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Zeidalkilani JM, Milhem YA, Shorafa RN, Taha S, Koni AA, Al-Jabi SW, Zyoud SH. Factors associated with patient activation among patients with diabetes on hemodialysis: a multicenter cross-sectional study from a developing country. BMC Nephrol 2024; 25:232. [PMID: 39033115 PMCID: PMC11265049 DOI: 10.1186/s12882-024-03674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 07/15/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients' quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM. METHODS This was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level. RESULTS Of the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis. CONCLUSIONS A higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.
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Affiliation(s)
- Jehad M Zeidalkilani
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Yazan A Milhem
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Reem N Shorafa
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sari Taha
- An-Najah Global Health Institute (GHI), An-Najah National University, Nablus, 44839, Palestine
- Department of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
- Department of Anatomy, Biochemistry and Genetics, An-Najah National University, Nablus, 44839, Palestine
| | - Amer A Koni
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine.
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Keriakos M, Lee S, Stannard C, Ariss S, Dunn L, Wilkie M, Fotheringham J. Supporting patient self-management: A cross-sectional and prospective cohort study investigating Patient Activation Measure (PAM) and Clinician Support for PAM scores as part of a multi-centre haemodialysis breakthrough series collaborative. PLoS One 2024; 19:e0303299. [PMID: 38776355 PMCID: PMC11111028 DOI: 10.1371/journal.pone.0303299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Patient self-management, measured by the Patient Activation Measure (PAM), is associated with reduced healthcare utilisation and better health-related quality of life. Self-management in haemodialysis (HD) is challenging and may require support from clinicians with positive attitudes towards self-management, measured by the Clinician Support for PAM (CSPAM). OBJECTIVES To assess whether kidney staff CSPAM scores are: 1) associated with their centre's patient PAM scores and 2) modifiable through staff coaching. METHODS Baseline PAM and CSPAM and six-month CSPAM were collected from HD patients and kidney staff respectively in seven UK kidney centres as part of a six-month breakthrough series collaborative (BTSC), which trained kidney staff in supporting patient independence with HD tasks. Firstly, multivariable linear regression analyses adjusted for patient characteristics were used to test the baseline association between centre-level staff CSPAM scores and patient PAM scores. Secondly, paired univariate and unpaired multivariable linear regression analyses were conducted to compare staff CSPAM scores at baseline and six months. RESULTS 236 PAM questionnaires (mean score = 55.5) and 89 CSPAM questionnaires (median score = 72.6) were analysed at baseline. There was no significant association between centre-level mean CSPAM scores and PAM scores in univariate analyses (P = 0.321). After adjusting for patient-level characteristics, increasing centre-level mean CSPAM score by 1 point resulted in a non-significant 0.3-point increase in PAM score (0.328 (95% CI: -0.157 to 0.812; P = 0.184). Paired (n = 37) and unpaired (n = 174) staff analyses showed a non-significant change in CSPAM scores following the BTSC intervention (mean change in CSPAM score in unpaired analysis = 1.339 (95% CI: -1.945 to 4.623; P = 0.422). CONCLUSIONS Lack of a significant: 1) association between CSPAM and PAM scores and 2) change in CSPAM scores suggest that modifying staff beliefs alone is less likely to influence patient self-management, requiring co-production between patients and staff.
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Affiliation(s)
- Maria Keriakos
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
| | - Sonia Lee
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | | | - Steven Ariss
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James Fotheringham
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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Okazawa Y, Kizaki H, Suzuki N, Osaka W, Hori S. Influence of Participation in a Medical-Themed Science Café on Patient Activation. Patient Prefer Adherence 2023; 17:3093-3106. [PMID: 38045110 PMCID: PMC10693243 DOI: 10.2147/ppa.s424460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study aims to investigate the impact of a Science Café (SC) dealing with medical topics on participants' patient activation (PA), a concept that refers to patients' involvement in managing their own health, working with their healthcare providers, and maintaining their health. Material and Methods Semi-structured interviews were conducted with patients who had participated in a medical SC (n = 10) to identify the medical SC-associated factors that influenced PA. Through a questionnaire of medical SC participants (n = 23), the impact on PA and correlations with relevant psychological measures were quantitatively assessed. Results The interviews revealed three factors: "Experience & acceptance of chronic conditions", "Features of medical SC" and "Changes as a result of participation." The questionnaire results showed a positive correlation between PA and resilience and a negative correlation with decision regret. Conclusions Participation in a medical SC by people with illnesses can improve PA by improving knowledge and skills for self-management and increasing self-awareness of illness in a supportive environment. The study highlights the potential benefits of using medical SC as a strategy for healthcare providers to improve PA and health outcomes.
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Affiliation(s)
- Yuta Okazawa
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
| | - Hayato Kizaki
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
| | | | - Wakako Osaka
- Keio University Faculty of Nursing and Medical Care, Tokyo, 160-8582, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, 105-8512, Japan
- Patient Salon Association, Tokyo, Japan
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