significant improvements were owed largely to the high level of organization, intuitive user interface, and suitable content of the program for this cohort. Conclusions The Empowered Patient Program pilot resulted in a desired outcome indicating its satisfactory development. The next steps are to test the Empowered Patient program in a larger sample.
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Affiliation(s)
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
- Corresponding author.
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Overcoming barriers to recruitment and retention of African-American women with SLE in behavioural interventions: lessons learnt from the WELL study. Lupus Sci Med 2021; 7:7/1/e000391. [PMID: 32532797 PMCID: PMC7295441 DOI: 10.1136/lupus-2020-000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
Background African–Americans are historically under-represented in SLE studies and engaging them in behavioural interventions is challenging. The Women Empowered to Live with Lupus (WELL) study is a trial conducted to examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among African–American women with SLE. We describe enrolment and retention challenges and successful strategies of the WELL study. Methods The Georgians Organized Against Lupus (GOAL) cohort, a population-based cohort established in Atlanta, Georgia, was used to enrol a sample of 168 African–American women with SLE into the CDSMP. The CDSMP is a 6-week, group-based programme led by peers to enhance self-management skills in people with chronic conditions. Study performance standards were predefined and close monitoring of recruitment and retention progress was conducted by culturally competent staff members. Continuous contact with participants, research coordinators’ notes and regular research team meetings served to assess barriers and define strategies needed to meet the desired recruitment and retention outcomes. Results While no substantial barriers were identified to enrol GOAL participants into the WELL study, WELL participants faced difficulties registering for and/or completing (attending ≥4 sessions) a CDSMP workshop. Major barriers were unpredicted personal and health-related issues, misunderstanding of the scope and benefits of the intervention, and transportation problems. Early implementation of tailored strategies (eg, CDSMP scheduled on Saturdays, CDSMP delivered at convenient/familiar facilities, transportation services) helped to reduce participant barriers and achieve a CDSMP registration of 168 participants, with 126 (75%) completers. Frequent contact with participants and compensation helped to reach 92.3% retention for the 6-month survey. Conclusions Predefined standards and monitoring of participant barriers by a culturally competent research team and proactive solutions were critical to implementing successful strategies and achieving the desired recruitment and retention outcomes of a behavioural trial involving African–American women with SLE. Trial registration number NCT02988661.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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Donnelly S, Wilson AG, Mannan H, Dix C, Whitehill L, Kroll T. (In)Visible illness: A photovoice study of the lived experience of self-managing rheumatoid arthritis. PLoS One 2021; 16:e0248151. [PMID: 33684123 PMCID: PMC7939378 DOI: 10.1371/journal.pone.0248151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic illnesses, such as Rheumatoid Arthritis (RA), are a growing burden on health care systems worldwide. Self-management emphasises the patient's central role in managing their illness. This is pertinent given the majority of care is provided by the individual themselves; yet how individuals make sense of self-management in everyday life is largely unseen. OBJECTIVE The purpose of this study was to capture the strengths and concerns of individuals with RA in self-managing their illness, raise awareness of their lived experience and spark a dialogue among stakeholders. METHODS A community-based participatory approach, Photovoice, was adopted. A purposive sample of participants were tasked with taking photographs to represent the challenges and solutions to living with RA. Group workshops and semi-structured interviews were conducted to facilitate reflection, dialogue and analysis. Data analysis followed Braun and Clarke's thematic analysis. Public exhibitions were held throughout the Autumn of 2019. RESULTS Eight women and three men (n = 11) across suburban and urban regions of Ireland were recruited (mean age 57 years, disease duration 4-21 years). Participants identified four main themes which reflected the lived experience of self-managing RA: (i) I'm Here but I'm Not, (ii) Visible Illness, (iii) Medicine in All its Forms, (iv) Mind Yourself. These themes captured the challenge of reduced agency, limited contribution and participation, and a complex relationship between visible and invisible illness. Solutions focused on improving psychological and emotional resilience, particularly through personal reflection and increased agency. CONCLUSIONS Our findings suggest that RA is experienced as a fluid relationship between states of masking and surfacing of illness shaped by contextual and situational factors. Photovoice was a highly effective tool to capture and communicate this complexity. Supporting increased agency among individuals with RA to control the (in)visibility of illness and disability can inform the development of future self-management support.
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Affiliation(s)
- Susie Donnelly
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Anthony G. Wilson
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Hasheem Mannan
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- FLAME University, Pune, India
| | | | - Laura Whitehill
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Schmidt F, Ribi K, Haslbeck J, Urech C, Holm K, Eicher M. Adapting a peer-led self-management program for breast cancer survivors in Switzerland using a co-creative approach. PATIENT EDUCATION AND COUNSELING 2020; 103:1780-1789. [PMID: 32345575 DOI: 10.1016/j.pec.2020.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 03/08/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The peer-led Cancer Thriving and Surviving Program (CTS) has demonstrated improved health outcomes for cancer survivors. We describe a co-creative process for adapting the CTS for breast cancer survivors in Switzerland and integrating the program into the clinical pathway of Swiss breast centers. METHODS A co-creative approach was employed. Breast cancer survivors and health care professionals (total n = 81) participated in three workshops, an online rating, and a consensus conference. An iterative cycle (evidence, ideas, refining, rating, and synthesis) guided the adaptation process. RESULTS Survivors involvement in the adaptation process allowed to tailor the self-management program to the psychosocial needs identified as the highest priority. New contents "Being a woman", "Breast cancer and my (working) life" and "My exercise" were added to the CTS. Program duration was expanded from 6 to 7 weeks. Transition to follow-up care was considered as the optimal time point for program integration into the clinical pathway. CONCLUSION The co-creative process may serve as a model in adapting supportive interventions for cancer. A subsequent pilot testing examined the feasibility and preliminary efficacy. PRACTICE IMPLICATIONS Combining expertise of health care professionals and patients to co-create a peer-led breast cancer self-management program may enhance acceptability and adoption.
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Affiliation(s)
- Franziska Schmidt
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and University Hospital Lausanne, Lausanne, Switzerland
| | - Karin Ribi
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and University Hospital Lausanne, Lausanne, Switzerland; International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | - Joerg Haslbeck
- Swiss Cancer League, Division Follow-up Care, Bern, Switzerland; Nursing Science, University of Basel, Basel, Switzerland
| | - Corinne Urech
- Women's Hospital, University Hospital Basel, Basel, Switzerland
| | - Karin Holm
- Patient Advocates for Cancer Research and Treatment (Association PACRT), Geneva, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne and University Hospital Lausanne, Lausanne, Switzerland.
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12
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Horrell L, Knafl GJ, Brady T, Lazard A, Linnan L, Kneipp S. Communication Cues and Engagement Behavior: Identifying Advertisement Strategies to Attract Middle-Aged Adults to a Study of the Chronic Disease Self-Management Program. Prev Chronic Dis 2020; 17:E48. [PMID: 32584754 PMCID: PMC7316415 DOI: 10.5888/pcd17.190413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Low- and middle-income, middle-aged adults have high rates of disease and death from chronic disease, yet their participation in self-management programs is low. This may be because advertisements for such programs often target elderly, predominantly white, affluent adults. Our study used data from a parent randomized controlled trial to identify theoretically driven advertisement cues to engage low- and middle-income, middle-aged adults in the Chronic Disease Self-Management Program (CDSMP). METHODS A framework that combined the Elaboration Likelihood Model and Protection Motivation Theory was used to guide χ2 and regression analyses to assess relationships between advertisement cue preferences and 5 stages of cognitive engagement (cue processing, cognitive appraisal of the advertised study, motivation to enroll) and behavioral engagement of study participants (enrollment and program participation). RESULTS One advertisement cue (taking control of one's future) and 1 cue combination (financial security and taking control of one's future) were significantly associated with study enrollment, as were motivation to enroll and cue processing. CONCLUSION These results can inform CDSMP recruitment efforts to better engage low- and middle-income, middle-aged adults in an effort to mitigate the disproportionate burden of chronic disease in this population.
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Affiliation(s)
- Lindsey Horrell
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
- University of North Carolina at Chapel Hill, Rosenau Hall 135 Dauer Drive Chapel Hill, NC 27599‑7400.
| | - George J Knafl
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia
| | - Allison Lazard
- University of North Carolina at Chapel Hill, Hussman School of Journalism and Media, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Laura Linnan
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Shawn Kneipp
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
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13
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Tan SS, Pisano MM, Boone AL, Baker G, Pers YM, Pilotto A, Valsecchi V, Zora S, Zhang X, Fierloos I, Raat H. Evaluation Design of EFFICHRONIC: The Chronic Disease Self-Management Programme (CDSMP) Intervention for Citizens with a Low Socioeconomic Position. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111883. [PMID: 31142017 PMCID: PMC6603786 DOI: 10.3390/ijerph16111883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/14/2019] [Accepted: 05/25/2019] [Indexed: 12/21/2022]
Abstract
Background/rationale: The Chronic Disease Self-Management Programme (CDSMP) intervention is an evidence-based program that aims to encourage citizens with a chronic condition, as well as their caregivers, to better manage and maintain their own health. CDSMP intervention is expected to achieve greater health gains in citizens with a low socioeconomic position (SEP), because citizens with a low SEP have fewer opportunities to adhere to a healthy lifestyle, more adverse chronic conditions and a poorer overall health compared to citizens with a higher SEP. In the EFFICHRONIC project, CDSMP intervention is offered specifically to adults with a chronic condition and a low SEP, as well as to their caregivers (target population). Study objective: The objective of our study is to evaluate the benefits of offering CDSMP intervention to the target population. Methods: A total of 2500 participants (500 in each study site) are recruited to receive the CDSMP intervention. The evaluation study has a pre-post design. Data will be collected from participants before the start of the intervention (baseline) and six months later (follow up). Benefits of the intervention include self-management in healthy lifestyle, depression, sleep and fatigue, medication adherence and health-related quality of life, health literacy, communication with healthcare professionals, prevalence of perceived medical errors and satisfaction with the intervention. The study further includes a preliminary cost-effectiveness analysis with a time horizon of six months. Conclusion: The EFFICHRONIC project will measure the effects of the CDSMP intervention on the target population and the societal cost savings in five European settings.
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Affiliation(s)
- Siok Swan Tan
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Marta M Pisano
- Fundación para el Fomento en Asturias de la Investigación Científica Aplicada y la Tecnología (FICYT), Cabo Noval St, 11, 1ºC, 33007 Oviedo-Asturias, Spain.
| | - An Ld Boone
- Public Health General Directorate, Principality of Asturias (CSPA), C/ Ciriaco Miguel Vigil 9, 33006 Oviedo, Spain.
| | - Graham Baker
- Quality Institute for Self Management Education & Training (QISMET), Harbour Court, Compass Road, North Harbour, Portsmouth, Hampshire PO6 4ST, UK.
| | - Yves-Marie Pers
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier CEDEX 5, France.
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Verushka Valsecchi
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie University Hospital, Montpellier, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier CEDEX 5, France.
| | - Sabrina Zora
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy.
| | - Xuxi Zhang
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Irene Fierloos
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
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Kneipp SM, Horrell L, Gizlice Z, Smith M, Linnan L, Brady T. Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions. Am J Health Promot 2019; 33:172-182. [PMID: 30614267 PMCID: PMC7161073 DOI: 10.1177/0890117118821843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a "health self-management program" [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. DESIGN Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). SUBJECTS The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. MEASURES Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. ANALYSES Multinomial logistic regression and post-hoc marginal effects models. RESULTS Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. CONCLUSION Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
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Affiliation(s)
- Shawn M. Kneipp
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lindsey Horrell
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ziya Gizlice
- Health Promotion and Disease Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Smith
- Center for Population Health and Aging, Texas A&M University, and the College of Public Health, The University of Georgia
| | - Laura Linnan
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta GA
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15
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Kiami SR, Sky R, Goodgold S. Facilitators and barriers to enrolling in falls prevention programming among community dwelling older adults. Arch Gerontol Geriatr 2019; 82:106-113. [PMID: 30771600 DOI: 10.1016/j.archger.2019.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/14/2018] [Accepted: 01/19/2019] [Indexed: 10/27/2022]
Abstract
The purpose of this cross-sectional survey study was to identify factors that increase the likelihood of enrolling in falls prevention programming among community dwelling older adults. A convenience sample of 369 participants completed a written, selfadministered questionnaire on history and beliefs related to falls, and facilitators and barriers associated with enrollment. History of falling, fear of falling, self-efficacy, and recognition of program benefits were all associated with a greatly likelihood to enroll in falls prevention programming. Additionally, seven facilitators were associated with greater likelihood to enroll, including offered close to home (OR = 6.75(3.829-11.898); p = 0.000), free vision screen (OR = 4.816 (1.442-16.084); p = 0.005), friendly leader (OR = 3.930 (2.049-7.538); p = 0.000), coffee hour to socialize (OR = 3.789 (1.309-10.971); p = 0.009), no cost (OR = 3.653 (2.125-6.253); p = 0.000), group exercise (OR = 2.584 (1.341-4.980); p = 0.004), and safe place (OR = 2.378 (1.181-4.789); p = 0.013). Physician advice to attend a program, however, was not associated with likelihood to register (p = 0.99), supporting the need for a paradigm shift from physicians serving as the key change-agent in falls prevention to multiple partnerships. In addition, although 72% of participants were likely to register for a falls prevention program, only 28% knew if a program was being offered in their community. These findings highlight a critical need to disseminate information about falls prevention programming through social marketing in locations where older adults go in their everyday lives.
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Affiliation(s)
- Sheri R Kiami
- Northeastern University, Department of Physical Therapy, Movement & Rehabilitation Sciences, 301 Robinson Hall, 360 Huntington Avenue, Boston, MA, 02115, United States.
| | - Rebecca Sky
- Foundation for Healthy Communities, 125 Airport Road, Concord, NH, 03301, United States.
| | - Shelley Goodgold
- Simmons College, Physical Therapy Department, 300 The Fenway, Boston, MA, 02115, United States.
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