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Farzandipour M, Heidarzadeh Arani M, Sharif R, Nabovati E, Akbari H, Anvari S. Improving asthma control and quality of life via a smartphone self-management app: A randomized controlled trial. Respir Med 2024; 223:107539. [PMID: 38325663 DOI: 10.1016/j.rmed.2024.107539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Mobile phone applications (apps) show promise for enhancing asthma self-management, but their effectiveness varies. This study examined the effect of a smartphone asthma app on asthma control and quality of life. METHODS Using block randomization, 60 patients with asthma were allocated to an intervention group (n = 30) or control group (n = 30) for this single-blind randomized controlled trial. At baseline, both groups completed the Asthma Control Test (ACT) and Asthma Quality of Life Questionnaire-Marks (AQLQ-M). The intervention group used a smartphone-based asthma self-management app plus their regular treatment, while the control group received only usual care. Follow-up ACT and AQLQ-M assessments occurred at 3 and 6 months. SPSS version 26 was used for analysis, including descriptive statistics, non-parametric tests (Wilcoxon and Mann-Whitney U), and analysis of variance with repeated measurements. RESULTS Both groups showed improved asthma control and quality of life at 3 and 6 months compared to baseline. However, after 6 months the intervention group had significantly greater improvement than controls (p < 0.05). Repeated measures ANOVA revealed divergent changes in ACT and AQLQ-M scores over time, with the intervention group demonstrating greater enhancement of asthma control and quality of life (p < 0.001). CONCLUSION This study demonstrated that use of a smartphone-based asthma self-management app improved asthma control and quality of life after 6 months compared to usual care alone. These findings indicate that guideline-based asthma apps can positively impact outcomes.
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Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Heidarzadeh Arani
- Pediatric Department, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Asthma and Allergy Clinic, Kashan University of Medical Sciences, Kashan, Iran
| | - Reihane Sharif
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran.
| | - Ehsan Nabovati
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Biostatistics and Epidemiology, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Anvari
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran; Department of Health Information Management and Technology, Allied Medical Sciences Faculty, Kashan University of Medical Sciences, Kashan, Iran
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Salandi J, Hayden MC, Heinrichs K, Limbach M, Schultz K, Schwarzl G, Neumeister W, Loerbroks A. Can an educational intervention in the context of inpatient pulmonary rehabilitation improve asthma self-management at work? A study protocol of a randomized controlled trial. BMC Pulm Med 2024; 24:40. [PMID: 38233800 PMCID: PMC10795332 DOI: 10.1186/s12890-024-02847-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Asthma self-management (e.g., trigger avoidance or correct medication use) is a cornerstone of therapy. Its successful implementation in everyday working life is determined by psychosocial working conditions, in particular by support from superiors and colleagues and the job decision latitude (i.e., when and how to carry out which tasks). To empower individuals with asthma to modify their working conditions, employees need to use certain communication skills and acquire specific knowledge. Both could be taught as part of patient education during pulmonary rehabilitation. Therefore, the aim of the planned study is the development and multicentre implementation of an education module for individuals with asthma during their rehabilitation and to generate evidence on its effectiveness. METHODS Participants (n ≥ 180) will be recruited, randomized into an intervention and a control group, trained and surveyed in two rehabilitation clinics. The intervention group will receive the supplementary patient education module "Asthma and Work" while the control group will participate in a program on " Eating behaviour" (both 2 × 50 min). The effectiveness of the intervention will be examined based on pre-post measurements (T1 and T2) and a 3-month follow-up (T3). We will consider behavioural intention (T2) and asthma self-management at work (T3) as primary outcomes. Secondary outcomes will include self-management-related knowledge, self-efficacy, number of sick days, number of exacerbations, asthma control (Asthma Control Test), asthma-related quality of life (Marks Asthma Quality of Life Questionnaire), and subjective employment prognosis (Brief Scale Measuring the Subjective Prognosis of Gainful Employment). The pre-post comparisons are to be evaluated using univariate analyses of covariance. DISCUSSION Improving asthma self-management at work could increase the work ability and social participation of employees with asthma. This could reduce costs, e.g. in terms of asthma-related sick leave. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00031843).
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Affiliation(s)
- Julia Salandi
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany.
| | - Markus C Hayden
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Katherina Heinrichs
- Institute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Limbach
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Konrad Schultz
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | - Gabriele Schwarzl
- Clinic Bad Reichenhall, Centre for Rehabilitation, Pneumology and Orthopaedics, Bad Reichenhall, Germany
| | | | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
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Patel NB, Céspedes A, Liu J, Bruzzese JM. Depressive symptoms are related to asthma control but not self-management among rural adolescents. FRONTIERS IN ALLERGY 2024; 4:1271791. [PMID: 38274547 PMCID: PMC10809796 DOI: 10.3389/falgy.2023.1271791] [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: 08/02/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Depression, a relevant comorbidity with asthma, has been reported to be associated with asthma morbidity. Asthma self-management is essential to asthma control and may be negatively impacted by depression. We examined these associations in rural adolescents, a group with relatively high asthma morbidity and depressive symptoms, a population often ignored in asthma research. Methods We used baseline data from a randomized trial of an asthma intervention for adolescents in rural South Carolina (n = 197). Adolescents completed the Center for Epidemiological Studies-Depression (CES-D), three indices of asthma self-management (the Asthma Prevention Index, the Asthma Management Index and the Asthma Self-Efficacy Index), and the Asthma Control Test (ACT). Poisson and linear regression tested associations between depression, self-management, and asthma control. The models controlled for demographic variables and included school as a fixed effect. Results Most participants (mean age = 16.3 ± 1.2 years) self-identified as female (68.5%) and Black (62.43%). The mean CES-D score was 19.7 ± 10.3, with 61.4% of participants at risk for depression. The depressive symptoms were significantly related to asthma control [β = -0.085, 95% confidence interval (CI) = -0.14 to -0.03] but not to prevention [relative risk (RR) = 1.00, 95% CI = 0.99-1.01], management (RR = 1.00, 95% CI = 0.99-1.01), or self-efficacy (β = -0.002, 95% CI = -0.01 to 0.01). Conclusions In this sample of rural adolescents, as depressive symptoms increased, asthma control declined. Depressive symptoms were not associated with asthma self-management, suggesting that the aspects of self-management we assessed are not an avenue by which depression impacts asthma control. Additional research is needed to further understand the relationship between depressive symptoms, asthma self-management, and control.
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Affiliation(s)
- Neha B. Patel
- Division of Pediatric Pulmonary, Columbia University Medical Center, New York, NY, United States
| | | | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, United States
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Isik E, Mack G, Sockrider MM, Fredland NM, Shegog R. Assessing Available Adolescent Self-Reported Measures for Asthma Management: A Systematic Literature Review. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:69-89. [PMID: 37669446 DOI: 10.1089/ped.2023.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Objective: Asthma is a common chronic disease and a substantial public health problem for children, adolescents, and adults. Adolescence, a period of increased independence and striving for autonomy, is an opportune time for youth transitioning to adulthood to assume more responsibility for their own asthma self-management. However, accurate measures of adolescent asthma outcomes are limited. The purpose of this systematic review is to identify self-reported asthma measures currently available in the empirical literature focused on adolescent populations. Methods: Search terms were based on the National Library of Medical Subject Headings and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Databases searched included CINAHL, Nursing Allied Health Prevention, Medline, ProQuest, and PubMed. Included studies were peer reviewed and published in English between 2010 and 2022. All studies reported on asthma measures for adolescents between 10 and 19 years old. Results: Nineteen studies were included, comprising 15 experimental and 4 quasi-experimental. This review revealed the following asthma measure domains: asthma knowledge, self-efficacy, attitudes, self-care, self-regulation, symptom prevention and management, medication adherence, asthma disease control, symptoms, and quality of life (QOL) for evaluating psychosocial, behavioral, clinical, and QOL outcomes. Conclusion: This review revealed the necessity of developing a comprehensive measure to assess the asthma self-management behaviors of adolescents. A comprehensive tool related to adolescent asthma self-management behavior would enhance the assessment and evaluation of adolescent asthma self-management behaviors and extend the science and clinical practice around adolescent self-management. Present measures for asthma self-management behavior for adolescents are limited; therefore, developing a valid and reliable measure is necessary not only to assess adolescents' asthma self-management behavior outcomes but also to identify and evaluate the essential components to include in educational interventions for adolescent self-management.
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Affiliation(s)
- Elif Isik
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Gardner Mack
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Marianna M Sockrider
- Pediatric Pulmonology, Texas Children's Hospital, Houston, Texas, USA
- Pediatric Pulmonology, Baylor College of Medicine, Houston, Texas, USA
| | - Nina M Fredland
- Nelda C. Stark College of Nursing, Texas Woman's University, Houston, Texas, USA
| | - Ross Shegog
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas, Houston, Texas, USA
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Sangngam J, Prasopkittikun T, Nookong A, Pacharn P, Chamchan C. Causal relationships among self-management behaviors, symptom control, health-related quality of life and the influencing factors among Thai adolescents with asthma. Int J Nurs Sci 2023; 10:309-317. [PMID: 37545770 PMCID: PMC10401355 DOI: 10.1016/j.ijnss.2023.06.001] [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: 01/25/2023] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Objective To examine causal relationships among asthma self-management behaviors, asthma symptom control, health-related quality of life and the influencing factors among Thai adolescents. Methods A cross-sectional study was conducted using convenience sampling. A total of 240 adolescent-caregiver dyads from three tertiary hospitals in Bangkok, Thailand was ultimately included. Interviews and self-administered questionnaires assessing health-related quality of life, asthma symptom control, asthma self-management behaviors, health literacy, depression, comorbidities, family support, peer support, home environmental management, and relationships with health care providers were administered between November 2020 and July 2021. A hypothesized model based on the revised self- and family-management framework was proposed. Data were analyzed using descriptive statistics and path analysis. Results It was shown that the proposed model was a good fit for the empirical data and accounted for 67.2% of the variance in health-related quality of life. Depression and asthma symptom control directly affected quality of life (β = -0.132, P < 0.05; and β = 0.740, P < 0.05, respectively), while asthma self-management behaviors did not. Both depression and asthma self-management behaviors had indirect effects on the quality of life through asthma symptom control (β = -0.382, P < 0.05; and β = 0.225, P < 0.05, respectively). Health literacy (β = 0.343, P < 0.05), family support (β = 0.167, P < 0.05), peer support (β = 0.163, P < 0.05), and relationships with health care providers (β = 0.181, P < 0.05) also showed direct effects on asthma self-management behaviors. Conclusion The findings confirmed the causal relationships among asthma symptom control, self-management behaviors, depression and health-related quality of life. Health literacy, support from family and peers, and relationships with health care providers were also found to influence asthma self-management behaviors. To achieve effective asthma control and good quality of life, a nursing intervention promoting asthma self-management for Thai adolescents should be developed. Early detection and intervention of depressive symptoms are also suggested.
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Affiliation(s)
| | | | - Apawan Nookong
- Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Punchama Pacharn
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chalermpol Chamchan
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Wallace-Farquharson T, Rhee H, Oguntoye AO, Elder JH, Ezenwa MO, Fedele D, Duckworth L, Wilkie DJ. Adolescents' practical knowledge of asthma self-management and experiences in the context of acute asthma: a qualitative content analysis. J Asthma 2023; 60:277-287. [PMID: 35195484 PMCID: PMC9470766 DOI: 10.1080/02770903.2022.2045309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/12/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To characterize adolescents' practical knowledge of asthma self-management and experiences during acute asthma episodes, and compare practical knowledge between minority and non-minority groups. METHODS We conducted a secondary analysis using a qualitative descriptive design of textual data collected from 126 adolescents that participated in a randomized controlled trial of an asthma self-management program. Directed content analysis was conducted using four constructs of asthma self-management including symptom prevention, symptom monitoring, acute symptom management, and symptom communication. RESULTS Most of the adolescents knew how to prevent exercised-induced bronchoconstriction, but had limited understanding about how to assess and monitor the severity of acute symptoms, appropriately use bronchodilators, seek timely medical help, and communicate acute symptoms to caregivers or healthcare providers during a slow-onset and rapid-onset asthma attack. More minority participants monitored asthma using peak expiratory flow than non-minority participants, who often relied on symptom-based monitoring. Minority adolescents more frequently mentioned bronchodilator use to manage asthma attacks, while non-minority adolescents often reported use of complementary and alternative approaches. Minority youth mentioned accessing healthcare services for acute episodes more often than their non-minority counterparts. Minority participants mentioned communicating acute symptoms to their providers, or family members less frequently than non-minority youth. CONCLUSIONS Adolescents have insufficient practical knowledge about ways to prevent and manage acute asthma. Periodic assessment of learning needs related to asthma attacks should be considered a routine part of clinical visits for adolescents to provide targeted information support to address their identified needs.
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Affiliation(s)
- Tanya Wallace-Farquharson
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Hyekyun Rhee
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Anne O. Oguntoye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Miriam O. Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - David Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, USA
| | - Laurie Duckworth
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
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Evans C, Fidler A, Baker D, Wagner M, Fedele D. Sleep and asthma management in youth with poorly-controlled asthma and their caregivers: a qualitative approach. J Asthma 2022; 59:1131-1138. [PMID: 33827372 PMCID: PMC10072859 DOI: 10.1080/02770903.2021.1914650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Youth with poorly-controlled asthma are at increased risk for sleep disturbances caused by nocturnal symptoms like coughing. Asthma-related sleep disturbances can have downstream consequences for youth with asthma and their families. This study aims to describe (1) sleep disturbances in adolescents with poorly-controlled asthma and their caregivers and (2) the relationship between sleep and asthma management. METHODS Adolescents with poorly-controlled asthma and their caregivers completed the Family Asthma Management System Scale (FAMSS), a semi-structured interview that assesses youth asthma management within the family context. Interviews were audio-recorded and transcribed. Two authors coded each transcript for sleep-related data in NVivo using descriptive content analysis. RESULTS Thirty-three adolescents ages 12-15 years old (M = 13.2, SD = 1.2) with poorly-controlled asthma and their caregivers participated in this study. Four main themes emerged: sleep difficulties, sleep environment, sleep and self-management, and fatigue and self-management. 42% of youth and caregivers reported worse nocturnal asthma symptoms (e.g. coughing) that caused frequent nighttime awakening. Approximately 27% of caregivers expressed distress over their child's nocturnal asthma and described their management strategies (e.g. co-sleeping, nighttime symptom monitoring). Adolescents described sleepiness as a barrier to asthma self-management tasks (e.g. medication adherence, response to exacerbation). CONCLUSION Interview responses demonstrated the considerable interrelationship of sleep and asthma management in adolescents with poorly-controlled asthma. Asthma providers should consider discussing sleep difficulties with their adolescent patients and their families. Addressing these difficulties may help adolescents improve their asthma self-management and help caregivers better cope with their child's disease.
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Affiliation(s)
- Corinne Evans
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Andrea Fidler
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Dawn Baker
- UF Health Pediatric Pulmonary, University of Florida, Gainesville, FL, USA
| | - Mary Wagner
- UF Health Pediatric Pulmonary, University of Florida, Gainesville, FL, USA
| | - David Fedele
- Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Jia L, Hu Y. Self-Management About Adjuvant Therapy in Breast Cancer Survivors: A Qualitative Study. Patient Prefer Adherence 2022; 16:2663-2681. [PMID: 36176347 PMCID: PMC9514877 DOI: 10.2147/ppa.s379435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aims to describe the experience and connotations of self-management about adjuvant therapy (AT) in Chinese breast cancer survivors (BCS) and explore possible factors that affect their self-management level. METHODS Semi-structured interviews were conducted in postoperative BCS undergoing AT using a qualitative description method. The conceptual structure and connotations were extracted after researchers collected and coded interview transcripts. RESULTS After interviewing 29 patients, the conceptual framework of self-management in BCS during AT was optimized with three major themes: medical-related, emotion, and role management. Medical-related management includes AT-related adverse reactions; medical cooperation and knowledge acquisition; recovery and protection of affected limb; medical compliance; body image; sexual function and fertility; healthy lifestyle; catheter daily protection; and AT-related financial burdens. Emotion management includes recognition, prevention, and regulation of negative emotions. Role management consists of three aspects: family role, social role, and work role. CONCLUSION The conceptual structure and connotations formed in this study can help researchers to evaluate and intervene in the self-management ability of BCS during AT, so as to formulate the best model of care to improve their quality of life and clinical outcomes.
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Affiliation(s)
- Lingying Jia
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Yan Hu, School of Nursing, Fudan University, Shanghai, People’s Republic of China, Tel +86 21 6443 1273, Fax +86 21 6416 1784, Email
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Leonard SI, Turi ER, Powell JS, Usseglio J, Kolmodin MacDonell K, Bruzzese JM. Associations of asthma self-management and mental health in adolescents: A scoping review. Respir Med 2022; 200:106897. [PMID: 35714575 PMCID: PMC9871877 DOI: 10.1016/j.rmed.2022.106897] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adolescent asthma is highly prevalent and frequently uncontrolled despite control being achievable with good self-management. Anxiety, depression, and stress are associated with worse asthma outcomes, and may impact self-management; no previous review has examined this relationship. AIM This scoping review assessed the nature of the current literature on mental health and asthma self-management among adolescents ages 11 to 24 and synthesized their relationships. METHODS Guided by the PRISMA-ScR guidelines, we systematically searched the literature using MEDLINE, Embase, CINAHL, PsycInfo, and Scopus in September 2020 and updated it in June 2021. Included studies examined associations between anxiety, depression, and/or stress and asthma self-management in adolescents ages 11-24. We did not restrict study design, location, or date. RESULTS Out of 1559 records identified, 14 met inclusion criteria. Types of self-management included trigger control, healthcare adherence, and overall symptom prevention and management. Anxiety symptoms were associated with poorer asthma self-management in four studies, but better in three. Depressive symptoms were associated with poorer asthma self-management in five studies, but better in two. Stress was associated with poorer self-management in one study. Mental health symptoms were nearly universally associated with poorer trigger control, but associations with healthcare adherence and overall symptom prevention and management varied. CONCLUSION Mental health symptoms may facilitate or hinder asthma self-management depending on the types of mental health and self-management. Further research is needed to better understand this relationship and inform future interventions. Providers might assess mental health as a potential barrier to adolescent asthma self-management.
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Affiliation(s)
- Sarah I. Leonard
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Eleanor R. Turi
- Office of Scholarship and Research, Columbia University School of Nursing
| | - Jennifer S. Powell
- Division of Global and Community Health, Medical University of South Carolina
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia University Irving Medical Center
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Heinrichs K, Schultz K, Hummel S, Jütjens O, Loerbroks A. Asthma self-management at work, asthma morbidity, and the subjective prognosis of gainful employment - the role of work engagement and overcommitment: a cross-sectional study. J Asthma 2021; 59:719-729. [PMID: 33600726 DOI: 10.1080/02770903.2021.1892751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Work engagement is considered a constructive and satisfying state of mind promoting well-being, whereas overcommitment contributes to ill-health. We investigated if these psychosocial factors are related to asthma self-management at the workplace (i.e. physical activity, trigger avoidance, acute symptom management, communication), asthma control, asthma-specific quality of life, and the subjective prognosis of gainful employment among employees with asthma. METHODS Questionnaires were distributed in three pulmonary rehabilitation clinics (10/2017-05/2018) in Germany. Work engagement was measured by three items from the Copenhagen Psychosocial Questionnaire and overcommitment by six items from the effort-reward imbalance questionnaire. Asthma self-management was mainly assessed by self-developed items, asthma morbidity by the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire, and the subjective prognosis of gainful employment by a validated three-item scale. After dichotomization of all variables we ran Poisson regression analyses to calculate multivariable prevalence ratios with 95% confidence intervals. RESULTS The sample comprised 221 individuals with asthma. Low work engagement was related to physical inactivity. Low work engagement and high overcommitment were associated with inadequate trigger avoidance and acute symptom management, reduced asthma-specific quality of life, and a poor prognosis of gainful employment. No relationships were observed with communication or asthma control. CONCLUSIONS Our findings highlight the potential contribution of high levels of work engagement to adequate asthma self-management, good quality of life, and a positive subjective prognosis of gainful employment among employees with asthma. Overcommitment shows associations with those outcomes in the opposite direction, which suggests a detrimental role in asthma.
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Affiliation(s)
- Katherina Heinrichs
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.,Institute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall der DRV Bayern Süd, Bad Reichenhall, Germany
| | | | - Olaf Jütjens
- Nordseeklinik Borkum der DRV Rheinland, Borkum, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Mammen JR, Turgeon K, Philibert A, Schoonmaker JD, Java J, Halterman J, Berliant MN, Crowley A, Reznik M, Feldman JM, Fortuna RJ, Arcoleo K. A mixed-methods analysis of younger adults' perceptions of asthma, self-management, and preventive care: "This isn't helping me none". Clin Exp Allergy 2021; 51:63-77. [PMID: 33007115 PMCID: PMC7821137 DOI: 10.1111/cea.13751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Young adults (ages 18-44) have increased emergency department use for asthma and poor adherence to medications. The objective of this mixed-methods study was to understand experiences with and approaches to managing asthma, of which little is known in this age group. METHODS Surveys (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire) and 1:1 semi-structured interviews were used to explore experiences with asthma, symptoms, self-management behaviours, and relationship to asthma control and quality of life. Qualitative data were analysed using content analysis techniques. Descriptive statistics and bivariate correlations were used to examine distributive characteristics and associations between variables. RESULTS Forty urban adults participated (mean age 32.7 ± 6.2, 1σ). Coughing was reported nearly 46% more often than wheezing, with 42.5% (17/40) coughing until the point of vomiting most days. Most participants delayed using medication for symptoms due to misperceptions about inhalers. Higher symptom frequency and worse asthma control were associated with greater use of non-pharmacologic symptom management strategies (r = 0.645, P < .001; r = 0.360, P = .022, respectively). Five themes were identified regarding young adults experiences with asthma: (1) having asthma means being limited and missing out on life; (2) health care for asthma is burdensome, and other things are more important; (3) there is not enough personal benefit in medical interactions to make preventive care worthwhile; (4) there are insufficient support and education about asthma for adults; and (5) people normalize chronic symptoms over time and find ways of coping that fit with their lifestyle. CONCLUSIONS AND CLINICAL RELEVANCE Young adults may tolerate symptoms without using quick-relief medication or seeking preventive care. Increasing engagement with preventive services will require decreasing perceived burdens and increasing the personal benefits of care. Evaluating for non-pharmacologic approaches to managing symptoms and asthma-related coughing may identify uncontrolled asthma. Enhanced training for clinicians in patient-centric asthma care may be needed.
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Affiliation(s)
| | - Kelsey Turgeon
- College of NursingUniversity of Rhode IslandKingstonRIUSA
| | | | | | - James Java
- Department of Biostatistics and Computational BiologyUniversity of RochesterRochesterNYUSA
| | - Jill Halterman
- Department of PediatricsUniversity of Rochester School of MedicineRochesterNYUSA
| | - Marc N. Berliant
- Department of Internal MedicineUniversity of Rochester School of MedicineRochesterNYUSA
| | - Amber Crowley
- Department of Internal MedicineUniversity of Rochester School of MedicineRochesterNYUSA
| | - Marina Reznik
- Department of PediatricsDivision of Academic General PediatricsAlbert Einstein College of MedicineChildren’s Hospital at MontefioreBronxNYUSA
| | - Jonathan M. Feldman
- Department of PediatricsDivision of Academic General PediatricsAlbert Einstein College of MedicineChildren’s Hospital at MontefioreBronxNYUSA
- Ferkauf Graduate School of PsychologyYeshiva UniversityBronxNYUSA
| | - Robert J. Fortuna
- Department of PediatricsUniversity of Rochester School of MedicineRochesterNYUSA
- Department of Internal MedicineUniversity of Rochester School of MedicineRochesterNYUSA
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Fedele DA, Cushing CC, Koskela-Staples N, Patton SR, McQuaid EL, Smyth JM, Prabhakaran S, Gierer S, Nezu AM. Adaptive Mobile Health Intervention for Adolescents with Asthma: Iterative User-Centered Development. JMIR Mhealth Uhealth 2020; 8:e18400. [PMID: 32374273 PMCID: PMC7240449 DOI: 10.2196/18400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use. OBJECTIVE The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content. METHODS We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17-year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development. RESULTS Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow). CONCLUSIONS ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process.
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Affiliation(s)
- David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Christopher C Cushing
- Clinical Child Psychology Program & Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, United States
| | - Natalie Koskela-Staples
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL, United States
| | - Susana R Patton
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, FL, United States
| | - Elizabeth L McQuaid
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Joshua M Smyth
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | | | - Selina Gierer
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, MO, United States
| | - Arthur M Nezu
- Department of Psychology, Drexel University, Philadelphia, PA, United States
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Saxby N, Ford K, Beggs S, Battersby M, Lawn S. Developmentally appropriate supported self-management for children and young people with chronic conditions: A consensus. PATIENT EDUCATION AND COUNSELING 2020; 103:571-581. [PMID: 31611128 DOI: 10.1016/j.pec.2019.09.029] [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: 03/21/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE/S To create a consensus list of self-management definitions, recommendations, and endpoints for children and young people (0-20 years) with chronic conditions. METHODS This study used a Delphi technique. Based on the number of relevant peer-reviewed publications, clinical academics were invited to participate in three survey rounds. Round one contained open-ended and multiple-choice questions eliciting general opinions on self-management. For round two, results were provided to the interdisciplinary expert panel as statements for rating their agreement using a 7-point Likert scale, with consensus predefined as moderately or extremely satisfied by >70% of participants. Statements not meeting consensus were re-presented in round three, with group feedback incorporated. Finalised statements informed creation of the 'Partners in Health: Self-Management Consensus List for Children and Young People'. RESULTS Sixteen clinical academics participated: 12 completed round one; 14 completed round two; and 12 completed round three. Of 101 statements, 90 reached consensus, with statements separated into five developmentally appropriate groups. Statements covered broad self-management and self-management support domains including knowledge, involvement, monitoring/responding to symptoms, transition, impact, lifestyle, and support. Division of responsibility and autonomy were distinct themes. CONCLUSION AND PRACTICE IMPLICATIONS This research provides consensus-based guidance for clinicians providing paediatric self-management support.
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Affiliation(s)
- Nicole Saxby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia; Department of Women's and Children's Services, Royal Hobart Hospital, Hobart, Australia.
| | - Karen Ford
- Centre of Education and Research Nursing and Midwifery, Royal Hobart Hospital, Hobart, Australia; College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Sean Beggs
- Department of Women's and Children's Services, Royal Hobart Hospital, Hobart, Australia; College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, Australia
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eHealth only interventions and blended interventions to support self-management in adolescents with asthma: A systematic review. CLINICAL EHEALTH 2020. [DOI: 10.1016/j.ceh.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Heinrichs K, Hummel S, Gholami J, Schultz K, Wild B, Li J, Sheikh A, Loerbroks A. Psychosocial working conditions and the subjective prognosis of gainful employment among employees with asthma: a cross-sectional study. Disabil Rehabil 2019; 43:1299-1306. [PMID: 31522569 DOI: 10.1080/09638288.2019.1662496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE The present study set out to examine whether low job decision latitude (JDL, i.e., limited work autonomy) and low social support at work are related to a poor subjective prognosis of gainful employment (SPE) among working rehabilitants with asthma. METHODS JDL and support were assessed by the Copenhagen Psychosocial Questionnaire. The SPE was measured by a validated three-item scale. Separate logistic regression analyses were conducted for all variables to calculate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Among the 221 participants (response rate = 29.3%), those reporting low JDL or low support had more than doubled odds of being unsure that they would be working until retirement age (OR = 2.28; 95% CI = 1.19-4.37; OR = 2.78; 95% CI = 1.43-5.40, respectively) and of considering their work ability permanently at risk due to ill-health (OR = 3.89; 95% CI = 2.03-7.46; OR = 2.05; 95% CI = 1.08-3.90, respectively) compared to those with good working conditions. The associations of JDL or support were weaker with one's consideration to apply for premature pension (OR = 1.54; 95% CI = 0.60-3.98; OR = 2.18; 95% CI = 0.83-5.77, respectively). Additional analyses identified job satisfaction as a possible explanatory factor for the observed relationships. CONCLUSIONS Adverse psychosocial working conditions are related to a poor SPE, and low job satisfaction may explain those relationships. Future prospective research is needed to confirm our findings.Implications for rehabilitationEarlier research suggested that asthma increases the risk of disability retirement and thus causes high direct and indirect costs.Prior findings showed that adverse psychosocial working conditions are related to poorer asthma self-management and increased asthma morbidity among rehabilitants with asthma.Consistent with earlier work the present study found that job decision latitude and social support at work are associated with the subjective prognosis of gainful employment among working rehabilitants with asthma.If the reported findings are confirmed by prospective studies, interventions could be developed to improve the working conditions for rehabilitants with asthma and to thereby reduce their risk of disability retirement.
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Affiliation(s)
- Katherina Heinrichs
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | | | - Jalal Gholami
- Nordseeklinik Borkum der DRV Rheinland*, Borkum, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall der DRV Bayern Süd*, Bad Reichenhall, Germany
| | - Burkhard Wild
- refonet - Rehabilitations-Forschungsnetzwerk der DRV Rheinland*, Bad Neuenahr, Germany
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany.,Department of Environmental Health Sciences, Fielding School of Public Health; School of Nursing, University of California, Los Angeles, USA
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, UK
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Heinrichs K, Li J, Loerbroks A. General practitioner visits and physical activity with asthma-the role of job decision authority: a cross-sectional study. Int Arch Occup Environ Health 2019; 92:1173-1178. [PMID: 31273499 DOI: 10.1007/s00420-019-01456-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/30/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Psychosocial working conditions-in terms of job decision authority, among others-may influence asthma self-management at work and in leisure time, as recent qualitative research has shown. We sought to statistically investigate potential relationships between job decision authority and two types of self-management behaviours: physical activity (PA) and visits to the general practitioner (GP). METHODS We combined data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) for cross-sectional analyses. The sample was restricted to participants who were employed and reported asthma but no other chronic lung disease (n = 387). The three key variables were each measured by one item. We estimated the prevalence ratios of adequate PA (i.e., more than once a week) and regular GP visits (i.e., ≥ 4 per year) according to job decision authority (low vs. high) using Poisson regression with the robust variance. RESULTS We found no evidence of a relationship between job decision authority and PA. However, employees with low levels of job decision authority had a higher prevalence of reporting that they consulted their GP at least four times per year (prevalence ratio = 1.30; 95% confidence interval = 1.03-1.65). CONCLUSIONS This study was the first to quantitatively investigate the relationship between job decision authority and PA specifically among individuals with asthma. Our results contradict prior epidemiological studies among general working populations, which reported a positive relationship between job decision authority and PA. Our results concerning the association between low job decision authority and more GP visits are inconsistent with our qualitative findings but supported by epidemiological studies among general occupational samples.
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Affiliation(s)
- Katherina Heinrichs
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany.,Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095-1772, USA
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstr. 1, 40225, Düsseldorf, Germany.
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Heinrichs K, Hummel S, Gholami J, Schultz K, Li J, Sheikh A, Loerbroks A. Psychosocial working conditions, asthma self-management at work and asthma morbidity: a cross-sectional study. Clin Transl Allergy 2019; 9:25. [PMID: 31168356 PMCID: PMC6509772 DOI: 10.1186/s13601-019-0264-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Adverse psychosocial working conditions—in particular poor job decision latitude and poor social support at work—may impair the effective implementation of asthma self-management behaviour at work and may be associated with increased asthma morbidity. In this study, we investigate for the first time the association of job decision latitude and social support at work with (1) four asthma-specific self-management behaviours at work (i.e., physical activity, trigger avoidance, acute symptom management, and communication) and with (2) asthma morbidity.
Methods A total of 221 employees with asthma recruited through three rehabilitation clinics completed questionnaires (response rate = 29.3%). Job decision latitude and social support were measured using items from the Copenhagen Psychosocial Questionnaire. The four asthma self-management behaviours were mainly assessed by self-developed items. We used the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire to measure asthma morbidity. We dichotomized all variables and conducted logistic regression analyses to calculate odds ratios with 95% CIs. Results Low job decision latitude and low social support were significantly associated with poorer trigger avoidance (odds ratios ≥ 2.09) and poorer acute symptom management (odds ratios ≥ 2.29); low social support was further related to significantly less communication (odds ratio = 2.82). Low job decision latitude and low social support were also associated with significantly poorer asthma control (odds ratios ≥ 1.95) and poorer asthma-specific quality of life (odds ratios ≥ 2.05). The relationships with asthma morbidity were attenuated after adjustment for the four asthma self-management behaviours (odds ratios ranging from 1.1 to 1.9). Conclusions Adverse psychosocial working conditions are associated with poorer asthma self-management behaviour at work and with increased asthma morbidity. The latter association may be mediated by asthma self-management behaviour. Trial registration German Clinical Trials Register, registration number: DRK S00011309, date of registration: 22.12.2016. Electronic supplementary material The online version of this article (10.1186/s13601-019-0264-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherina Heinrichs
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Stefan Hummel
- MEDIAN Klinik Heiligendamm, Kinderstrand 1, 18209 Bad Doberan, Germany
| | - Jalal Gholami
- Nordseeklinik Borkum der DRV Rheinland, Bubertstraße 4, 26757 Borkum, Germany
| | - Konrad Schultz
- 4Klinik Bad Reichenhall der DRV Bayern Süd, Salzburger Str. 8, 83435 Bad Reichenhall, Germany
| | - Jian Li
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.,5Department of Environmental Health Sciences, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA.,6School of Nursing, University of California Los Angeles, Los Angeles, CA 90095-1772 USA
| | - Aziz Sheikh
- 7Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Adrian Loerbroks
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
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Melgarejo González-Conde V, Pérez-Fernández V, Ruiz-Esteban C, Valverde-Molina J. Impact of Self-Efficacy on the Quality of Life of Children With Asthma and Their Caregivers. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.arbr.2019.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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Nickels-Nelson GM. Adolescent ownership of asthma health: A concept analysis. Nurs Forum 2019; 54:246-253. [PMID: 30589086 DOI: 10.1111/nuf.12324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 06/09/2023]
Abstract
AIM This concept analysis was developed to produce a working definition regarding ownership of health in advanced practice nursing. BACKGROUND Ownership of health is a new concept developed in nursing. Adolescence is a time of learning identity and needed life skills for a chronic illness. Nurses can utilize this concept for improvement of outcomes for their adolescent patients. DESIGN/METHOD This concept analysis is based on Walker and Avant. DATA SOURCE AND REVIEW OF LITERATURE As ownership of health is new in nursing, a literature search was based on elements of Donnelley's Functional Mastery of Health Ownership nursing model. RESULTS Attributes (responsibility, self-efficacy, mastery/control, and self-image), model/contrary case, antecedents (awareness, willingness, desire, and acceptance), consequences, and empirical referents are discussed. CONCLUSIONS The definition of ownership is critical to both nursing and the advanced practice nurse. Adolescents are a special population of patients; learning how to both be independent and to care for their health. By employing a framework of ownership, adolescents can be more likely to thrive versus merely survive with asthma and the impact will go beyond the patients to their families and impact health outcomes as well.
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Affiliation(s)
- Gina M Nickels-Nelson
- School of Nursing, The University of Texas at Tyler, Tyler, Texas
- Community Health Programs (CHP), Berkshire Pediatric Associates, Pittsfield, Massachusetts
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20
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Schmid-Mohler G, Caress AL, Spirig R, Yorke J. Introducing a model for emotional distress in respiratory disease: A systematic review and synthesis of symptom management models. J Adv Nurs 2019; 75:1854-1867. [PMID: 30734366 DOI: 10.1111/jan.13968] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022]
Abstract
AIM To undertake a theoretical systematic review to develop a conceptual model of illness-related emotional distress in the context of symptom management in chronic respiratory disease. DESIGN We performed a systematic search to identify conceptual models. DATA SOURCES Electronic databases MEDLINE, CINAHL, EMBASE and PsycINFO were searched and papers included from inception of the search term until June 2017. REVIEW METHODS The review was conducted following Pound and Campbell's and Turner's theory synthesis. Conceptual models were appraised using Kaplan's criteria. Models were excluded if they referred to a specific condition and/or lacked clarity. RESULTS This synthesis, which includes five models and additional evidence, yielded a new conceptual model describing the processes of regulation and symptom self-management in chronic respiratory disease. Identified sources of illness-related emotional distress are new or increased symptoms, additional treatment, new restrictions in performance of daily life roles and increased unpredictability. People goals and self-efficacy were identified as further drivers of symptom self-management. The regulation process is embedded in contextual factors. CONCLUSION Theory synthesis provided transparent guidance in developing a model to understand of the factors driving self-management decisions. Therefore, the model has the potential to guide development of interventions that support symptom self-management in chronic respiratory disease. IMPACT This newly presented conceptual model of illness-related emotional distress provides an understanding of the factors that drive self-management decisions when peoples experience new or increased symptoms. Such understanding is critical for nursing practice to developing appropriate interventions, especially in support of people decision-making.
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Affiliation(s)
| | - Ann-Louise Caress
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca Spirig
- Directorate of Nursing and Allied Health Professionals, University Hospital Zurich, Zurich, Switzerland
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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21
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Starliper N, Mohammadzadeh F, Songkakul T, Hernandez M, Bozkurt A, Lobaton E. Activity-Aware Wearable System for Power-Efficient Prediction of Physiological Responses. SENSORS 2019; 19:s19030441. [PMID: 30678188 PMCID: PMC6387359 DOI: 10.3390/s19030441] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 02/04/2023]
Abstract
Wearable health monitoring has emerged as a promising solution to the growing need for remote health assessment and growing demand for personalized preventative care and wellness management. Vital signs can be monitored and alerts can be made when anomalies are detected, potentially improving patient outcomes. One major challenge for the use of wearable health devices is their energy efficiency and battery-lifetime, which motivates the recent efforts towards the development of self-powered wearable devices. This article proposes a method for context aware dynamic sensor selection for power optimized physiological prediction using multi-modal wearable data streams. We first cluster the data by physical activity using the accelerometer data, and then fit a group lasso model to each activity cluster. We find the optimal reduced set of groups of sensor features, in turn reducing power usage by duty cycling these and optimizing prediction accuracy. We show that using activity state-based contextual information increases accuracy while decreasing power usage. We also show that the reduced feature set can be used in other regression models increasing accuracy and decreasing energy burden. We demonstrate the potential reduction in power usage using a custom-designed multi-modal wearable system prototype.
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Affiliation(s)
- Nathan Starliper
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Farrokh Mohammadzadeh
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Tanner Songkakul
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Michelle Hernandez
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27516, USA.
| | - Alper Bozkurt
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Edgar Lobaton
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27695, USA.
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Mammen J, Rhee H, Norton SA, Butz AM, Halterman JS, Arcoleo K. An integrated operational definition and conceptual model of asthma self-management in teens. J Asthma 2018; 55:1315-1327. [PMID: 29351005 PMCID: PMC6053334 DOI: 10.1080/02770903.2017.1418888] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/05/2017] [Accepted: 12/14/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES A previous definition of adolescent asthma self-management was derived from interviews with clinicians/researchers and published literature; however, it did not incorporate perspectives of teens or parents. Therefore, we conducted in-depth interviews with teens and parents and synthesized present findings with the prior analysis to develop a more encompassing definition and model. METHODS Focal concepts were qualitatively extracted from 14-day self-management voice-diaries (n = 14) and 1-hour interviews (n = 42) with teens and parents (28 individuals) along with concepts found in the previous clinical/research oriented analysis. Conceptual structure and relationships were identified and key findings synthesized to develop a revised definition and model of adolescent asthma self-management. RESULTS There were two primary self-management constructs: processes of self-management and tasks of self-management. Self-management was defined as the iterative process of assessing, deciding, and responding to specific situations in order to achieve personally important outcomes. Clinically relevant asthma self-management tasks included monitoring asthma, managing active issues through pharmacologic and non-pharmacologic strategies, preventing future issues, and communicating with others as needed. Self-management processes were reciprocally influenced by intrapersonal factors (both cognitive and physical), interpersonal factors (family, social and physical environments), and personally relevant asthma and non-asthma outcomes. CONCLUSION This is the first definition of asthma self-management incorporating teen, parent, clinician, and researcher perspectives, which suggests that self-management processes and behaviors are influenced by individually variable personal and interpersonal factors, and are driven by personally important outcomes. Clinicians and researchers should investigate teens' symptom perceptions, medication beliefs, current approaches to symptom management, relevant outcomes, and personal priorities.
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Affiliation(s)
- Jennifer Mammen
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Hyekyun Rhee
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Sally A Norton
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
| | - Arlene M Butz
- b Johns Hopkins University, Pediatrics , Freeland , USA
| | - Jill S Halterman
- c University of Rochester School of Medicine and Dentistry, Pediatrics , Rochester , USA
| | - Kimberly Arcoleo
- a University of Rochester School of Nursing, School of Nursing , Rochester , USA
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23
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Roberts C, Sage A, Geryk L, Sleath B, Carpenter D. Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study. JMIR Form Res 2018; 2:e10055. [PMID: 30684424 PMCID: PMC6334705 DOI: 10.2196/10055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/25/2018] [Accepted: 06/21/2018] [Indexed: 01/27/2023] Open
Abstract
Background Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors.
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Affiliation(s)
- Courtney Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Adam Sage
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lorie Geryk
- Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland, OR, United States
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,The Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Delesha Carpenter
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Asheville, Asheville, NC, United States
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Heinrichs K, Vu-Eickmann P, Hummel S, Gholami J, Loerbroks A. What are the perceived influences on asthma self-management at the workplace? A qualitative study. BMJ Open 2018; 8:e022126. [PMID: 30158229 PMCID: PMC6119450 DOI: 10.1136/bmjopen-2018-022126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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 Asthma can represent a substantial challenge to the affected individual, but is usually well controlled by adequate asthma self-management behaviour (SMB). Asthma SMB comprises symptom prevention, symptom monitoring, acute symptom management and communication with important others. The implementation of asthma SMB seems to depend on contextual factors. For employed adults, working conditions may be important in this respect. We, therefore, aimed to explore the perceived influences on effective asthma SMB at work. DESIGN Our qualitative study built on semi-structured interviews and qualitative content analysis. SETTING Participants were recruited in two pulmonary rehabilitation clinics in Northern Germany. PARTICIPANTS We conducted 27 interviews among employees with asthma (female: n=15) who worked at least 20 hours per week and were diagnosed with asthma at least 6 months prior to interviewing. Patients with chronic obstructive pulmonary disease were excluded. RESULTS According to participants, the most influential factors with regard to asthma SMB at work appeared to be job decision latitude (JDL) and social support. JDL (ie, the control over one's tasks and when and how things were done) was perceived to affect symptom prevention, symptom monitoring, and acute symptom management, but not communication. Support by colleagues, line managers, and the employer, for example, practical, emotional, or structural support, was perceived to exert effects on symptom prevention, acute symptom management, and communication (ie, self-disclosure of one's condition). CONCLUSIONS Perceived JDL and social support were experienced as influencing successful implementation of asthma SMB at the workplace. TRIAL REGISTRATION NUMBER German Clinical Trials Register no: DRKS00011309.
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Affiliation(s)
- Katherina Heinrichs
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Patricia Vu-Eickmann
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Stefan Hummel
- Department of Pneumology and Allergy, MEDIAN Klinik Heiligendamm, Bad Doberan, Germany
| | - Jalal Gholami
- Department of Pneumology, Nordseeklinik Borkum, Borkum, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Carpenter DM, Jurdi R, Roberts CA, Hernandez M, Horne R, Chan A. A Review of Portable Electronic Spirometers: Implications for Asthma Self-Management. Curr Allergy Asthma Rep 2018; 18:53. [PMID: 30145683 DOI: 10.1007/s11882-018-0809-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Although portable electronic spirometers allow for at-home lung function monitoring, a comprehensive review of these devices has not yet been conducted. We conducted a systematic search and review of commercially available portable electronic spirometers designed for asthma patient use. RECENT FINDINGS All devices (N = 16) allowed for monitoring of basic lung function parameters, but only 31% provided in-app videos on how to perform breathing maneuvers. Most devices (63%) provided graphical representations of lung function results, but only 44% gave immediate feedback on the quality of the breathing maneuver. Several devices (25%) were FDA-approved and cost ranged from US$99 to $1390. Information on data security (63%), measurement accuracy (50%), and association with patient outcomes (0%) was commonly limited. This review found that providers' ability to make informed decisions about whether asthma patients may benefit from portable electronic spirometers is limited due to lack of patient outcome data.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, 1 University Heights, CPO 2125, Asheville, NC, 28804, USA.
| | - Reina Jurdi
- School of Pharmacy, University College London, 29-39 Brunswick Square, Bloomsbury, London, WC1N 1AX, UK
| | - Courtney A Roberts
- Eshelman School of Pharmacy, University of North Carolina, 1 University Heights, CPO 2125, Asheville, NC, 28804, USA
| | - Michelle Hernandez
- School of Medicine, University of North Carolina, 104 Mason Farm Road, CB #7310, Chapel Hill, NC, 27599-7310, USA
| | - Robert Horne
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, Tavistock House North, Tavistock Square, London, WC1H 9HR, UK
| | - Amy Chan
- Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, Mezzanine Floor, Entrance A, Tavistock House North, Tavistock Square, London, WC1H 9HR, UK
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26
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Melgarejo González-Conde V, Pérez-Fernández V, Ruiz-Esteban C, Valverde-Molina J. Impact of Self-Efficacy on The Quality of Life of Children With Asthma and Their Caregivers. Arch Bronconeumol 2018; 55:189-194. [PMID: 30119934 DOI: 10.1016/j.arbres.2018.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/08/2018] [Accepted: 07/13/2018] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Health-related quality of life is an important outcome measurement in the monitoring of asthma control. Self-efficacy is a determinant of self-management behaviors that can contribute to the improvement of asthma control and quality of life. Our objective was to analyze the relationship between self-efficacy and quality of life in children with asthma and their caregivers. METHODS We included 176 patients aged 6-14 years with asthma, and determined their level of self-efficacy according to three groups (low, medium and high levels). Each child and their main caregiver completed the PAQLQ and PACQLQ questionnaires, respectively. RESULTS PAQLQ range=1-7: 5.61±1.11; PACQLQ range=1-7: 5.42±1.35; self-efficacy range=0-60: low level 28.44±4.58; average level 37.41±1.7, and high level 47.50±5.5. Significant differences were observed in quality of life according to low-medium vs. high levels of self-efficacy. Specific related domains: PAQLQ emotions and PAQLQ symptoms with self-efficacy in problem-solving skills related to asthma and treatment self-efficacy; PACQLQ emotions with self-efficacy in problem-solving skills related to asthma. CONCLUSIONS A high level of self-efficacy is associated with a better quality of life for children and their caregivers. Based on these results, the measurement of self-efficacy could be incorporated in the assessment of educational interventions in self-management targeted at the quality of life of the patient and his or her family.
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Affiliation(s)
| | - Virginia Pérez-Fernández
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, IMIB, Facultad de Medicina, Universidad de Murcia , El Palmar, Murcia, España
| | - Cecilia Ruiz-Esteban
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Murcia, Espinardo, Murcia, España
| | - José Valverde-Molina
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología, IMIB, Facultad de Medicina, Universidad de Murcia , El Palmar, Murcia, España; Unidad de Neumología Pediátrica, Hospital Universitario Los Arcos del Mar Menor, San Javier, Murcia, España
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27
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Holley S, Walker D, Knibb R, Latter S, Liossi C, Mitchell F, Radley R, Roberts G. Barriers and facilitators to self-management of asthma in adolescents: An interview study to inform development of a novel intervention. Clin Exp Allergy 2018; 48:944-956. [PMID: 29573024 DOI: 10.1111/cea.13141] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Despite literature that spans twenty years describing the barriers to asthma self-management in adolescents, successful, clinically based interventions to address this important issue are lacking. Given the limitations of some of the previous studies, we conducted a study that aimed to gain a broader insight into barriers and facilitators to self-management of asthma by adolescents, not just adherence to treatment, and triangulated their views with those of their parents and healthcare professionals. METHODS Focus groups and interviews were conducted separately for 28 adolescents with asthma aged 12-18 years, 14 healthcare professionals and 12 parents. Focus groups and interviews were audio-recorded, and transcripts from each participant group were analysed separately using inductive thematic analysis. We triangulated the three perspectives by comparing themes that had emerged from each analysis. RESULTS Adolescents', parents' and healthcare professionals' views were summarized into ten related themes that included forgetting and routines, knowledge, embarrassment and confidence, communication with healthcare professionals, triggers, support at school, apathy and taking responsibility. We found that adolescents, parents and healthcare professionals raised similar barriers and facilitators to self-management and our results provide further validation for previous studies. CONCLUSION AND CLINICAL RELEVANCE Our study highlights that healthcare professionals may need to consider a range of psychological and contextual issues influencing adolescents' ability to effectively self-manage their asthma, in particular, how they implement treatment routines and the understanding that adolescents have of their condition and treatments. Crucially, healthcare professionals need to consider how this information is communicated and ensure they facilitate open, inclusive, two-way consultations. From this more comprehensive understanding, we have developed interventional strategies that healthcare professionals can utilize to empower adolescents to improve their asthma self-management.
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Affiliation(s)
- S Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Knibb
- Aston University, Birmingham, UK
| | - S Latter
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - C Liossi
- School of Psychology, University of Southampton, Southampton, UK.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - F Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
| | - R Radley
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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28
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Matarese M, Lommi M, De Marinis MG, Riegel B. A Systematic Review and Integration of Concept Analyses of Self-Care and Related Concepts. J Nurs Scholarsh 2018; 50:296-305. [DOI: 10.1111/jnu.12385] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Maria Matarese
- Associate Professor, Research Unit of Nursing Science; Campus Bio-medico University of Rome; Rome Italy
| | - Marzia Lommi
- Adjunct Professor, University of Rome Tor Vergata; Rome Italy
| | - Maria Grazia De Marinis
- Professor, Research Unit of Nursing Science; Campus Bio-medico University of Rome; Rome Italy
| | - Barbara Riegel
- Professor and Edith Clemmer Steinbright Chair of Gerontology; School of Nursing, University of Pennsylvania; Philadelphia PA USA
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29
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Mammen JR, Rhee H, Atis S, Grape A. Changes in asthma self-management knowledge in inner city adolescents following developmentally sensitive self-management training. PATIENT EDUCATION AND COUNSELING 2018; 101:687-695. [PMID: 29129307 PMCID: PMC5878979 DOI: 10.1016/j.pec.2017.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate efficacy of a developmentally sensitive curriculum for improving asthma self-management knowledge, attitude, and self-efficacy in adolescents. METHODS Fourty-two inner-city adolescents (ages 16-20) participated in a 12hour asthma self-management training program. Self-management knowledge, attitude toward asthma, and asthma-related self-efficacy were measured using short-answer tests before and after training. T-Tests were used to evaluate impact and effect sizes were calculated. RESULTS Mean pretest knowledge was 21.37/46 points; mean posttest was 36.33/46 points. Change from pre- to posttest was highly significant (t=10.34; p<0.0001), with a large effect size (d=1.68). Females improved more than males (18.66±8.58 vs. 12.29±8.13, p=0.039). Greatest effects were seen in awareness of long-term consequences of uncontrolled asthma (d=2.04), ability to recognize symptoms of life-threatening asthma (d=1.61), correctly monitor symptoms (d=1.49), and tell if asthma was uncontrolled (d=1.39). Asthma self-efficacy also improved significantly (p=0.017), particularly confidence in ability to correctly manage asthma, however improvements in attitude did not achieve statistical significance. CONCLUSION Developmentally appropriate training is effective in increasing critical self-management knowledge and self-efficacy in inner city adolescents, particularly females. PRACTICE IMPLICATIONS Providers should screen carefully for symptoms and educate using developmentally appropriate training materials on ways to correctly monitor and manage symptom.
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Affiliation(s)
- Jennifer R Mammen
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States.
| | - Hyekyun Rhee
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Shannska Atis
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
| | - Annette Grape
- University of Rochester, School of Nursing, 601 Elmwood Ave. Box SON, Rochester, NY 14642, United States
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30
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Convery E, Hickson L, Meyer C, Keidser G. Predictors of hearing loss self-management in older adults. Disabil Rehabil 2018; 41:2026-2035. [DOI: 10.1080/09638288.2018.1457091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elizabeth Convery
- HEARing Cooperative Research Centre, Melbourne, Australia
- National Acoustic Laboratories, National Acoustic Laboratories, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Louise Hickson
- HEARing Cooperative Research Centre, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Carly Meyer
- HEARing Cooperative Research Centre, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Gitte Keidser
- HEARing Cooperative Research Centre, Melbourne, Australia
- National Acoustic Laboratories, National Acoustic Laboratories, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
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31
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Heinrichs K, Angerer P, Loerbroks A. Psychosocial working conditions as determinants of asthma self-management at work: A systematic review. J Asthma 2017; 55:1095-1104. [PMID: 29200315 DOI: 10.1080/02770903.2017.1396469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma exerts a considerable impact on patients and their employers. While adequate self-management is able to improve patients' prognosis, its actual implementation in everyday life may depend on contextual factors. We aimed to review the literature on the potential determinants of asthma self-management at the workplace. DATA SOURCES We systematically searched Medline and PsycINFO using terms related to the key concepts of interest (i.e., adult asthma, working conditions, and self-management). STUDY SELECTION We included original studies published in peer-reviewed journals in English or German since 1992 addressing any type of asthma self-management behavior as the outcome and any type of working condition as the determinant. RESULTS Upon implementation of a multi-stage selection process, seven articles were included. As those studies showed considerable methodological heterogeneity, a qualitative analysis was applied. A first study identified three different adaptation profiles among employees with asthma with implications for self-management behavior. Another study suggested that concerns about taking time off from work may be associated with the utilization of emergency ambulance services for asthma. Five studies among workers with various chronic illnesses addressed determinants of self-disclosure, coping with acute symptoms (e.g., medication use at work), and the potential effect of practical and emotional support from line managers or colleagues on self-management. CONCLUSION Our review indicates that the evidence for a potential link of occupational factors with asthma self-management at work is relatively sparse. Future research should take a more comprehensive approach by considering multiple types of working conditions and asthma self-management behaviors simultaneously.
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Affiliation(s)
- Katherina Heinrichs
- a Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine , University of Düsseldorf , Düsseldorf , Germany
| | - Peter Angerer
- a Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine , University of Düsseldorf , Düsseldorf , Germany
| | - Adrian Loerbroks
- a Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine , University of Düsseldorf , Düsseldorf , Germany
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32
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Carpenter DM, Geryk LL, Sage A, Arrindell C, Sleath BL. Exploring the theoretical pathways through which asthma app features can promote adolescent self-management. Transl Behav Med 2017; 6:509-518. [PMID: 27118115 DOI: 10.1007/s13142-016-0402-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Asthma apps often lack strong theoretical underpinnings. We describe how specific features of asthma apps influenced adolescents' self-observation, self-judgment, and self-reactions, which are key constructs of Self-Regulation Theory (SRT). Adolescents (ages 12-16) with persistent asthma (n = 20) used two asthma self-management apps over a 1-week period. During semi-structured interviews, participants identified their asthma goals and the app features that best promoted self-observation, self-judgment, and fostered positive self-reactions. Interviews were digitally recorded, transcribed verbatim, and analyzed thematically using MAXQDA. Adolescents' goals were to reduce the impact of asthma on their lives. Adolescents reported that self-check quizzes, reminders, and charting features increased their ability to self-observe and self-judge their asthma, which, in turn, helped them feel more confident they could manage their asthma independently and keep their asthma well-controlled. Asthma apps can positively influence adolescents' self-management behaviors via increased self-observation, self-judgment, and increased self-efficacy.
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Affiliation(s)
- Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 1 University Heights, CPO 2125, Asheville, NC, 28804, USA.
| | - Lorie L Geryk
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Adam Sage
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Courtney Arrindell
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy at the Eshelman School of Pharmacy, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC, 27759, USA
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33
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Tseng TJ, Chang AM, Wu CJJ. A randomized control trial of an asthma self-management program for adolescents in Taiwan: A study protocol. Contemp Clin Trials Commun 2017; 8:122-126. [PMID: 29696200 PMCID: PMC5898548 DOI: 10.1016/j.conctc.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022] Open
Abstract
Uncontrolled asthma in adolescents can be explained by developmental changes and lack of priority for self-care activities. Limited reports on asthma self-management programs for adolescents to enhance prevention behaviors in Taiwan were found. The protocol paper presents a two-armed, randomized controlled trial aiming to test the effectiveness of a newly developed self-management program for 112 adolescents with asthma in Taiwan. The primary outcome is asthma self-efficacy. Data will be collected at baseline and the week 4. The findings of this study will determine the extent to which a self-management program for adolescents with asthma in Taiwan enhances asthma management self-efficacy, self-management activities in asthma prevention and management, and achievement of well-controlled asthma. Trial Registration No: ACTRN12613001294741.
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Affiliation(s)
- Tzu-Jung Tseng
- Department of Nursing, Chang Gung University of Science and Technology, No.2, Sec. W., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan, ROC
| | - Anne M Chang
- Adjunct Professor, School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, Australia
| | - Chiung-Jung Jo Wu
- Associate Professor, School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast.,Visiting Fellow, School of Nursing, Queensland University of Technology, Brisbane, Australia.,Honorary Research Fellow, Royal Brisbane and Women's Hospital, Brisbane (RBWH), Australia.,Honorary Research Fellow, Mater Research Institute-University of Queensland (MRI-UQ), Brisbane, Australia
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34
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Holley S, Morris R, Knibb R, Latter S, Liossi C, Mitchell F, Roberts G. Barriers and facilitators to asthma self-management in adolescents: A systematic review of qualitative and quantitative studies. Pediatr Pulmonol 2017; 52:430-442. [PMID: 27717193 DOI: 10.1002/ppul.23556] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/18/2016] [Accepted: 08/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many adolescents have poor asthma control and impaired quality of life despite the availability of modern pharmacotherapy. Research suggests that poor adherence to treatment and limited engagement in self-management could be contributing factors. OBJECTIVE To conduct a systematic review of the barriers and facilitators to self-management of asthma reported by adolescents using a narrative synthesis approach to integrate the findings. DESIGN MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for all types of study design. Full papers were retrieved for study abstracts that included data from participants aged 12-18 years referring to barriers or facilitators of asthma self-management behaviors. RESULTS Sixteen studies (5 quantitative and 11 qualitative) underwent data extraction, quality appraisal, and thematic analysis. Six key themes were generated that encompassed barriers and/or facilitators to self-management of asthma in adolescents: Knowledge, Lifestyle, Beliefs and Attitudes, Relationships, Intrapersonal Characteristics, and Communication. CONCLUSIONS There is a pressing need to prepare adolescents for self-management, using age-appropriate strategies that draw on the evidence we have synthesized. Current clinical practice should focus on ensuring adolescents have the correct knowledge, beliefs, and positive attitude to self-manage their illness. This needs to be delivered in a supportive environment that facilitates two-way communication, fosters adolescents' self-efficacy to manage their disease, and considers the wider social influences that impinge on self-management. Pediatr Pulmonol. 2017;52:430-442. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Simone Holley
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton Faculty of Medicine, Southampton, United Kingdom
| | - Ruth Morris
- NIHR/Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Christina Liossi
- School of Psychology, University of Southampton, United Kingdom.,Department of Paediatric Psychology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Frances Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, United Kingdom
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development in Health Academic Units, University of Southampton Faculty of Medicine, Southampton, United Kingdom.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, United Kingdom.,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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35
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Mammen JR, Rhee H, Norton SA, Butz AM. Perceptions and experiences underlying self-management and reporting of symptoms in teens with asthma. J Asthma 2017; 54:143-152. [PMID: 27337035 PMCID: PMC5182183 DOI: 10.1080/02770903.2016.1201835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Teens often have inadequate asthma self-management and control. However, little is known of their perceptions of or rationales for self-management behaviors. OBJECTIVES To explore how teens self-manage asthma, including experiences, perceptions, responses to and reporting of symptoms. METHODS A case-based, qualitative-descriptive design was used. Data were collected from minority and non-minority teens with controlled and uncontrolled asthma and their respective parents (N = 28). There were four data-collection points, including: (1) a primary teen interview; (2) parent interview; (3) 2-week self-management voice-diary; and (4) follow-up teen interview, incorporating symptom-response card-sorting to map symptoms and associated self-management responses. Seventy data sources were included in the analysis. RESULTS Teens thought of their asthma symptoms as normal or unusual relative to their personal baseline symptom pattern; Those with uncontrolled asthma normalized higher levels of asthma symptoms than their counterparts with controlled asthma. Second, teens' decisions to treat symptoms of asthma with rescue medication were based on perceived benefits, burdens and accessibility of treatment balanced against perceived normalcy of symptoms. Teens with uncontrolled asthma had substantially higher treatment thresholds and delayed responses to symptoms compared to controlled peers. Third, teens never reported perceived normal symptoms of asthma to parents or providers, who were thus only aware of unusual or visible/audible symptoms. CONCLUSIONS Teen's perceptions of symptoms and understanding of what is normal is the basis for self-management decisions. Improving self-management will likely entail modifying perceptions of symptoms and benefits/burdens of treatment to achieve healthier self-management patterns.
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Affiliation(s)
| | - Hyekyun Rhee
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Sally A Norton
- a University of Rochester School of Nursing , Rochester , NY , USA
| | - Arlene M Butz
- b Johns Hopkins University, School of Medicine , Baltimore , MD , USA
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Abstract
AIM To report an analysis and clarification of the concept of goals of care. BACKGROUND Goals of care have been used by healthcare providers since 1978, but no operationalized, consensual definition exists. DESIGN Norris's method of concept clarification was used to create an operational definition, conceptual model and testable hypotheses of goals of care from the healthcare provider's perspective. DATA SOURCES Data came from current research reports, interviews with experts and web sites of professional organizations. Research reports were published between 2003-2013. METHODS Antecedents, definitions and consequences were systematized and organized into coherent and more abstract groups to define goals of care. A conceptual model and testable hypotheses were created from this process. RESULTS Goals of care are desired health expectations that are formulated through the thoughtful interaction between a human being seeking medical care and the healthcare team in the healthcare system and are appropriate, agreed on, documented and communicated. CONCLUSIONS Development of clear goals of care can increase patient satisfaction and quality of care while decreasing costs, hospital length of stay and hospital readmission. Goals of care are dynamic and should be reassessed regularly. How and when goals of care transition from implicit to explicit should be explored further, and what prompts this transition. Nurses, physicians and healthcare providers need education on how to best fill their roles in the development of goals of care.
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Affiliation(s)
- Susan Stanek
- University of Rochester School of Nursing, New York, USA
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37
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Blok AC. A Middle-Range Explanatory Theory of Self-Management Behavior for Collaborative Research and Practice. Nurs Forum 2016; 52:138-146. [PMID: 27438773 DOI: 10.1111/nuf.12169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/14/2016] [Accepted: 05/25/2016] [Indexed: 01/20/2023]
Abstract
AIM To report an analysis of the concept of self-management behaviors. BACKGROUND Self-management behaviors are typically associated with disease management, with frequent use by nurse researchers related to chronic illness management and by international health organizations for development of disease management interventions. DESIGN A concept analysis was conducted within the context of Orem's self-care framework. Walker and Avant's eight-step concept analysis approach guided the analysis. DATA SOURCES Academic databases were searched for relevant literature including CIHAHL, Cochrane Databases of Systematic Reviews and Register of Controlled Trials, MEDLINE, PsycARTICLES and PsycINFO, and SocINDEX. REVIEW METHODS Literature using the term "self-management behavior" and published between April 2001 and March 2015 was analyzed for attributes, antecedents, and consequences. RESULTS A total of 189 journal articles were reviewed. Self-management behaviors are defined as proactive actions related to lifestyle, a problem, planning, collaborating, and mental support, as well as reactive actions related to a circumstantial change, to achieve a goal influenced by the antecedents of physical, psychological, socioeconomic, and cultural characteristics, as well as collaborative and received support. CONCLUSIONS The theoretical definition and middle-range explanatory theory of self-management behaviors will guide future collaborative research and clinical practice for disease management.
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Affiliation(s)
- Amanda C Blok
- Postdoctoral Associate, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Mammen JR, Norton SA, Rhee H, Butz AM. New approaches to qualitative interviewing: Development of a card sort technique to understand subjective patterns of symptoms and responses. Int J Nurs Stud 2016; 58:90-96. [PMID: 26897540 PMCID: PMC4837076 DOI: 10.1016/j.ijnurstu.2015.12.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/18/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ability to elicit individuals' perceptions of complex behavioral processes can be challenging, as it hinges not only upon the skill of the researcher, but also upon assumptions of a shared language and individuals' ability to recall, analyze, and effectively communicate events. In a case-based qualitative-descriptive study about teens' experiences of asthma self-management, we found that variations in terminology and descriptions of events, symptoms, and responses made it difficult to understand teens' experiences of asthma. In particular, teens' conceptualization of their asthma symptoms and self-management responses differed from situation to situation, from other teens in the study, from the interviewer, and from prior reports in the literature. These differences across many levels made it difficult to identify patterns in individual processes of self-management, and among teens in general.. OBJECTIVES To address these challenges, we developed a card sorting activity to facilitate in-depth exploration of teens' experiences of asthma. DESIGN Case-based qualitative description. SETTING Teen-parent dyads (N=28) were recruited from the community, Emergency Department, Pediatric Pulmonary Department, and prior study subjects of a major medical center. METHODS Teens first identified and then sequenced their own unique sets of asthma symptoms and self-management responses. Teens then developed contextually grounded narratives using the card sort they had created as a visual aid. RESULTS This technique not only allowed us to bridge teen-interviewer communication barriers and develop shared terminology, but also resulted in a visible sequence of asthma symptoms and self-management responses. CONCLUSIONS The card sort technique facilitated researcher-teen discussion and enabled comparison of self-management patterns across teens in our study. This technique is potentially useful for other areas of research exploring behavioral processes with complex and individual-specific experiences, in particular those involving sequences of events and self-management responses. This paper delineates the development, utility, and potential applications of the symptom-response card sorting technique for research and clinical practice.
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Affiliation(s)
- Jennifer R. Mammen
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester NY, 14642
| | - Sally A. Norton
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester NY, 14642
| | - Hyekyun Rhee
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester NY, 14642
| | - Arlene M. Butz
- Johns Hopkins University, School of Medicine, 600 N. Wolfe Street, CMSC-144, Baltimore, MD 21287
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Roberts CA, Geryk LL, Sage AJ, Sleath BL, Tate DF, Carpenter DM. Adolescent, caregiver, and friend preferences for integrating social support and communication features into an asthma self-management app. J Asthma 2016; 53:948-54. [PMID: 27116540 DOI: 10.3109/02770903.2016.1171339] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study examines: 1) adolescent preferences for using asthma self-management mobile applications (apps) to interact with their friends, caregivers, medical providers, and other adolescents with asthma and 2) how caregivers and friends would use mobile apps to communicate with the adolescent and serve as sources of support for asthma management. METHODS We recruited 20 adolescents aged 12-16 years with persistent asthma, their caregivers (n = 20), and friends (n = 3) from two suburban pediatric practices in North Carolina. We gave participants iPods with two preloaded asthma apps and asked them to use the apps for 1 week. Adolescents and caregivers provided app feedback during a semi-structured interview at a regularly-scheduled clinic appointment and during a telephone interview one week later. Friends completed one telephone interview. Interviews were audio-recorded and transcribed verbatim. An inductive, theory-driven analysis was used to identify themes and preferences. RESULTS Adolescents preferred to use apps for instrumental support from caregivers, informational support from friends, and belonging and informational support from others with asthma. The majority of adolescents believed apps could enhance communication with their caregivers and medical providers, and the theme of self-reliance emerged in which caregivers and adolescents believed apps could enable adolescents to better self-manage their asthma. Friends preferred to use apps to provide instrumental and informational support. CONCLUSIONS Given preferences expressed in this study, apps may help adolescents obtain social support to better self-manage their asthma. Future app-based interventions should include features enabling adolescents with asthma to communicate and interact with their caregivers, medical providers, and friends.
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Affiliation(s)
- Courtney A Roberts
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Lorie L Geryk
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Adam J Sage
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Betsy L Sleath
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
| | - Deborah F Tate
- b Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | - Delesha M Carpenter
- a Eshelman School of Pharmacy , University of North Carolina , Chapel Hill , NC , USA
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Loerbroks A, Leucht V, Keuneke S, Apfelbacher CJ, Sheikh A, Angerer P. Patients' needs in asthma treatment: development and initial validation of the NEAT questionnaire. J Asthma 2016; 53:427-37. [PMID: 26786054 DOI: 10.3109/02770903.2015.1099664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We aimed to develop and tentatively validate an instrument assessing patients' needs related to asthma treatment. METHODS Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire's psychometric properties and validity. RESULTS Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients' fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales ("patient expertise", "drug effects", "handling drugs" and "exacerbations"). Cronbach's alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction. CONCLUSIONS The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.
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Affiliation(s)
- Adrian Loerbroks
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany .,b Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University , Mannheim , Germany
| | - Verena Leucht
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Susanne Keuneke
- c Faculty of Philosophy, Social Sciences Institute, University of Düsseldorf , Düsseldorf , Germany
| | - Christian J Apfelbacher
- d Division of Medical Sociology, Department of Epidemiology and Preventive Medicine , University of Regensburg , Regensburg , Germany .,e Division of Public Health and Primary Care , Brighton and Sussex Medical School, University of Brighton , Falmer , UK
| | - Aziz Sheikh
- f Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Centre of Medical Informatics, The University of Edinburgh, Medical School , Edinburgh , UK .,g Division of General Internal Medicine and Primary Care , Brigham and Women's Hospital , Boston , MA , USA , and.,h Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Peter Angerer
- a Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
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Brockow K, Ring J, Scheewe S, Staab D. Schulungen. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Crowder SJ, Hanna KM, Carpenter JS, Broome ME. Factors Associated with Asthma Self-Management in African American Adolescents. J Pediatr Nurs 2015; 30:e35-43. [PMID: 25936998 PMCID: PMC4624611 DOI: 10.1016/j.pedn.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 01/03/2023]
Abstract
Few studies have focused on asthma self-management in African American adolescents, a group with high rates of the disease. This study examined factors associated with asthma self-management in 133 African Americans aged 14-16 years including gender, asthma impairment, prior asthma education, cognitive and emotional illness representations. Twenty-five percent of the variance in asthma self-management was explained by having attended an asthma education program, perceiving more asthma consequences (illness consequences), and reporting greater understanding of asthma as an illness (illness coherence). Findings suggest that these variables may be important targets of interventions to improve asthma self-management in African American middle adolescents.
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Affiliation(s)
- Sharron J Crowder
- Community and Health Systems Department, Indiana University School of Nursing, Indianapolis, IN.
| | - Kathleen M Hanna
- Carol M. Wilson Endowed Chair in Nursing, Nebraska Medical Center College of Nursing, Omaha, NE
| | - Janet S Carpenter
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, IN
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Pizzulli A, Perna S, Florack J, Pizzulli A, Giordani P, Tripodi S, Pelosi S, Matricardi PM. The impact of telemonitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitis. Clin Exp Allergy 2015; 44:1246-54. [PMID: 25109375 DOI: 10.1111/cea.12386] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/05/2014] [Accepted: 07/01/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Adherence to controller therapy in allergic diseases is low. Telemonitoring has been proposed to improve adherence to treatment in chronic diseases. However, this strategy has never been tested in allergic rhinoconjunctivitis. OBJECTIVE To test whether Internet-based telemonitoring during the grass-pollen season of children with allergic rhinoconjunctivitis may enhance adherence to treatment. METHODS Children and adolescents, 5-18 years old, with moderate-to-severe seasonal allergic rhinoconjunctivitis to grass pollen requiring daily administration of nasal corticosteroid (NCS) (mometasone) were recruited (April 2013) in a paediatric allergy practice. Participants were randomized to Internet-based monitoring (AllergyMonitor(™) , AM) or to usual care (no diary at all, controls) and followed from 13 May (T0) to 15 June 2013 (T2). An intermediate visit (T1) was performed between 31 May and 2 June. Optimal adherence to therapy was expressed as the use of at least 0.190 g/day of mometasone, corresponding to 1 puff/nostril/day, and it was measured by canister weights during (T1) and at the end (T2) of the study period. Main secondary outcomes included the reported disease severity (validated self-questionnaire) and quality of life (AdoIRQLQ questionnaire), disease knowledge (multiple-choice questionnaire), nasal flow and resistance at baseline and at T2. RESULTS The use of mometasone, expressed as both optimal adherence rate (48.4% vs. 12.5%; P = 0.002) and average daily use (0.20 ± 0.12 g/day vs. 0.15 ± 0.07 g/day; P = 0.037), was higher in the AM group (n = 31) than among controls (n = 32). Disease knowledge improved among the patients using AM (83.3% vs. 68.3%; P < 0.001) but not among controls (68.2% vs. 67.7% right answers; P > 0.05). No differences were observed in the reported severity of disease, nasal flow and resistance and quality of life both at baseline and at follow-up visits. CONCLUSIONS Internet-based telemonitoring improves adherence to NCS treatment and disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis.
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Affiliation(s)
- A Pizzulli
- Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany; Practice for Pediatric Allergy and Pneumology, Berlin, Germany
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Carpenter DM, Stover A, Slota C, Ayala GX, Yeatts K, Tudor G, Davis S, Williams D, Sleath B. An evaluation of physicians' engagement of children with asthma in treatment-related discussions. J Child Health Care 2014; 18:261-74. [PMID: 23818146 PMCID: PMC5379471 DOI: 10.1177/1367493513489780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
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Affiliation(s)
- Delesha M Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Angela Stover
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Slota
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Guadalupe X Ayala
- Graduate School of Public Health, San Diego State University, California, USA
| | - Karen Yeatts
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Gail Tudor
- Department of Science and Mathematics, Husson University, Maine, USA
| | | | - Dennis Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Betsy Sleath
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA Cecil G Sheps Center for Health Services Research, North Carolina, USA
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Blaakman SW, Cohen A, Fagnano M, Halterman JS. Asthma medication adherence among urban teens: a qualitative analysis of barriers, facilitators and experiences with school-based care. J Asthma 2014; 51:522-9. [PMID: 24494626 DOI: 10.3109/02770903.2014.885041] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Teens with persistent asthma do not always receive daily preventive medications or do not take them as prescribed, despite established clinical guidelines. The purpose of this study was to understand urban teens' experiences with asthma management, preventive medication adherence and participation in a school-based intervention. METHODS Teens (12-15 years) with persistent asthma, and prescribed preventive medication, participated in a pilot study that included daily observed medication therapy at school and motivational interviewing. Semi-structured interviews occurred at final survey. Qualitative content analysis enabled data coding to identify themes. RESULTS Themes were classified as "general asthma management" or "program-specific." For general management, routines were important, while hurrying interfered with taking medications. Forgetfulness was most commonly linked to medication nonadherence. Competing demands related to school preparedness and social priorities were barriers to medication use. Independence with medications was associated with several benefits (e.g. avoiding parental nagging and feeling responsible/mature). Program-specific experiences varied. Half of teens reported positive rapport with their school nurse, while a few felt that their nurse was dismissive. Unexpected benefits and barriers within the school structure included perceptions about leaving the classroom, the distance to the nurse's office, the necessity of hall passes and morning school routines. Importantly, many teens connected daily medication use with fewer asthma symptoms, incenting continued adherence. CONCLUSIONS Teens with asthma benefit from adherence to preventive medications but encounter numerous barriers to proper use. Interventions to improve adherence must accommodate school demands and unique teen priorities. The school nurse's role as an ally may support teens' transition to medication independence.
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Affiliation(s)
- Susan W Blaakman
- School of Nursing, University of Rochester , Rochester, NY , USA and
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