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Lu S, Leduc N, Moullec G. Type 2 diabetes peer support interventions as a complement to primary care settings in high-income nations: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:3267-3278. [PMID: 36038395 DOI: 10.1016/j.pec.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Inadequate social support make way for peer support initiatives to complement the health system delivery of diabetes self-management education programs for type 2 diabetes (T2D). This review synthesizes knowledge about T2D peer support in terms of their various models and impact, endorsement, and contextual information in high-income nations. METHODS A scoping review was conducted on published and grey literature in four electronic bibliographic databases between January 2007 to December 2021. RESULTS 76 records were included. Face-to-face self-management programs and telephone-based peer support seem the most promising modalities given the largest scientific coverage on T2D outcomes. Face-to-face self-management programs were the most preferred by ethnic minority groups. Unlike peer supporters, healthcare professionals had mixed views about T2D peer support interventions. Managers of peer support programs perceived cultural competency as a cornerstone for peer support implementation. Care must be taken in recruiting, training and retaining peer supporters for sustainable practice. CONCLUSIONS Various T2D peer support models lie at the interface between primary care and community-based settings. PRACTICE IMPLICATIONS Fostering the role of peer support beyond healthcare organizations should be encouraged to engage the hardly reached, and to leverage community support to complement the health system.
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Affiliation(s)
- Sonia Lu
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada.
| | - Nicole Leduc
- University of Montreal, School of Public Health, Department of Health Management, Evaluation and Policy, Montreal, Canada
| | - Grégory Moullec
- University of Montreal, School of Public Health, Department of Social and Preventive Medicine, Montreal, Canada
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Huber C, Montreuil C, Christie D, Forbes A. Integrating Self-Management Education and Support in Routine Care of People With Type 2 Diabetes Mellitus: A Conceptional Model Based on Critical Interpretive Synthesis and A Consensus-Building Participatory Consultation. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:845547. [PMID: 36992783 PMCID: PMC10012123 DOI: 10.3389/fcdhc.2022.845547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
The integration of self-management education and support into the routine diabetes care is essential in preventing complications. Currently, however, there is no consensus on how to conceptualise integration in relation to self-management education and support. Therefore, this synthesis presents a framework conceptualising integration and self-management. Methods Seven electronic databases (Medline, HMIC, PsycINFO, CINAHL, ERIC, Scopus and Web of Science) were searched. Twenty-one articles met the inclusion criteria. Data were synthesised using principles of critical interpretive synthesis to build the conceptual framework. The framework was presented to 49 diabetes specialist nurses working at different levels of care during a multilingual workshop. Results A conceptual framework is proposed in which integration is influenced by five interacting components: the programme ethos of the diabetes self-management education and support intervention (content and delivery), care system organisation (the framework in which such interventions are delivered), adapting to context (the aspects of the people receiving and delivering the interventions), interpersonal relationship (the interactions between the deliverer and receiver of the intervention), and shared learning (what deliverer and receiver gain from the interactions). The critical inputs from the workshop participants related to the different priorities given to the components according to their sociolinguistic and educational experiences, Overall, they agreed with the conceptualisation of the components and their content specific to diabetes self-management education and support. Discussion Integration was conceptualised in terms of the relational, ethical, learning, contextual adapting, and systemic organisational aspects of the intervention. It remains uncertain which prioritised interactions of components and to what extent these may moderate the integration of self-management education and support into routine care; in turn, the level of integration observed in each of the components may moderate the impact of these interventions, which may also apply to the impact of the professional training. Conclusion This synthesis provides a theoretical framework that conceptualises integration in the context of diabetes self-management education and support in routine care. More research is required to evaluate how the components identified in the framework can be addressed in clinical practice to assess whether improvements in self-management education and support can be effectively realised in this population.
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Affiliation(s)
- Claudia Huber
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
| | - Chantal Montreuil
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland
| | - Derek Christie
- HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Science Fribourg, Fribourg, Switzerland
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, James Clerk Maxwell Building, London, United Kingdom
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Al Slamah T, Nicholl BI, Alslail FY, Harris L, Kinnear D, Melville CA. Correlates of type 2 diabetes and glycaemic control in adults in Saudi Arabia a secondary data analysis of the Saudi health interview survey. BMC Public Health 2020; 20:515. [PMID: 32303201 PMCID: PMC7164173 DOI: 10.1186/s12889-020-08597-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 03/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that type 2 diabetes self-management programmes may have a positive impact on health outcomes of adults living in Gulf countries. However, none of the programmes evaluated were developed using evidence about the specific needs of adults with Type 2 diabetes living in the Gulf countries. This study is part of a wider programme of research, which uses a cultural adaptation framework to generate information on how to tailor type 2 diabetes self-management to the Saudi context. METHODS Secondary data analysis of the Saudi Health Interview Survey (SHIS) (N = 10,821) was conducted. Bivariate and multivariate logistic regression modelling assessed factors associated with type 2 diabetes and its control / self-management including sociodemographic factors (e.g. age, gender), lifestyle (e.g. diet, physical activity), and health seeking behaviours (e.g. chronic illnesses, health services). RESULTS 7% (N = 808) of all participants had type 2 diabetes (59% male), however it represents 35% at or above 55 years. In multivariate analysis at older age, being overweight or obese, male, having hypertension, and reporting a reduction in health status in the 12 months prior to questionnaire completion, were significantly associated with having type 2 diabetes. Participants who reported walking for more than 10 min per day were less likely to report type 2 diabetes. Unexpectedly there was a significant association between type 2 diabetes and lower frequency of fast food intake, while increased fruit and vegetable intake was associated with poor glycaemic control. CONCLUSIONS Being overweight and/or hypertensive are concomitant with type 2 diabetes in Saudi Arabia. Any self-management programmes for type 2 diabetes patients with either of these conditions should be tailored accordingly. Walking behaviours should be prioritised in Saudi self-management programmes. Prediabetes management programmes may be of special importance to the Saudi community.
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Affiliation(s)
- Thamer Al Slamah
- Human Health Department, College of Applied Medical Sciences, Qassim University, Buraydah, Kingdom of Saudi Arabia.
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road R202 House 2, Glasgow, G12 9LX, UK.
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK.
| | - Barbara I Nicholl
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road R202 House 2, Glasgow, G12 9LX, UK
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK
| | - Fatima Y Alslail
- Director of the National Diabetes Control and Prevention Program, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Leanne Harris
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Deborah Kinnear
- Mental Health and Wellbeing, Institute of Health and Wellbeing, Glasgow, UK
| | - Craig A Melville
- College of Medicine, Veterinary and Life Science, University of Glasgow, Glasgow, UK
- Mental Health and Wellbeing, Institute of Health and Wellbeing, Glasgow, UK
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Impact of nurse champion on quality of care and outcomes in type 2 diabetes patients. INT J EVID-BASED HEA 2019; 17:3-13. [PMID: 30520763 DOI: 10.1097/xeb.0000000000000156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over 29 million people in the United States have diabetes, with an additional 86 million living with prediabetes. On inpatient hospital units it is estimated that 50% of admitted patients have diabetes as a primary or secondary diagnosis. Nurse champions have improved outcomes and quality of life for patients across different clinical settings. The purposes of this evidence literature review are to evaluate and synthesize evidence regarding the impact of a nurse champion model on nurses' performances and diabetic patient health outcomes. Nurse champions in this review also refer to clinical nurse specialists, certified diabetes educators, and clinical mentors. Search of evidence-based literature was conducted using PubMed, CINAHL, Ovid, Cochrane Library, and Google Scholar databases. Keywords included Nurse Champion and Diabetes, Clinical Mentor and Diabetes, and Diabetes Educator. Search limits included date of publication within last 15 years, English language, and peer-reviewed journals. A total of 14 articles were included in the synthesis of literature with level of evidence ranging from I to V. The study designs of selected evidence fluctuate from randomized controlled trials (3), case studies (6), qualitative studies (2), systematic review (1), and quasi-experimental study (1). The synthesis of evidence indicated that implementation of a nurse champion model did not only significantly improve nurses' diabetic knowledge and skills, but also improved the health outcomes of diabetic patients including reduction in hemoglobin A1c levels, reduction in perceived Diabetes Distress Scale, quality of life improvement, reduction of number of near misses, decreased readmission rates, improved hypoglycemic outcomes, and greater weight loss in patients with type 2 diabetes. Improving diabetic patient outcomes could save the hospital a significant amount of money and create a higher standard of care across the healthcare field. Bettering patient outcomes are good not only for the patient but also the hospital and nurses. Implementation of nurse champion models into nursing practice could significantly improve patient outcomes and quality of life as well as nursing performance. Nurse champion models also can create new leadership roles in nursing.
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Sherman KA, Kilby CJ, Elder E, Ridner SH. Factors associated with professional healthcare advice seeking in women at risk for developing breast cancer-related lymphedema. PATIENT EDUCATION AND COUNSELING 2018; 101:445-451. [PMID: 29107400 DOI: 10.1016/j.pec.2017.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Approximately 6-20% of breast cancer patients undergoing lymph node surgery will develop lymphedema. At-risk individuals are encouraged to seek professional healthcare advice if symptoms arise. This study aimed to identify cognitive and affective factors associated with professional healthcare advice (PHCA) seeking behavior in women with heightened lymphedema risk. METHODS Women with increased lymphedema risk (N=462) completed an online survey measuring cognitive and affective responses to lymphedema risk, including the Illness Perception Questionnaire (Revised), and adherence to seeking PHCA. RESULTS Overall, 62% of women reported seeking professional healthcare advice if symptoms arose. Logistic regression analysis indicated that adherence to seeking PHCA if lymphedema symptoms arise was associated with greater illness coherence, belief in the efficacy of seeking PHCA, and lymphedema risk-related emotional distress. CONCLUSION Women were more likely to seek PHCA if symptoms arose if they held a coherent understanding of lymphedema and believed in the usefulness of seeking PHCA. For these women, psychological distress associated with lymphedema risk was associated with enhanced adherence to seeking PHCA. PRACTICE IMPLICATIONS Health professionals should target lymphedema education to ensure at-risk women have a coherent understanding of lymphedema and that they believe in the effectiveness of seeking PHCA to help manage lymphedema symptoms.
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Affiliation(s)
- Kerry A Sherman
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Christopher J Kilby
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia; Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
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Miller J, MacDermid JC, Richardson J, Walton DM, Gross A. Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies. Arch Physiother 2018; 7:4. [PMID: 29340199 PMCID: PMC5759926 DOI: 10.1186/s40945-017-0032-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/05/2017] [Indexed: 01/13/2023] Open
Abstract
Background Previous evidence suggests self-management programs for people with chronic pain improve knowledge and self-efficacy, but result in small to negligible changes in function. The purpose of this multiple case studies design was to describe the unique responses of six participants to a new self-management program aimed at improving function, to detail each component of the program, and to explore potential explanations for the varied trajectories of each of the participants. Case Presentation Six participants who had been experiencing chronic pain for at least 5 years were included. All participants were enrolled 6 weeks of ChrOnic pain self-ManageMent support with pain science EducatioN and exercise (COMMENCE). Participants completed an assessment at baseline, 7 weeks (1-week follow-up), and 18 weeks (12-week follow-up). Each participant had a unique initial presentation and goals. Assessments included: function as measured by the Short Musculoskeletal Function Assessment – Dysfunction Index, how much participants are bothered by functional difficulties, pain intensity, fatigue, pain interference, cognitive and psychological factors associated with pain and disability, pain neurophysiology, self-efficacy, satisfaction, and perceived change. The self-management program was 6-weeks in length, consisting of one individual visit and one group visit per week. The program incorporated three novel elements not commonly included in self-management programs: pain neurophysiology education, individualized exercises determined by the participants’ goals, and additional cognitive behavioural approaches. Participants were all satisfied with self-management support received. Change in function was variable ranging from 59% improvement to 17% decline. Two potential explanations for variances in response, attendance and social context, are discussed. Several challenges were identified by participants as barriers to attendance. Conclusions A primary care self-management intervention including pain education and individualized exercise has potential to improve function for some people with chronic pain, although strategies to improve adherence and reduce barriers to participation may be needed to optimize the impact. Electronic supplementary material The online version of this article (doi:10.1186/s40945-017-0032-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordan Miller
- School of Rehabilitation Therapy, Queen's University, Kingston, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Joy C MacDermid
- School of Rehabilitation Therapy, Queen's University, Kingston, 31 George Street, Kingston, Ontario K7L 3N6 Canada.,School of Physical Therapy, Western University, Room 1440, Elborn College, London, Ontario N6G 1H1 Canada
| | - Julie Richardson
- School of Rehabilitation Therapy, Queen's University, Kingston, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - David M Walton
- School of Physical Therapy, Western University, Room 1440, Elborn College, London, Ontario N6G 1H1 Canada
| | - Anita Gross
- School of Rehabilitation Therapy, Queen's University, Kingston, 31 George Street, Kingston, Ontario K7L 3N6 Canada
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Saha S, Riemenschneider H, Müller G, Levin-Zamir D, Van den Broucke S, Schwarz PEH. Comparative analysis of diabetes self-management education programs in the European Union Member States. Prim Care Diabetes 2017; 11:529-537. [PMID: 28663021 DOI: 10.1016/j.pcd.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups.
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Affiliation(s)
- Sarama Saha
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Henna Riemenschneider
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Diane Levin-Zamir
- Clalit Health Services, University of Haifa School of Public Health, Israel
| | | | - Peter E H Schwarz
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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Sherman KA, Kilby CJ, Moore DM, Shaw LK. The importance of coherently understanding cervical cancer vaccination: factors associated with young Australian women’s uptake of the HPV vaccine. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2017.1381023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kerry A. Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Christopher J. Kilby
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Danielle M. Moore
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Laura-Kate Shaw
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
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Smith A, McKinlay A, Wojewodka G, Ridsdale L. A systematic review and narrative synthesis of group self-management interventions for adults with epilepsy. BMC Neurol 2017. [PMID: 28623909 PMCID: PMC5474294 DOI: 10.1186/s12883-017-0893-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Epilepsy is a serious and costly long-term condition that negatively affects quality of life, especially if seizures persist on medication. Studies show that people with epilepsy (PWE) want to learn more about the condition and some educational self-management courses have been trialled internationally. The objectives of this review were to evaluate research and summarise results on group self-management interventions for PWE. METHODS We searched Medline and PsycINFO for results published in English between 1995 and 2015. Only studies evaluating face-to-face, group interventions for adults with epilepsy were included. Heterogeneity in study outcomes prevented the carrying out of a meta-analysis; however, a Cochrane style review was undertaken. RESULTS We found eleven studies, nine of which were randomised controlled trials. There were variable standards of methodological reporting with some risk of bias. Seven of the studies used quality of life as an outcome, with four finding statistically significant improvements in mean total score. Two found an improvement in outcome subscales. One study included some additional semi-qualitative data. CONCLUSIONS We identified promising trends in the trials reviewed. In particular, there were significant improvements in quality of life scales and seizure frequency in many of the interventions. However, considerable heterogeneity of interventions and outcomes made comparison between the studies difficult. Courses that included psychological interventions and others that had a high number of sessions showed more effect than short educational courses. Furthermore, the evidence was predominantly from pilot studies with small sample sizes and short follow-up duration. Further research is needed to better evaluate the role of group self-management interventions in outpatient epilepsy management.
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Affiliation(s)
- Amelia Smith
- GKT School of Medicine, King's College London, London, SE1 1UL, UK
| | - Alison McKinlay
- Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience Centre, King's College London, PO Box 57, London, SE5 8AF, UK
| | - Gabriella Wojewodka
- Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience Centre, King's College London, PO Box 57, London, SE5 8AF, UK
| | - Leone Ridsdale
- Institute of Psychiatry, Psychology & Neuroscience, Academic Neuroscience Centre, King's College London, PO Box 57, London, SE5 8AF, UK.
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Reeves BC, Wells GA, Waddington H. Quasi-experimental study designs series-paper 5: a checklist for classifying studies evaluating the effects on health interventions-a taxonomy without labels. J Clin Epidemiol 2017; 89:30-42. [PMID: 28351692 PMCID: PMC5669452 DOI: 10.1016/j.jclinepi.2017.02.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 10/02/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022]
Abstract
Objectives The aim of the study was to extend a previously published checklist of study design features to include study designs often used by health systems researchers and economists. Our intention is to help review authors in any field to set eligibility criteria for studies to include in a systematic review that relate directly to the intrinsic strength of the studies in inferring causality. We also seek to clarify key equivalences and differences in terminology used by different research communities. Study Design and Setting Expert consensus meeting. Results The checklist comprises seven questions, each with a list of response items, addressing: clustering of an intervention as an aspect of allocation or due to the intrinsic nature of the delivery of the intervention; for whom, and when, outcome data are available; how the intervention effect was estimated; the principle underlying control for confounding; how groups were formed; the features of a study carried out after it was designed; and the variables measured before intervention. Conclusion The checklist clarifies the basis of credible quasi-experimental studies, reconciling different terminology used in different fields of investigation and facilitating communications across research communities. By applying the checklist, review authors' attention is also directed to the assumptions underpinning the methods for inferring causality.
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Affiliation(s)
- Barnaby C Reeves
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7 Queen's Building, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
| | - George A Wells
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7
| | - Hugh Waddington
- International Initiative for Impact Evaluation (3ie), 202-203, Rectangle One, D-4, Saket District Centre, New Delhi, 110017, India
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Pilkington K, Loef M, Polley M. Searching for Real-World Effectiveness of Health Care Innovations: Scoping Study of Social Prescribing for Diabetes. J Med Internet Res 2017; 19:e20. [PMID: 28153817 PMCID: PMC5314100 DOI: 10.2196/jmir.6431] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Social prescribing is a process whereby primary care patients are linked or referred to nonmedical sources of support in the community and voluntary sector. It is a concept that has arisen in practice and implemented widely in the United Kingdom and has been evaluated by various organizations. OBJECTIVE The aim of our study was to characterize, collate, and analyze the evidence from evaluation of social prescribing for type 2 diabetes in the United Kingdom and Ireland, comparing information available on publicly available websites with the published literature. METHODS We used a broad, pragmatic definition of social prescribing and conducted Web-based searches for websites of organizations providing potentially relevant services. We also explored linked information. In parallel, we searched Medline, PubMed, Cochrane Library, Google Scholar, and reference lists for relevant studies published in peer-reviewed journals. We extracted the data systematically on the characteristics, any reported evaluation, outcomes measured and results, and terminology used to describe each service. RESULTS We identified 40 UK- or Ireland-based projects that referred people with type 2 diabetes and prediabetes to nonmedical interventions or services provided in the community. We located evaluations of 24 projects; 11 as published papers, 12 as Web-based reports, and 1 as both a paper and a Web-based report. The interventions and services identified included structured group educational programs, exercise referral schemes, and individualized advice and support with signposting of health-related activities in the community. Although specific interventions such as community-based group educational programs and exercise referral have been evaluated in randomized controlled trials, evaluation of individualized social prescribing services involving people with type 2 diabetes has, in most cases, used pre-post and mixed methods approaches. These evaluations report generic improvement in a broad range of outcomes and provide an insight into the criteria for the success of social prescribing services. CONCLUSIONS Our study revealed the varied models of social prescribing and nonmedical, community-based services available to people with type 2 diabetes and the extent of evaluation of these, which would not have been achieved by searching databases alone. The findings of this scoping study do not prove that social prescribing is an effective measure for people with type 2 diabetes in the United Kingdom, but can be used to inform future evaluation and contribute to the development of the evidence base for social prescribing. Accessing Web-based information provides a potential method for investigating how specific innovative health concepts, such as social prescribing, have been translated, implemented, and evaluated in practice. Several challenges were encountered including defining the concept, focusing on process plus intervention, and searching diverse, evolving Web-based sources. Further exploration of this approach will inform future research on the application of innovative health care concepts into practice.
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Affiliation(s)
- Karen Pilkington
- School of Life Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom.,School of Health Sciences and Social Work, Faculty of Science, University of Portsmouth, Portsmouth, United Kingdom
| | - Martin Loef
- Institute of Transcultural Health Studies, European University Viadrina, Frankfurt, Germany
| | - Marie Polley
- School of Life Sciences, Faculty of Science and Technology, University of Westminster, London, United Kingdom
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Pickett K, Loveman E, Kalita N, Frampton GK, Jones J. Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness. Health Technol Assess 2016; 19:1-176, v-vi. [PMID: 26502807 DOI: 10.3310/hta19860] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases. DATA SOURCES Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted. REVIEW METHODS Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses. RESULTS Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area. LIMITATIONS The application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported. CONCLUSIONS There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective. STUDY REGISTRATION This study is registered as PROSPERO CRD42014007426. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Emma Loveman
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Houle J, Lauzier-Jobin F, Beaulieu MD, Meunier S, Coulombe S, Côté J, Lespérance F, Chiasson JL, Bherer L, Lambert J. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis. BMJ Open Diabetes Res Care 2016; 4:e000184. [PMID: 27239316 PMCID: PMC4873951 DOI: 10.1136/bmjdrc-2015-000184] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/27/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control. METHODS A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES. RESULTS Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c. CONCLUSIONS To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.
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Affiliation(s)
- Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
- CRCHUM, Montréal, Québec, Canada
| | | | - Marie-Dominique Beaulieu
- CRCHUM, Montréal, Québec, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Simon Coulombe
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - José Côté
- CRCHUM, Montréal, Québec, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - François Lespérance
- CRCHUM, Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Louis Chiasson
- CRCHUM, Montréal, Québec, Canada
- Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Louis Bherer
- PERFORM Centre, Concordia University, Montréal, Québec, Canada
- Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Jean Lambert
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
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Holliday HV, Jenstad LM, Grosjean G, Purves B. "You Can Lead a Horse to Water …": Focus Group Perspectives on Initiating and Supporting Hearing Health Change in Older Adults. Am J Audiol 2015; 24:360-76. [PMID: 25812995 DOI: 10.1044/2015_aja-14-0073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/22/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. METHOD Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. RESULTS Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. CONCLUSION Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.
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Wong CKH, Wong WCW, Wan EYF, Wong WHT, Chan FWK, Lam CLK. Increased number of structured diabetes education attendance was not associated with the improvement in patient-reported health-related quality of life: results from Patient Empowerment Programme (PEP). Health Qual Life Outcomes 2015; 13:126. [PMID: 26264130 PMCID: PMC4533960 DOI: 10.1186/s12955-015-0324-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 08/05/2015] [Indexed: 12/21/2022] Open
Abstract
AIMS To assess the effect of a structured education intervention, Patient Empowerment Programme (PEP) patient-reported health-related quality of life (HRQOL) among type 2 diabetes mellitus (T2DM) patients, and if positive effect is confirmed, to further explore any association between frequency of sessions attendance and HRQOL. METHODS A total of 298 T2DM patients were recruited when they attended the first session of PEP, between March and September 2010, and were followed over a one-year period from baseline. HRQOL data were assessed using Short Form-12 Health Survey version 2 (SF-12) and Short Form-6 Dimension (SF-6D) at baseline and one-year follow-up. Individuals' anthropometric and biomedical data were extracted from an administrative database in Hong Kong. Unadjusted and adjusted analyses of linear regression models were performed to examine the impact of PEP session attendance on the change in the HRQOL scores, accounting for the socio-demographic and clinical characteristics at baseline. RESULTS Of the 298 eligible patients, 257 (86.2%) participated in the baseline assessment and 179 (60.1%) patients completed the follow-up assessment, respectively. Overall, PEP resulted in a significant improvement in SF-12 bodily pain and role emotional subscales and SF-6D utility scores. These positive changes were not associated with the level of participation as shown in both unadjusted and adjusted analyses. CONCLUSIONS The PEP made significant improvement in bodily pain, role emotional and overall aspects of HRQOL. Higher number of session attendance was not associated with improvement in HRQOL in primary care real-world setting. Key Messages ● Participants with type 2 diabetes mellitus who participated in structured diabetes education programme made significant improvement in bodily pain and role emotional subscales and SF-6D scores. ● There was no association between the number of sessions attended and any aspect of HRQOL.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong.
| | - William C W Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
| | - Eric Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
| | - Winnie H T Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
| | - Frank W K Chan
- Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Ap Lei Chau, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
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