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Sequeira C, Coelho M, Costa Santos I, Ramos Lopes S, Teixeira C, Mangualde J, Cremers I, Oliveira AP. Knowledge in Inflammatory Bowel Disease: Translation to Portuguese, Validation, and Clinical Application of the IBD-KNOW Questionnaire. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:246-255. [PMID: 39022302 PMCID: PMC11250478 DOI: 10.1159/000530628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/14/2023] [Indexed: 07/20/2024]
Abstract
Background/Aims Inflammatory bowel disease (IBD)-related knowledge empowers patients, providing the development of adaptative coping strategies. Recently, a more comprehensive questionnaire for evaluating IBD-related knowledge was developed, the IBD-KNOW. The main aim of our study was to translate to Portuguese and validate the IBD-KNOW questionnaire. We also explored the predictors of high scores of disease-related knowledge and the effect of knowledge on health-related quality of life (HRQoL) and therapeutic adherence. Methods This is an observational, unicentric, and cross-sectional study. We translated and adapted the original English version of the IBD-KNOW questionnaire into Portuguese. Afterwards, IBD patients in the outpatient clinics were invited to fill out a multimodal form including the Portuguese version of IBD-KNOW, a visual analogue scale (VAS) of self-perceived knowledge, the Portuguese version of Short IBD Questionnaire (SIBDQ) and the Portuguese version of Morisky Adherence Scale 8-item (MMAS-8). Demographic and disease characteristics were collected. We assessed validity (through discriminate validity among non-IBD volunteers and correlation between IBD-KNOW and VAS) and reliability (through internal consistency, test-retest, and intraclass correlation). Statistical analysis was performed using SPSS version 25.0. Results The mean IBD-KNOW score was significantly different among non-IBD validation group (doctors: 23, nurses: 18, and non-medical volunteers: 12, p < 0.001). IBD-KNOW showed a high internal consistency (Cronbach's α 0.78) and intraclass correlation (0.90). As expected, the IBD-KNOW score was positively correlated with VAS for self-perceived knowledge (r = 0.45, p < 0.001). One hundred and one patients with IBD (54 with ulcerative colitis and 47 with Crohn's disease) completed the questionnaire at baseline. Multivariate analyses showed that a high IBD-KNOW score was associated with longer disease duration (OR: 2.59 [CI 1.11-5.74]; p = 0.04), previous hospitalization (OR: 3.63 [CI 1.301-9.96]; p = 0.01), current biologic treatment (OR: 3.37 [CI 1.31-8.65]; p = 0.02), and higher educational level (OR: 4.66 [CI 1.74-10.21]; p = 0.02). Moreover, there was no significant correlation between overall IBD-KNOW and SIBDQ, nor between IBD treatment adherence (MMAS-8 = 8) and a higher mean IBD-KNOW score (p = 0.552). Conclusion The Portuguese version of IBD-KNOW is a simple, valid, and reliable tool for assessing IBD-related knowledge. Longer disease duration, hospitalization, use of biologics, and higher educational level are associated with higher levels of knowledge. Higher patient knowledge was not associated with higher HRQoL and adherence to therapy.
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Affiliation(s)
- Cristiana Sequeira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Mariana Coelho
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Inês Costa Santos
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Sara Ramos Lopes
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cristina Teixeira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - João Mangualde
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Isabelle Cremers
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Paula Oliveira
- Gastroenterology Department, Centro Hospitalar de Setúbal, Setúbal, Portugal
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Barry JN, Moses JD, Kim SC. A Clinician's Guide To Effectively Transitioning and Transferring Care For Pediatric Patients With Inflammatory Bowel Diseases From The Pediatric To Adult Gastroenterologist. Curr Gastroenterol Rep 2024:10.1007/s11894-024-00936-6. [PMID: 39009946 DOI: 10.1007/s11894-024-00936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Transition of care for pediatric patients with inflammatory bowel diseases (IBD) is a continuous, dynamic process that takes place over several years with a coordinated approach executed by a multidisciplinary team. We review the concepts, tools, and research in effective transitioning and transfer of care for adolescent/young adult patients with IBD. RECENT FINDINGS Given the constraints within the healthcare system, effective transitioning can be challenging to implement in everyday clinical practice. Different barriers include resources and expertise in effective transitioning by pediatric and adult gastroenterology healthcare providers and the impact of non-gastrointestinal issues facing young adult patients who are learning to manage and coordinate all aspects of their medical care and health maintenance. Factors that facilitate successful care transitioning and transfer include structured transitioning programs, utilization of validated transition checklists, and IBD medical summaries. Proactive transitioning by pediatric gastroenterologists in partnership with their emerging young adult patients with IBD leads to better clinical and psychosocial outcomes and ultimately, effective transfer of care to adult gastroenterology. By utilizing utilize comprehensive transition assessment tools and medical summaries in partnership with their patients, pediatric and adult gastroenterology teams can better prepare patients as they transfer to independent care and health maintenance.
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Affiliation(s)
- Jessica N Barry
- Cleveland Clinic, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland, OH, USA
| | - Jonathan D Moses
- Stanford Medicine Children's Health Division of Gastroenterology, Hepatology, and Nutrition, Palo Alto, CA, USA
| | - Sandra C Kim
- Cleveland Clinic, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cleveland, OH, USA.
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Vernon-Roberts A, Chan P, Christensen B, Havrlant R, Giles E, Williams AJ. Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand. Inflamm Bowel Dis 2024:izae087. [PMID: 38701328 DOI: 10.1093/ibd/izae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The incidence of pediatric inflammatory bowel disease (IBD) is rising, and there is an increasing need to support adolescents when they transition to adult care. Evidence supports the use of a structured transition process but there is great variation across Australasia. The study aim was to develop evidence and expert opinion-based consensus statements to guide transitional care services in IBD. METHODS A modified UCLA-RAND methodology was employed to develop consensus statements. An IBD expert steering committee was formed and a systematic literature review was conducted to guide the drafting of consensus statements. A multidisciplinary group was formed comprising 16 participants (clinicians, nurses, surgeons, psychologists), who anonymously voted on the appropriateness and necessity of the consensus statements using Likert scales (1 = lowest, 9 = highest) with a median ≥7 required for inclusion. Patient support groups, including direct input from young people with IBD, informed the final recommendations. RESULTS Fourteen consensus statements were devised with key recommendations including use of a structured transition program and transition coordinator, mental health and transition readiness assessment, key adolescent discussion topics, allied health involvement, age for transition, and recommendations for clinical communication and handover, with individualized patient considerations. Each statement reached median ≥8 for appropriateness, and ≥7 for necessity, in the first voting round, and the results were discussed in an online meeting to refine statements. CONCLUSIONS A multidisciplinary group devised consensus statements to optimize pediatric to adult transitional care for adolescents with IBD. These guidelines should support improved and standardized delivery of IBD transitional care within Australasia.
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Affiliation(s)
| | - Patrick Chan
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rachael Havrlant
- Transition Care Network, Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Edward Giles
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Kuriakose Kuzhiyanjal AJ, Nigam GB, Antoniou GA, Farraye FA, Cross RK, Limdi JK. Management of Inflammatory Bowel Disease Using E-health Technologies: A Systematic Review and Meta-Analysis. J Crohns Colitis 2023; 17:1596-1613. [PMID: 37099723 PMCID: PMC10637047 DOI: 10.1093/ecco-jcc/jjad075] [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: 09/15/2022] [Indexed: 04/28/2023]
Abstract
BACKGROUND AND AIMS Technological advances have provided innovative, adaptive, and responsive models of care for inflammatory bowel diseases [IBD]. We conducted a systematic review to compare e-health interventions with standard care in management of IBD. METHODS We searched electronic databases for randomised, controlled trials [RCT] comparing e-health interventions with standard care for patients with IBD. Effect measures were standardised mean difference [SMD], odds ratio [OR], or rate ratio [RR], calculated using the inverse variance or Mantel-Haenszel statistical method and random-effects models. Version 2 of the Cochrane tool was used to assess the risk of bias. The certainty of evidence was appraised with the GRADE framework. RESULTS Fourteen RCTs [n = 3111; 1754 e-health and 1357 controls] were identified. The difference in disease activity scores (SMD 0.09, 95% confidence interval [CI]: -0.09-0.28) and clinical remission (odds ratio [OR] 1.12, 95% CI: 0.78-1.61) between e-health interventions and standard care were not statistically significant. Higher quality of life [QoL] [SMD 0.20, 95% CI: 0.05-0.35) and IBD knowledge [SMD 0.23, 95% CI: 0.10-0.36] scores were noted in the e-health group, and self-efficacy levels [SMD -0.09, 95% CI: -0.22-0.05] were comparable. E-health patients had fewer office [RR 0.85, 95% CI: 0.78-0.93] and emergency [RR 0.70, 95% CI: 0.51- 0.95] visits, with no statistically significant difference in endoscopic procedures, total health care encounters, corticosteroid use, and IBD related hospitalisation or surgery. The trials were judged to be at high risk of bias or to have some concerns for disease remission. The certainty of evidence was moderate or low. CONCLUSION E-health technologies may have a role in value-based care in IBD.
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Affiliation(s)
- Anish J Kuriakose Kuzhiyanjal
- Northern Care Alliance NHS Foundation Trust, Division of Gastroenterology-Section of IBD, Manchester, UK; and. Edgehill University, Ormskirk, UK
| | - Gaurav B Nigam
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; and Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, UK; and Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Francis A Farraye
- Mayo Clinic, Division of Gastroenterology and Hepatology, Jacksonville, FL, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, Division of Gastroenterology & Hepatology, Baltimore, MD, USA
| | - Jimmy K Limdi
- Northern Care Alliance NHS Foundation Trust, Division of Gastroenterology-Section of IBD, Manchester, UK; and Manchester Academic Health Sciences, University of Manchester, Manchester, UK
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Razima Wan Ibrahim N, Danaee M, Khoo XH, Sithambaram S, Shahrani S, Hwong-Ruey Leow A, Chang JV, Francis Mayberry J, Normiha Hilmi I. The development of a novel, multilingual IBD knowledge questionnaire for Asian patients with inflammatory bowel disease. BMC Gastroenterol 2023; 23:185. [PMID: 37231353 DOI: 10.1186/s12876-023-02817-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease is an uncommon disease in developing nations whereby patient's knowledge on the disease may be limited. The CCKNOW questionnaire, a widely known questionnaire to assess patient's knowledge on the disease, may be too complex to comprehend for patients in developing countries. The aim of this study is to develop a new tool known as AIBDKQ questionnaire to evaluate the local inflammatory bowel disease patient's knowledge. METHODS This was a prospective study carried out in four phases. In phase 1, three gastroenterologists with expertise in IBD generated a total of 21 questions related to the general knowledge of the disease in the English language. Phase 2 involved content and face validity whereby the questions were further validated by other gastroenterologists. In phase 3, the validated questions were translated into three languages namely Malay, Mandarin and Tamil which are commonly used in Malaysia. In phase 4 (statistical validity), administration of the questionnaires to patients and hospital staff were conducted to assess the construct validity, discriminative ability, predictive validity and reliability of the questionnaires. RESULTS A total of 21 questions were generated initially. Further evaluation indicated that 20 items had adequate kappa and content validity index for relevance (CVI: 0.714 to 1, Kapp: 0.645 to 1) and clarity (CVI: 0.714 to 1, Kapp: 0.645 to 1). The questionnaires in four languages were administered to 213 patients to assess the construct validity. Six items were removed (three for low communality, one for small loading factors, two for cross loading), resulting in 16 final questions. Assessment with 34 hospital staff involving nurses, doctors and clerks showed significant differences in knowledge between the groups (F = 14.007, p < 0.001) and were able to discriminate doctors from nurses and clerks. Another group of 18 hospital staff administered with AIBDKQ and CCKNOW questionnaires showed a Pearson's correlation coefficient of 0.8 indicating strong correlation and concurrent predictive validity between the two questionnaires. Final assessment with 38 patients for reliability assessment revealed high intraclass correlation of the questionnaire among the four languages. CONCLUSIONS The AIBDKQ has an excellent discriminant ability and internal consistency with a strong correlation when compared to the standard CCKNOW questionnaire.
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Affiliation(s)
- Nik Razima Wan Ibrahim
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia
| | - Mahmoud Danaee
- Department of Social Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Xin-Hui Khoo
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia
| | | | - Shahreedhan Shahrani
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia
| | - Alex Hwong-Ruey Leow
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia
| | - Jo-Ven Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia
| | | | - Ida Normiha Hilmi
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University Malaya, Lembah Pantai, Kuala Lumpur, 59100, Malaysia.
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Xie H, Zhang J, Liu C, Yang B, Dong W. Development and validation of a questionnaire to test Chinese patients' knowledge of inflammatory bowel disease. Sci Rep 2023; 13:7061. [PMID: 37121924 PMCID: PMC10149500 DOI: 10.1038/s41598-023-34286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023] Open
Abstract
A good understanding of a disease facilitates patient-centered management. We aimed to develop and validate a questionnaire to assess inflammatory bowel disease (IBD)-related knowledge and analyze the factors affecting patients' knowledge of IBD. We invited 15 experts to develop and modify an IBD knowledge questionnaires and 709 patients to test the reliability and validity of the questionnaires as well as analyze the factors related to the disease knowledge of patients with IBD. In internal consistency, Cronbach's α coefficients for the common items, ulcerative colitis (UC), and Crohn's disease (CD) knowledge questionnaires were 0.886, 0.89, and 0.886, respectively. In cross-item consistency, Spearman-Brown split coefficients of the common items, UC, and CD knowledge questionnaires were 0.843, 0.812, and 0.812, respectively. In time consistency, the test-retest reliability ICC was 0.862 (P < 0.001). The correlation between researcher scores, IBD-KNOW scores, and the original questionnaire scores was greater than 0.7 (P < 0.001). Multiple linear regression demonstrated that the factors, including disease type, age, body mass index, education level, income, treatment cost, duration of disease, and frequency of visits, affected the IBD patients' knowledge of the disease (P < 0.05). The IBD knowledge questionnaires had good reliability and validity and, therefore, can be used to assess patient knowledge of the disease.
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Affiliation(s)
- Huabing Xie
- Department of General Practice, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jixiang Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China
| | - Chuan Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China
| | - Bingxiang Yang
- Department of School of Nursing, Wuhan University, Wuhan, 430062, China
| | - Weiguo Dong
- Department of General Practice, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Jiefang Road 238, Wuhan, 430060, China.
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Leung T, Long M, Horst S, Afzali A, Sapir T, Fajardo K, De Felice K, Sandler R, Cross R. A Novel Remote Patient and Medication Monitoring Solution to Improve Adherence and Persistence With Inflammatory Bowel Disease Therapy (ASSIST Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40382. [PMID: 36520519 PMCID: PMC9801266 DOI: 10.2196/40382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Inflammatory bowel diseases (IBDs) are chronic inflammatory conditions of the gastrointestinal tract. Although adherence to IBD therapies is associated with improved clinical outcomes, overall adherence is poor. Consequently, there is a critical need to develop interventions that monitor adherence in real time and identify reasons for nonadherence to support clinical teams in initiating effective interventions. Recently, electronic- and web-based platforms have been developed to monitor adherence and guide interventions. A novel remote therapy monitoring (RTM) technology, the Tappt digital health system, has been developed to monitor real-time medication adherence patterns through smart label technologies, capture patient-reported outcomes and barriers to care, and process patient data through algorithms that trigger personalized digital and human touch points between clinical visits. Such a digital health solution enables care teams to proactively identify and mitigate nonadherence and worsening clinical outcomes. OBJECTIVE We propose a 12-month multicenter randomized controlled trial to assess the effectiveness of the Tappt digital health system on adherence, clinical outcomes, and health care use among patients diagnosed with IBD starting a new oral or subcutaneous therapy. METHODS The digital health system intervention will provide automatic measurement of medication adherence via smart labels for pill bottles or injectors as well as a monitoring platform for providers. The system will prompt patients to complete a two-item assessment of symptoms monthly using the PRO-2 scales for UC and Crohn disease, from which increased symptoms will be alerted to providers. Participants will be randomized 2:1 to the intervention group or the control group, which will receive standard of care. All participants are required to complete questionnaires at baseline as well as at 12, 26, and 52 weeks. Assuming an adherence rate of 0.65 and 0.9 among control and intervention participants, respectively, we will need to enroll 123 participants: 82 (66.7%) in the intervention group and 41 (33.3%) controls. We will compare adherence as measured by the medication possession ratio, defined as the number of days of supply of medication obtained during the observation period out of the total number of days in the observation period, in participants using the RTM versus those receiving standard of care. We will also compare clinical outcomes and health care use in participants using the RTM versus those receiving standard of care. RESULTS We anticipate starting recruitment in December 2022. CONCLUSIONS Effective medication adherence monitoring and intervention programs need to be cost-efficient, pose little or no burden to the patient, record reliable data in real time, and provide actionable insights to the health care team. We anticipate the Tappt digital health system to improve the medication possession ratio, clinical outcomes, and health care use compared with standard of care. TRIAL REGISTRATION ClinicalTrials.gov NCT05316584; https://clinicaltrials.gov/ct2/show/NCT05316584. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/40382.
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Affiliation(s)
| | - Millie Long
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Sara Horst
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Anita Afzali
- Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | | | - Kara De Felice
- Division of Gastroenterology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Robert Sandler
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Raymond Cross
- Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
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Laube R, Selinger C, Leong RW. Medication adherence in women with IBD of childbearing age likely associated with disease knowledge. Therap Adv Gastroenterol 2022; 15:17562848221144088. [PMID: 36545386 PMCID: PMC9761214 DOI: 10.1177/17562848221144088] [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: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence in inflammatory bowel disease (IBD) is crucial, particularly during pregnancy. Unplanned pregnancies are common; therefore, efforts to maximise adherence should not be restricted to pregnant women. OBJECTIVES We aimed to assess medication adherence in women with IBD of childbearing age, regardless of their reproduction plans. DESIGN We performed a multi-centre pilot questionnaire study of women with IBD age 18-45 years. METHODS Survey questions included patient demographics, disease history, and validated assessments of IBD and pregnancy knowledge, medication adherence and quality of life. The primary outcome was rates and predictors of medication adherence. RESULTS In all, 72 women [58.3% Crohn's disease (CD) and 37.5% ulcerative colitis] completed the survey. The median patient age was 30 years [interquartile range (IQR): 24.8-36.0) and 37.5% had children. Medication adherence was high (84%; median Medication Adherence Report Scale: 19.0/20; IQR: 17.0-20.0). Knowledge scores were adequate for both the Crohn's and Colitis Knowledge (CCKnow; median: 15.5/30; IQR: 12.3-18.0) and Crohn's and Colitis Pregnancy Knowledge (CCPKnow; median: 8.0/17; IQR: 4.0-11.0). Disease knowledge was predictive of high medication adherence (CCPKnow: p = 0.02; CCKnow: p ⩽ 0.01). Higher adherence was significantly associated with a diagnosis of CD (p = 0.01), exposure to biological agents (p = 0.03) and immunomodulators (p = 0.04), childbearing after diagnosis with IBD (p = 0.03), and correctly understanding the importance of delivery modality (p = 0.02) and IBD activity in pregnancy (p = 0.01). CONCLUSIONS Following dedicated education at the IBD clinic, medication adherence, disease-specific and pregnancy-specific knowledge in women with IBD of childbearing age tends to be high. Unplanned pregnancies are frequent; therefore, we should aim to maximise medication adherence in all women of childbearing age to optimise maternofoetal outcomes if unexpected pregnancies occur.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences,
Macquarie University, Sydney, NSW, Australia,Department of Gastroenterology, Macquarie
University Hospital, Sydney, NSW, Australia
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Wu Y, Huang L, Sun J, Wang H, Fang L, Miao J. Prevalence and predictors of medication non-adherence in children with inflammatory bowel disease in China: A cross-sectional study. Front Pharmacol 2022; 13:1062728. [DOI: 10.3389/fphar.2022.1062728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Non-adherence to physician-prescribed medications, especially oral medications, is common in children with inflammatory bowel disease (IBD), and medication non-adherence is associated with poorer outcomes in IBD. Therefore, understanding and improving medication adherence in children with IBD is critical for optimizing treatment and improving treatment outcomes. Despite the relatively high prevalence of IBD in children in China, to date, very little is known about medication adherence in these patients.Objective: The aim of this study was to investigate the prevalence of medication non-adherence and its risk factors in children with IBD in China to provide a basis for developing adherence improvement strategies.Methods: A cross-sectional design was employed. Children (aged <18 years) with IBD who visited the Children’s Hospital, Zhejiang University School of Medicine, from September 2020 to December 2021 were included. Data were collected by a general information questionnaire, the 4-item Medication Adherence Report Scale (MARS-4) and Crohn’s and Colitis Knowledge (CCKNOW) questionnaire. Subsequently, forward stepwise binary logistic regression analysis was performed to determine independent predictors of medication non-adherence.Results: A total of 119children were included in this study. The results showed that 33 (27.73%) and 86 (72.27%) children had poor and good medication adherence, respectively. Of these, 83 (69.75%) had forgotten to take their medications sometimes, often, or always. On binary logistic regression, we found that the incidence of medication non-adherence in children with IBD course of 3 years and above [OR 4.82 (95%CI: 1.47-15.88); p = 0.01] was significantly higher than that in children with course of 3 months to 1 year, whereas children with higher parental CCKNOW scores [OR 0.77 (95%CI: 0.67-0.88); p = 0.00] had significantly lower incidence of medication non-adherence than those with lower parental CCKNOW scores, and the results of the correlation between parental knowledge scores of the four categories and children’s medication adherence showed that drug knowledge scores (r = 0.36, p < 0.00) and complication knowledge scores (r = 0.24, p = 0.01) were positively correlated with medication adherence.Conclusion: Poor medication adherence in children with IBD in China was common, and forgetting to take medication was the main barrier. Longer disease duration (3 years and above) in children could act as a risk factor for medication adherence, whereas higher level of parental knowledge about IBD could act as a protective factor, and one interesting novel finding was that the level of parental knowledge about drug and complication were significantly correlated with medication adherence in children with IBD. Our results may inform on the design and implementation of medication adherence interventions for children with IBD.
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Sheldon EM, Lillington G, Simpson K, Gibson K, Chambers L, D'Afflitto M, Greig N, Stearn T, Hind D, Ainley R, Winsor G, Ridsdale K, Totton N, Lobo A. Development of an inflammatory bowel disease (IBD) Patient-Reported Experience Measure (PREM): A patient-led consensus work and 'think aloud' study for a quality improvement programme. Health Expect 2022; 26:213-225. [PMID: 36335578 PMCID: PMC9854292 DOI: 10.1111/hex.13647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patient-Reported Experience Measures (PREMs) are key in improving healthcare quality, but no PREM exists for inflammatory bowel disease (IBD). This study aimed to co-produce a PREM with IBD service users for IBD service evaluation and quality improvement programme. METHODS A pool of 75 items was drawn from published survey instruments covering interactions with services and aspects of living with IBD. In Stage 1, during two workshops, eight expert service users reduced candidate items through a ranked-choice voting exercise and suggested further items. During Stage 2, 18 previously uninvolved people with IBD assessed the face and content validity of the candidate items in 'Think Aloud' interviews. During two final workshops (Stage 3), the expert service users removed, modified and added items based on the interview findings to produce a final version of the PREM. RESULTS Stage 1 generated a draft working PREM mapped to the following four domains: Patient-Centred Care; Quality; Accessibility; Communication and Involvement. The PREM included a set of nine items created by the expert group which shifted the emphasis from 'self-management' to 'living with IBD'. Stage 2 interviews showed that comprehension of the PREM was very good, although there were concerns about the wording, IBD-relevance and ambiguity of some items. During the final two workshops in Stage 3, the expert service users removed 7 items, modified 15 items and added seven new ones based on the interview findings, resulting in a 38-item PREM. CONCLUSIONS This study demonstrates how extensive service user involvement can inform PREM development. PATIENT OR PUBLIC CONTRIBUTION Patients were involved as active members of the research team and as research participants to co-produce and validate a PREM for IBD services. In Stage 1, eight expert service users ('the expert group') reduced candidate items for the PREM through a voting exercise and suggested new items. During Stage 2, 18 previously uninvolved people with IBD (the 'think aloud' participants) assessed the validity of the candidate items in 'Think Aloud' interviews as research participants. In Stage 3, the expert group removed, changed and added items based on the interview findings to produce a final version of the 38-item PREM. This study shows how service user involvement can meaningfully inform PREM development.
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Affiliation(s)
- Elena M. Sheldon
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - George Lillington
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Kati Simpson
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Kirsty Gibson
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Lucy Chambers
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | | | - Nancy Greig
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Theresa Stearn
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Daniel Hind
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | | | | | - Katie Ridsdale
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Nikki Totton
- Sheffield Health and Related ResearchThe University of SheffieldSheffieldUK
| | - Alan Lobo
- Gastroenterology and Liver Unit, Royal Hallamshire HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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11
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Blunck D, Kastner L, Nissen M, Winkler J. The Effectiveness of Patient Training in Inflammatory Bowel Disease Knowledge via Instagram: Randomized Controlled Trial. J Med Internet Res 2022; 24:e36767. [PMID: 36260385 PMCID: PMC9631171 DOI: 10.2196/36767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Patients’ knowledge was found to be a key contributor to the success of therapy. Many efforts have been made to educate patients in their disease. However, research found that many patients still lack knowledge regarding their disease. Integrating patient education into social media platforms can bring materials closer to recipients. Objective The aim of this study is to test the effectiveness of patient education via Instagram. Methods A randomized controlled trial was conducted to test the effectiveness of patient education via Instagram among patients with inflammatory bowel disease. Participants were recruited online from the open Instagram page of a patient organization. The intervention group was educated via Instagram for 5 weeks by the research team; the control group did not receive any educational intervention. The knowledge about their disease was measured pre- and postintervention using the Inflammatory Bowel Disease Knowledge questionnaire. Data were analyzed by comparing mean knowledge scores and by regression analysis. The trial was purely web based. Results In total, 49 participants filled out both questionnaires. The intervention group included 25 participants, and the control group included 24 participants. The preintervention knowledge level of the intervention group was reflected as a score of 18.67 out of 24 points; this improved by 3 points to 21.67 postintervention. The postintervention difference between the control and intervention groups was 3.59 points and was statistically significant (t32.88=–4.56, 95% CI 1.98-5.19; P<.001). Results of the regression analysis, accounting for preintervention knowledge and group heterogeneity, indicated an increase of 3.33 points that was explained by the intervention (P<.001). Conclusions Patient education via Instagram is an effective way to increase disease-related knowledge. Future studies are needed to assess the effects in other conditions and to compare different means of patient education. Trial Registration German Clinical Trials Register DRKS00022935; https://tinyurl.com/bed4bzvh
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Affiliation(s)
- Dominik Blunck
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Lena Kastner
- Department of Health Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Michael Nissen
- Machine Learning and Data Analytics Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Buerkle KS, Vernon-Roberts A, Ho C, Schultz M, Day AS. A Short Knowledge Assessment Tool Is Valid and Acceptable for Adults with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:2049-2058. [PMID: 35511411 PMCID: PMC9068503 DOI: 10.1007/s10620-022-07507-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND For people with inflammatory bowel disease, validated knowledge questionnaires are valuable to identify gaps in understanding and explore the impact on disease variables. AIMS The aim of this study was to validate the short knowledge questionnaire Inflammatory Bowel Disease Knowledge Inventory Device 2, known as IBD-KID2, for use with adults with inflammatory bowel disease. METHODS Concurrent validity of IBD-KID2 was assessed by comparing scores with those achieved on the Crohn's and Colitis Knowledge Score (CCKNOW). IBD-KID2 reliability was assessed with test-retest completion at two time points, generalizability assessed by comparing IBD-KID2 cohort scores at different recruitment centres, and acceptability assessed using participant survey. RESULTS Seventy-five adults with inflammatory bowel disease completed the study. The mean percentage scores achieved on the IBD-KID2 and CCKNOW were 72.8% (SD 16.0) and 49.7% (SD 18.2), respectively. There was a significant correlation between IBD-KID2 and CCKNOW scores (R 0.573, P < 0.005), confirming concurrent validity. IBD-KID2 reliability was confirmed as no significant difference was seen between scores at test and retest (mean difference -0.2, P = 0.92). Generalizability was established as no significant score difference was seen between recruitment centres after controlling for population differences. The acceptability survey showed that 49 (69%) participants preferred IBD-KID2 to the CCKNOW, 60 (85%) found the IBD-KID2 easier to complete, and 38 (53%) considered the CCKNOW as most suitable for adults. CONCLUSIONS IBD-KID2 is a valid, reliable, and generalizable tool for measuring knowledge in adults with inflammatory bowel disease with good acceptability. IBD-KID2 is easy and quick to complete, hence limiting respondent burden.
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Affiliation(s)
- Katrin S. Buerkle
- Department of Medicine, University of Otago (Dunedin), PO Box 56, Dunedin, 9054 New Zealand
| | - Angharad Vernon-Roberts
- Department of Paediatrics, University of Otago (Christchurch), Riccarton Ave, Christchurch, 8011 New Zealand
| | - Christine Ho
- Gastroenterology Department, Southern District Health Board, Private Bag 1921, Dunedin, 9054 New Zealand
| | - Michael Schultz
- Department of Medicine, University of Otago (Dunedin), PO Box 56, Dunedin, 9054 New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago (Christchurch), Riccarton Ave, Christchurch, 8011 New Zealand
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13
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van Gaalen MAC, van Pieterson M, van den Brink G, de Ridder L, Rizopoulos D, van der Woude CJ, Escher JC. Rotterdam Transition Test: A Valid Tool for Monitoring Disease Knowledge in Adolescents With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2022; 74:60-67. [PMID: 34371508 DOI: 10.1097/mpg.0000000000003278] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Disease knowledge is important in adolescents with inflammatory bowel disease (IBD) transitioning to adult care. We developed an IBD-specific knowledge questionnaire, the Rotterdam Transition Test (RTT), and aimed to validate this tool. METHODS This is a prospective longitudinal validation study. The RTT has 25 open questions on IBD, medication, lifestyle, and transition to adult care. A scoring model was developed, and inter-rater agreement was assessed. Using a Rasch model, we determined the difficulty and performance of the questions. Cronbach alpha was used to demonstrate reliability. Patient factors (age, disease, education, medication use, illness acceptance, and independence) were correlated to RTT score. RESULTS A total of 207 RTTs were evaluated in 111 adolescent IBD patients. The scoring model showed a kappa score of >0.61 for all questions. Reliability with Cronbach alpha was good (0.81). Mean total result of the RTT was 58% (girls) and 55% (boys) of maximal score.The RTT discriminated well between the different levels of knowledge. Knowledge scores increased in patients who did repeated RTTs during the transition period. Male sex, low educational level, disease acceptance issues, and dependence on parents associated with a significantly lower total RTT score. Prednisone use within 3 months and treatment without biologics associated with significantly higher RTT scores. Disease activity was not a significant factor. CONCLUSIONS The RTT is a reliable and valid tool to assess IBD knowledge. The RTT can be used to detect and discuss knowledge gaps in adolescents with IBD transitioning to adult healthcare.
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Affiliation(s)
| | - Merel van Pieterson
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital
| | | | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital
| | | | | | - Johanna C Escher
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital
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14
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Ostromohov G, Fibelman M, Hirsch A, Ron Y, Cohen NA, Kariv R, Deutsch L, Kornblum J, Anbar R, Maharshak N, Fliss-Isakov N. Assessment of patients' understanding of inflammatory bowel diseases: Development and validation of a questionnaire. United European Gastroenterol J 2021; 10:104-114. [PMID: 34939350 PMCID: PMC8830304 DOI: 10.1002/ueg2.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background Educating patients regarding thier inflammatory bowel disease (IBD) is important for their empowerment and disease management. We aimed to develop a questionnaire to evaluate patient understanding and knowledge of IBD. Methods We have developed the Understanding IBD Questionnaires (U‐IBDQ), consisting of multiple‐choice questions in two versions [for Crohn's disease (CD) and ulcerative colitis (UC)]. The questionnaires were tested for content and face validity, readability, responsiveness and reliability. Convergent validity was assessed by correlating the U‐IBDQ score with physician's subjective assessment scores. Discriminant validity was assessed by comparison to healthy controls (HC), patients with chronic gastrointestinal (GI) conditions other than IBD, and to GI nurses. Multivariate analysis was performed to determine factors associated with a high level of disease understanding. Results The study population consisted of IBD patients (n = 106), HC (n = 35), chronic GI disease patients (n = 38) and GI nurses (n = 19). Mean U‐IBDQ score among IBD patients was 56.5 ± 21.9, similar for CD and UC patients (P = 0.941), but significantly higher than that of HC and chronic GI disease patients and lower than that of GI nurses (P < 0.001), supporting its discriminant validity. The U‐IBDQ score correlated with physician's subjective score (r = 0.747, P < 0.001) and was found to be reliable (intra‐class correlation coefficient = 0.867 P < 0.001). Independent factors associated with high U‐IBDQ scores included academic education (OR = 1.21, 95% CI 1.10–1.33, P < 0.001), biologic therapy experience (OR = 1.24, 95% CI 1.01–1.53, P = 0.046), and IBD diagnosis at <21 years of age (OR = 2.97, 95% CI 1.05–8.87, P = 0.050). Conclusions The U‐IBDQ is a validated, reliable and short, self‐reported questionnaire that can be used for assessing understanding of disease pathophysiology and treatment by IBD patients.
Established knowledge on this subject
Inflammatory bowel diseases (IBD) patients' beliefs and knowledge regarding their disease may affect disease management, quality of life and disease‐related psychological health. Therapy‐related disinformation is associated with low adherence to treatment. A standardized and validated tool for assessment of IBD patients' knowledge and understanding of their disease is lacking.
Significant findings of this study
We developed and meticulously validated the understanding of IBD questionnaire, a short questionnaire aimed at measuring understanding of disease pathophysiology and treatment of IBD. Inflammatory bowel diseases‐related knowledge was associated with education level and with younger age at IBD diagnosis.
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Affiliation(s)
| | - Morin Fibelman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine "A", Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayal Hirsch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yulia Ron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nathaniel Aviv Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Revital Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Liat Deutsch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jasmine Kornblum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ronit Anbar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Nutrition and Dietetics Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nitsan Maharshak
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Naomi Fliss-Isakov
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
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15
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Ewais T, Begun J, Kenny M, Hay K, Houldin E, Chuang KH, Tefay M, Kisely S. Mindfulness based cognitive therapy for youth with inflammatory bowel disease and depression - Findings from a pilot randomised controlled trial. J Psychosom Res 2021; 149:110594. [PMID: 34399198 DOI: 10.1016/j.jpsychores.2021.110594] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/21/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness-based cognitive therapy (MBCT) is a promising adjunctive treatment for adolescents and young adults (AYAs) with Inflammatory Bowel Disease (IBD) and comorbid depression. OBJECTIVES This pilot randomised controlled trial (RCT) aimed to evaluate feasibility and efficacy of an adapted MBCT program for AYA, aged 16-29, with IBD. METHODS Sixty-four AYAs were randomly allocated to MBCT (n = 33) or treatment as usual (TAU) (n = 31). Primary outcome measure was the depression score on Depression, Anxiety and Stress Scale. Secondary outcomes included anxiety, stress, IBD-related quality of life, coping, mindfulness, post-traumatic growth, medication adherence, IBD activity, inflammatory markers, microbiome characteristics and brain functional connectivity. RESULTS Study recruitment rate was 75%, retention rate 70%, and session attendance 92%. Intention to treat analyses revealed that, compared to TAU group, MBCT group had significantly lower depression (∆ = -6.0; 95%CI = -10.8 to -1.2; P = 0.015) and stress (∆ = -5.1; 95%CI = -10.1 to -0.0; P = 0.049), higher active coping (∆ = 1.0;95%CI = 0.1-1.9; P = 0.022), and total mindfulness scores (∆ = 10.9;95%CI = 1.1-20.8; P = 0.030) at 8 weeks (post-therapy), and improved coping by positive reframing (∆ = 1.1;95%CI = 0.0-2.2; P = 0.043) and planning (∆ = 0.9;95%CI = 0.0-1.9; P = 0.045), mindful awareness (∆ = 5.2.;95%CI = 2.0-8.5; P = 0.002) and total mindfulness scores (∆ = 10.8.;95%CI = 0.4-21.1; P = 0.042) at 20 weeks. On per protocol analysis, MBCT group had significantly lower depression (∆ = -6.3; 95%CI = -11.4 to -1.2; P = 0.015), stress (∆ = -6.0; 95%CI = -11.2 to -0.5; P = 0.032), increased active coping (∆ = 0.9;95%CI = 0-1.7; P = 0.05) at 8 weeks, and mindful awareness (∆ = 5.4; 95%CI = 2.1-8.6; P = 0.001) at 20 weeks. CONCLUSION In AYAs with IBD, MBCT is feasible and beneficial in improving depression, stress, mindfulness and adaptive coping. It holds promise as an important component of integrated IBD care. Trial registration number ACTRN12617000876392, U1111-1197-7370; Pre-results.
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Affiliation(s)
- T Ewais
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; School of Medicine, Griffith University, Gold Coast, Queensland 5005, Australia.
| | - J Begun
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Research Institute, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - M Kenny
- The University of Adelaide, Adelaide, South Australia 5005, Australia.
| | - K Hay
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Queensland 4006, Australia.
| | - Evan Houldin
- Queensland Brain Institute, St Lucia, Queensland 4072, Australia.
| | | | - M Tefay
- Mater Young Adult Health Centre, Mater Misericordiae Ltd, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - S Kisely
- School of Medicine, Mater Clinical School and Princess Alexandra Clinical School, Raymond Terrace, The University of Queensland, South Brisbane, Queensland 4101, Australia; Metro South Health Service, Wooloongabba, Queensland 4102, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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16
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Vernon-Roberts A, Lopez RN, Lewindon P, Lemberg DA, Bowcock NL, Alex G, Otley A, Jacobson K, Roberts AJ, Evans HM, Gearry RB, Day AS. Assessment of Disease-related Knowledge Among Children With Inflammatory Bowel Disease and their Family Using IBD-KID2: Evaluating Tool Generalizability. JPGN REPORTS 2021; 2:e093. [PMID: 37205959 PMCID: PMC10191511 DOI: 10.1097/pg9.0000000000000093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 05/21/2023]
Abstract
Children with inflammatory bowel disease (IBD) and their families benefit from improved knowledge of their disease and treatment. Knowledge levels of individual family members are infrequently studied but may identify where education is best directed. We aimed to assess disease-specific knowledge among children with IBD, parents, and siblings, using a validated assessment tool (IBD-KID2), and to establish generalizability of IBD-KID2. Methods Children with IBD and family members were recruited from tertiary IBD clinics in New Zealand, Australia, and Canada. All participants completed IBD-KID2 online at baseline, and the children with IBD again after 2 weeks to assess reliability. Results Participants included 130 children with IBD, 118 mothers, 55 fathers, and 37 siblings. Children with IBD had a mean score of 9.1 (SD 2.9) (maximum 15 points), significantly lower than parents (P < 0.005) and higher than siblings (P < 0.005). Scores of children with IBD were positively associated with current age (P < 0.005), age at diagnosis (P = 0.04) and fathers education level (P = 0.02). Significant score correlations were seen between children with IBD and their mother (P < 0.005) but not father. Sibling scores were not correlated with either parent. Test-retest reliability was high. The cohorts from each country were comparable, and no difference in group scores was seen between countries. Conclusion IBD-KID2 is a generalizable and reliable tool for the assessment of disease and treatment knowledge for children with IBD and their families. Score correlations between parents and children with IBD suggest transfer of knowledge, but sibling knowledge is low and targeted education may be beneficial.
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Affiliation(s)
- Angharad Vernon-Roberts
- From the Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
| | - Robert N Lopez
- Department of Paediatric Gastroenterology, Queensland Children's Hospital, Brisbane, Australia
| | - Peter Lewindon
- Department of Paediatric Gastroenterology, Queensland Children's Hospital, Brisbane, Australia
| | - Daniel A Lemberg
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Australia
| | - Nerissa L Bowcock
- Department of Paediatric Gastroenterology, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - George Alex
- Department of Paediatric Gastroenterology, Royal Children's Hospital, Melbourne, Australia
| | - Anthony Otley
- Department of Pediatrics, Dalhousie University, Nova Scotia, Canada
| | - Kevan Jacobson
- Department of Paediatric Gastroenterology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Amin J Roberts
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Helen M Evans
- Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago (Christchurch), Christchurch, New Zealand
| | - Andrew S Day
- From the Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
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Rodriguez A, Douphrate DI, de Porras DGR, Perez A, Hagevoort R, Nonnenmann M, Cienega L. Association of Category of Cattle Exposure with Tuberculosis Knowledge among Dairy Workers in Bailey County, Texas. J Agromedicine 2021; 26:313-322. [PMID: 32449645 PMCID: PMC7928191 DOI: 10.1080/1059924x.2020.1765931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: To determine the knowledge of tuberculosis (TB) among dairy workers in Bailey County, Texas. Methods: A cross-sectional study design was used to collect 225 survey responses concerning knowledge of TB among dairy workers on 10 dairy farms in Bailey County, Texas. Subjects used iPad tablets to log responses to 15 demographic questions and a 17-item TB knowledge quiz, measured by: (1) TB characteristics, (2) TB transmission, (3) TB symptoms, (4) TB diagnosis, (5) TB treatment, and (6) bovine TB. A proxy for exposure, dairy workers were classified into categories of cattle exposure - high, medium, and low. Results: Relative to the medium/low group, workers in the high group tended to be younger (32.6 (SD 11.0)), Guatemalan (52.6%), K'iche' speaking (37.8%), males (89.1%) with less years living in the U.S. (10.8 [SD 12.5]) and lower levels of formal education completed (59.6% with no formal/elementary level). Overall, the average score was 7.1 (SD 4.9) out of 17 (41.8% out of 100.0%). Relative to one another, the medium/low group (8.0 (SD 4.6) out of 17) scored better than the high group (6.7 [SD 5.1] out of 17). No significant associations were found between the category of exposure and TB knowledge score. Conclusion: Deficiencies in TB knowledge were identified in all categories of exposure. TB training on dairy farms should include all measured tested in this study and should be administered to all workers regardless of the category of exposure.
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Affiliation(s)
- Anabel Rodriguez
- University of Texas Health Science Center at Houston, School of Public Health in San Antonio, Texas USA, Department of Epidemiology, Human Genetics & Environmental Sciences, 7411 John Smith Drive, Suite 1100, San Antonio, Texas 78229
| | - David I. Douphrate
- University of Texas Health Science Center at Houston, School of Public Health in San Antonio, Texas USA, Department of Epidemiology, Human Genetics & Environmental Sciences, 7411 John Smith Drive, Suite 1100, San Antonio, Texas 78229
| | - David Gimeno Ruiz de Porras
- University of Texas Health Science Center at Houston, School of Public Health in San Antonio, Texas USA, Department of Epidemiology, Human Genetics & Environmental Sciences, 7411 John Smith Drive, Suite 1100, San Antonio, Texas 78229
| | - Adriana Perez
- University of Texas Health Science Center at Houston, School of Public Health in Austin, Department of Biostatistics and Data Science, 1616 Guadalupe Street, Suite 6.340, Austin, Texas 78701
| | - Robert Hagevoort
- New Mexico State University, College of Agricultural, Consumer, and Environmental Sciences, Department of Agricultural Science Center at Clovis, 2346 State Road 288, Clovis, New Mexico 88101
| | - Matthew Nonnenmann
- The University of Iowa, College of Public Health, Department of Occupational and Environmental Health, 145 N. Riverside Drive, 100 CPHB, Iowa City, Iowa 52242
| | - Leeroy Cienega
- Los Alamos National Laboratory, Department of Industrial Hygiene and Safety, P.O. Box 1663, Los Alamos, New Mexico 87545
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19
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Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Crooks B, McLaughlin J, Matsuoka K, Kobayashi T, Yamazaki H, Limdi JK. The dietary practices and beliefs of people living with inactive ulcerative colitis. Eur J Gastroenterol Hepatol 2021; 33:372-379. [PMID: 32956176 DOI: 10.1097/meg.0000000000001911] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Diet is implicated in the aetiopathogenesis of inflammatory bowel disease (IBD) and in generating symptoms. Few studies have explored dietary practices in people with IBD, in which participants perceived strong links between diet in triggering flares and maintaining remission. Fewer studies have explored dietary habits in self-reported remission. Our aim was to describe dietary practices and beliefs in those with inactive ulcerative colitis. METHODS A questionnaire was developed and prospectively administered to 208 participants with inactive ulcerative colitis attending IBD clinics. RESULTS Thirty-one percent believed diet was the initiating factor for ulcerative colitis with 37% believing diet could trigger relapse. Fifty-nine percent avoided dietary items to prevent relapse. Most frequently avoided were spicy (43%) and fatty (38%) foods, alcohol (27%), carbonated drinks (26%), coffee (24%) and milk products (21%). Females were more likely to practice dietary avoidance (P = 0.007). Twenty-three percent had used exclusion diets, most commonly gluten- or lactose-free. Those reporting relapse in the previous year were more likely to avoid the same menu as their family (P = 0.01) and females were less likely to eat out in order to prevent relapse (P = 0.004). Information resources guiding food avoidance included participants' own experiences (90%), healthcare professionals' advice (19%) and the internet (11%). CONCLUSION People with inactive ulcerative colitis hold dietary beliefs and display practices with a high level of consistency around perceived triggers. Food avoidance whilst in remission raises the possibility of visceral hypersensitivity or altered physiology alongside psychosocial, neurocognitive or co-existing functional factors.
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Affiliation(s)
- Benjamin Crooks
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Stott Lane, Salford
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Stott Lane, Salford
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jimmy K Limdi
- Division of Diabetes, Endocrinology & Gastroenterology, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester
- Section of IBD - Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Metropolitan University, Manchester, UK
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21
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Gray WN, Wagoner ST, Schaefer MR, Reed B, Morgan P, Holbrook E, Yacyshyn B, Mackner L, Young M, Maddux M, Saeed SA, Denson LA, Hommel K. Transition to Adult IBD Care: A Pilot Multi-Site, Telehealth Hybrid Intervention. J Pediatr Psychol 2021; 46:1-11. [PMID: 33236097 DOI: 10.1093/jpepsy/jsaa088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Transition to adult IBD care continues to be a challenge. Efficacious models of improving transition to adult care in the United States are lacking. We present data from a pilot, prospective, non-randomized, intervention implemented at IBD centers in the Midwest and Southeast United States. DESIGN AND METHODS Adolescents and young adults (AYAs; 16-20 years) with IBD and their parents completed a 4- to 5-month transition program (1 in-person group session; 4 individual telehealth sessions). Primary outcomes were feasibility (i.e., recruitment, retention, fidelity) and acceptability (i.e., program satisfaction). Secondary outcomes were changes in transition readiness, self-management skill acquisition, perceived readiness to transfer to adult care, and disease knowledge. RESULTS The study exceeded goals for recruitment (target N = 20; actual: 36) and retention (target: 80%; actual: 86.11%). On average, it took participants 20.91 ± 3.15 weeks to complete our 4- to 5-month intervention and there were no deviations from the study protocol. Participant ratings for overall program satisfaction, perceived helpfulness, and program length and format were positive. Increases in transition readiness, t(30) = 8.30, d = 1.49, p < .001, self-management skill acquisition, t(30) = 3.93, d = 0.70, p < .001, and disease knowledge, t(30) = 8.20, d = 1.58, p < .001 were noted. AYA- and parent-perceived transfer readiness also improved (p's < .05; d's = 0.76-1.68). CONCLUSIONS This article presents feasibility and acceptability data for a 4- to 5-month transition intervention. Improvements in AYA transition readiness, self-management skill acquisition, IBD knowledge, and AYA/parent perceived transfer readiness were also observed.
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Affiliation(s)
- Wendy N Gray
- Department of Psychology, Auburn University.,Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Bonney Reed
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine
| | - Pamela Morgan
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Erin Holbrook
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Bruce Yacyshyn
- Department of Internal Medicine, University of Cincinnati College of Medicine
| | - Laura Mackner
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Department of Pediatrics, Center for Biobehavioral Health, The Ohio State University
| | | | - Michele Maddux
- Division of Developmental and Behavioral Sciences/Division of Gastroenterology, Department of Pediatrics, Children's Mercy-Kansas City, University of Missouri-Kansas City School of Medicine
| | - Shehzad A Saeed
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Lee A Denson
- Department of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center
| | - Kevin Hommel
- Department of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
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22
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Disease-Related Knowledge in New Zealand Children with Inflammatory Bowel Disease (IBD) and Their Parents. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Insufficient disease-related knowledge can be a barrier to the effective management of the unpredictable and lifelong course of inflammatory bowel disease (IBD). Patients with chronic illnesses have high non-adherence rates, with direct clinical consequences. While no single intervention strategy can improve the adherence of all patients, the success of attempts to improve patient adherence depends upon the realistic assessment of patients’ knowledge and their understanding of the regimen. The aim of this study was to assess the disease-specific knowledge of the parents and patients with IBD in the South Island of New Zealand, and identify areas of poor knowledge. Families of children diagnosed with IBD were asked to complete the IBD Knowledge Inventory Device (IBD-KID). Patients 10 years and older were asked to participate along with their parents. Of 110 families, 91 responded, with completed questionnaires received from 153 parents and 66 patients. Overall, parents scored significantly higher (13.64 ± 3.88) than their children (10.03 ± 4.07; p < 0.001). Areas of poor knowledge included aspects of treatment (both conventional and alternative), along with long-term disease outcomes. This study has shown clear areas of concern in this population’s disease-specific knowledge of their disease. This should be addressed through targeted education for both the patient and the parents to improve not only their knowledge, but also their adherence and disease self-management.
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23
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Vernon-Roberts A, Gearry RB, Day AS. The Level of Public Knowledge about Inflammatory Bowel Disease in Christchurch, New Zealand. Inflamm Intest Dis 2020; 5:205-211. [PMID: 33313073 DOI: 10.1159/000510071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction There is a high degree of perceived stigma among adults with inflammatory bowel disease (IBD), with up to 84% considering a social stereotype against them due to their condition. This may negatively impact their treatment adherence and quality of life, as well as practical issues such as gaining urgent access to public bathroom facilities. It has been demonstrated that higher public knowledge levels can reduce public stigma, yet little is known about the general level of understanding of IBD in the community. A study was performed to ascertain the public knowledge levels of IBD in Christchurch, New Zealand, using a validated assessment tool. Objectives The aims of this study were to implement a validated knowledge survey (IBD-KID2) among members of the general public in Christchurch, New Zealand, and to assess the level of understanding about IBD. Methods Recruitment took place at a Health Research and Education showcase event at the University of Otago (Christchurch), which is a free event open to members of the public. All people over the age of 8 years were invited to participate. Demographic information was collected and the disease-specific knowledge assessment survey IBD-KID2 completed by all participants consenting to the research. Results One hundred people consented to the study, and the mean age 39.9 was years (SD 20, range 12-82 years). Of these 100 participants, 71 were female and 71 had a post-secondary education. Twelve participants had a family history of IBD. The mean IBD-KID2 score was 8.7 (SD 2.9), equal to a percentage total score of 58%. No independent variable was found to be significantly associated with IBD-KID2 scores. The frequency of correct answers showed knowledge deficiencies in the areas of nutrition, treatment, growth, and the cause of IBD. Conclusions This study highlighted knowledge deficiencies among members of the general public in Christchurch, New Zealand. These topics may be addressed with awareness campaigns in order to maximise community support for adults and children with IBD.
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Affiliation(s)
| | - Richard B Gearry
- Department of Medicine, University of Otago (Christchurch), Christchurch, New Zealand
| | - Andrew S Day
- Department of Pediatrics, University of Otago (Christchurch), Christchurch, New Zealand
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24
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Comparison of Disease-related Knowledge of Patients With Inflammatory Bowel Disease Between the West and the East Using an Updated Questionnaire (IBD-KNOW). J Clin Gastroenterol 2020; 54:720-724. [PMID: 31764490 DOI: 10.1097/mcg.0000000000001283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
GOALS The study aimed to compare the level and characteristics of disease-related knowledge of patients with inflammatory bowel disease (IBD) between the West and the East using an international version of a questionnaire regarding knowledge of inflammatory bowel disease (IBD-KNOW). BACKGROUND The authors recently developed a new questionnaire regarding IBD-KNOW, which showed excellent test characteristics in Korea. STUDY The IBD-KNOW questionnaire was administered to 100 patients with IBD from tertiary referral hospitals in the United States and Korea. Scores were calculated and compared between US and Korean patients, and factors associated with high scores were analyzed. RESULTS A total of 196 (100 US and 96 Korean) patients with IBD completed the questionnaires. Analysis of the baseline characteristics revealed that male sex, smoking status, disease duration, history of IBD-related operations, family history of IBD, and use of corticosteroids or biologics were significantly different between US and Korean patients. The mean IBD-KNOW score was higher in US patients than in Korean patients (14.8 vs. 11.3; P<0.001). Multivariate analyses showed that a high IBD-KNOW score (top 25%) was associated with a positive family history of IBD (odds ratio, 2.90; P=0.025) in US patients with IBD and with the use of biologics (odds ratio, 3.65; P=0.008) in Korean patients with IBD. CONCLUSIONS The IBD-KNOW questionnaire, an updated assessment tool of IBD-related knowledge, is simple, reliable, and available in various patient populations. IBD-KNOW can be used to identify the factors affecting the level of IBD-related knowledge to improve the quality of care in patients with IBD through a personalized approach.
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25
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Vernon-Roberts A, Gearry RB, Day AS. Assessment of Knowledge Levels Following an Education Program for Parents of Children With Inflammatory Bowel Disease. Front Pediatr 2020; 8:475. [PMID: 32903635 PMCID: PMC7438864 DOI: 10.3389/fped.2020.00475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/07/2020] [Indexed: 01/22/2023] Open
Abstract
Children with inflammatory bowel disease (IBD) and their parents have increasing roles in disease management and require sufficient, appropriate information for communication with their clinical team. Formal education is effective at improving disease knowledge, disease outcomes, and mental health, yet few interventions have been targeted for parents of children with IBD. A two day parent education program was held at the annual residential camp for children with IBD in New Zealand with knowledge levels tested pre and post intervention using a validated assessment tool: IBD-KID2. Thirty parents consented, 25 completed the study, 70% were female and 83% had a child with Crohn's disease. The pre-intervention mean score (maximum fifteen) was 10.6 (SD 2.9), with no associations with independent variables. Knowledge levels increased significantly following the education program to a mean 12.6 (SD 2.0) (p < 0.005). Disease specific knowledge may improve outcomes and should, therefore, be reinforced during clinic encounters, and regarded as an ongoing endeavor.
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Affiliation(s)
| | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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26
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Park J, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Higher levels of disease-related knowledge reduce medical acceleration in patients with inflammatory bowel disease. PLoS One 2020; 15:e0233654. [PMID: 32502199 PMCID: PMC7274391 DOI: 10.1371/journal.pone.0233654] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background and aims The disease-related knowledge levels in patients with inflammatory bowel disease (IBD) are important because it could affect the self-management ability and adaptive coping strategies. We set out to determine whether higher levels of disease-related knowledge reduce medical acceleration. Methods We evaluated the levels of disease-related knowledge in all patients at the time of enrollment for SNUBH IBD cohort using the validated IBD-KNOW questionnaire. Clinical data were prospectively collected and the factors related to step-up therapy were analyzed. Step-up therapy was defined as the new use of corticosteroids, immunomodulators, or biologics after the enrollment. Results Between April 2017 and January 2019, 298 patients were enrolled (mean age, 39.8 years; males, 69.5%); 193 patients (64.8%) had ulcerative colitis and 105 (35.2%) had Crohn’s disease. The mean disease duration was 35.8 months. During the mean follow-up of 14.7 months, 90 patients (30.2%) underwent step-up therapy and 208 (69.8%) underwent continuous therapy. The prevalence of continuous therapy increased with increasing IBD-KNOW scores (p for trend = 0.019). Cox proportional hazards analysis revealed that high IBD-KNOW scores (≥ 16) (hazards ratio [HR]: 0.498, 95% confidence interval [CI]: 0.276–0.897, p = 0.020) was negatively associated with the step-up therapy. Conclusions Higher disease-related knowledge could reduce the requirement of step-up therapy in IBD. The IBD-KNOW score was independently predictive of step-up therapy.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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Lopez RN, McCombie A, Gearry RB, Day AS. Impact of a Camp upon Disease-Specific Knowledge and Quality of Life in Children and Adolescents with Inflammatory Bowel Disease. Inflamm Intest Dis 2020; 5:65-69. [PMID: 32596256 DOI: 10.1159/000505918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 01/14/2020] [Indexed: 01/01/2023] Open
Abstract
Children with inflammatory bowel disease (IBD) who attend residential camps derive various psycho-social benefits from their attendance. This study evaluated the impact of camp attendance on participants' disease-specific knowledge and quality of life (QOL). Prior to attending a dedicated camp for children with IBD, all campers were contacted and asked to participate in an evaluation of outcomes. Campers were asked to complete questionnaires regarding background disease status, demographic information, disease-specific knowledge (Inflammatory Bowel Disease Knowledge Inventory Device [IBD-KID]) and QOL (IMPACT-III). Assessments were completed before the camp and then again 1 month and 6 months after the camp. The camp consisted of adventure-based experiences and did not include specific IBD-related educational activities. Thirty-nine of 44 campers provided baseline information. The responders comprised 21 boys, and the median age was 14 years. Most (n = 35) were diagnosed with Crohn's disease. Twenty-five of the baseline responders were in clinical remission. Mean IBD-KID scores increased from baseline at both 1 month and 6 months (p = 0.03 and p = 0.04, respectively). Although mean QOL scores did not increase after 1 or 6 months, body image sub-scores were increased at 6 months (p = 0.015). Children and adolescents with IBD attending this residential camp demonstrated enhanced disease-specific knowledge following the camp, which was maintained 6 months following the camp. QOL scores were not increased overall at either time point. These results demonstrate a further benefit of residential camps for children and adolescents with IBD.
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Affiliation(s)
- Robert N Lopez
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Andrew McCombie
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Andrew S Day
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
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28
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Vernon-Roberts A, Otley A, Frampton C, Gearry RB, Day AS. Validation of a Revised Knowledge Assessment Tool for Children with Inflammatory Bowel Disease (IBD-KID2). Inflamm Intest Dis 2020; 5:70-77. [PMID: 32596257 DOI: 10.1159/000506200] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/24/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction For children with inflammatory bowel disease (IBD), acquired knowledge of their condition and treatment is integral to their adherence and self-management. Assessing their knowledge is vital to identify deficits that may affect disease management. IBD-KID2 is a knowledge assessment tool written for children aged 8 years and over with IBD. Objectives In order to examine validity and reliability, a study was carried out using IBD-KID2 in a paediatric IBD population and a number of comparator groups with established levels of IBD knowledge. Methods IBD-KID2 was administered to 4 participant groups in Christchurch Hospital, New Zealand: children with IBD (n = 22), children without IBD (n = 20), medical staff (n = 15), and administration staff (n = 15). Between-group differences were tested using ANOVA and pairwise comparisons made with the IBD group. Repeat assessments by the IBD group determined test-retest reliability (n = 21). Results The mean age (range) of the paediatric groups were: IBD 13.3 years (8-18), without IBD 11.9 years (8-15). Group mean scores (SD) were: IBD 8.5 (±2.3), without IBD 3.7 (±2.2), medical staff 13.5 (±1.3), administration staff 6.3 (±2.5). Group means were all significantly different to the IBD group. Test-retest mean at baseline (8.4, CI ±2.4) and repeat (9.0, CI ±2.4) were not significant. Intraclass correlation coefficient was 0.82. Internal reliability was 0.85, and item-total statistics showed no improvement by specific item removal. Conclusions IBD-KID2 could distinguish between groups with different knowledge levels. Repeat assessment shows comparable scores on retest and good reproducibility. IBD-KID2 is a valid and reliable tool for use in the paediatric IBD population.
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Affiliation(s)
| | - Anthony Otley
- Dalhousie University Department of Pediatrics, Halifax, Nova Scotia, Canada
| | - Chris Frampton
- University of Otago (Christchurch), Department of Medicine, Christchurch, New Zealand
| | - Richard B Gearry
- University of Otago (Christchurch), Department of Medicine, Christchurch, New Zealand
| | - Andrew S Day
- University of Otago (Christchurch), Department of Pediatrics, Christchurch, New Zealand
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29
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Erős A, Soós A, Hegyi P, Szakács Z, Erőss B, Párniczky A, Mezősi E, Rumbus Z, Sarlós P. Spotlight on Transition in Patients With Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis 2020; 26:331-346. [PMID: 31504524 DOI: 10.1093/ibd/izz173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transition of adolescents from pediatric to adult care is of great importance in the management of inflammatory bowel disease (IBD). Our aim was to review and summarize the currently applied interventions and outcomes related to transition practices in IBD. METHODS A systematic review was performed in accordance with the PRISMA Statement. We searched PubMed, EMBASE, CENTRAL, and Web of Science databases up to February 15, 2019. Controlled studies evaluating adolescents and young adults with IBD participating in structured transition interventions or patient educational programs and single-arm (before-after) studies were included. Several individual, health care, and social outcomes were assessed. The PROSPERO registration number is CRD42019118520. RESULTS A total of 23 articles were eligible for qualitative synthesis. Eleven studies compared an intervention to a control group, whilst 12 studies were uncontrolled before-after studies. The age of the participants varied from 11 to 25 years. The most common structured transition interventions were joint visits and patient education programs. IBD nurses were operating as nominated transition coordinators in the transition process. Quality of life, patient satisfaction, self-efficacy, disease-specific knowledge, adherence rate, and nonattendance rate at outpatient clinic were identified as main health care transition outcomes besides disease-related outcomes. Despite the various study designs and methodological limitations, outcomes improved with the application of structured transition interventions in eleven of the studies. CONCLUSION These results facilitate the design of randomized controlled trials along better standards in transitional care in IBD.
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Affiliation(s)
- Adrienn Erős
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Hungarian Academy of Sciences-University of Szeged Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary.,First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál Children's Hospital, Budapest, Hungary
| | - Emese Mezősi
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Patricia Sarlós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
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30
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Tan B, Ong D. Pediatric to adult inflammatory bowel disease transition: the Asian experience. Intest Res 2020; 18:11-17. [PMID: 32013311 PMCID: PMC7000639 DOI: 10.5217/ir.2019.09144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 12/21/2022] Open
Abstract
Many tertiary inflammatory bowel disease (IBD) centers recognize that a structured transition program is fundamental for an IBD unit. However, the path to ensuring a seamless transition for all stakeholders is often fraught with challenges. In this review, we go through current evidence, identify the requirementsof a successful transition program, and the barriers to seamless transfer. We also aim to shed light on differences in needs between the Western and Asian adolescent IBD populations. Majority of healthcare providers viewed having a structured transition program to be very important. The lack of a standard protocol led us to come up with a list of requirements ofa successful program. These include: multidisciplinary team meetings, alternating visits between the adultand pediatric clinics, proper documentation of records, and determining the ideal timing for transfer. The difficulties forthe Asian adolescent IBD population may be attributed to the reliance on parental support to make decisions regarding medicaltreatment. Lastly, there are various physician, patient and disease factors which are barriers to seamless transition. These includethe lack of proper documentation, and lack of patient self-efficacy. We also propose a standardized template for documentation of medical records for IBD patients.
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Affiliation(s)
- Bernice Tan
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - David Ong
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
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31
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Bilgrami Z, Abutaleb A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy. Dig Dis Sci 2020; 65:96-103. [PMID: 30604373 PMCID: PMC7883399 DOI: 10.1007/s10620-018-5433-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. METHODS We assessed change in patient activation and general self-efficacy from baseline to 12 months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2 years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). RESULTS Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). CONCLUSIONS Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.
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Affiliation(s)
- Zaid Bilgrami
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Ameer Abutaleb
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Kenechukwu Chudy-Onwugaje
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Patricia Langenberg
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - J Kathleen Tracy
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Seema A Patil
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Sandra M Quezada
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Katharine M Russman
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | - Charlene C Quinn
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA
| | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Raymond K Cross
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 8-00, Baltimore, MD, 21201, USA.
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Cousin C, Bevilacqua C, Roman C, Roquelaure B, Loundou A, Baumstarck K, Fabre A. MICI-MINOTS: Linguistic and metric validation of a pediatric questionnaire on knowledge about inflammatory bowel disease. Arch Pediatr 2019; 27:110-116. [PMID: 31796231 DOI: 10.1016/j.arcped.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/23/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Therapeutic education is an essential part of the treatment of chronic diseases, such as inflammatory bowel disease (IBD). The IBD-KID, developed in Canada in English, assesses children's and adolescents' acquired knowledge about their condition and has been validated in Canadian and Australian populations. However, there is no pediatric questionnaire in French to assess patients' knowledge about IBD. OBJECTIVE To report the linguistic validation process and metric validity of the MICI-MINOTS, the French version of the IBD-KID. METHOD The translation process consisted of three consecutive steps: forward-backward translation, acceptability testing, and cognitive interviews. The IBD-KID consists of 23 questions, but a 24th question about immunomodulatory therapy was added in the MICI-MINOTS. Psychometric testing was conducted with five groups: children with IBD, their parents, children in a control group, their parents, and health workers recruited from the Timone Pediatric Hospital and the Saint-Sébastien Maternal and Child Protection Center, Marseille, France. A total of 15 individuals completed the tool twice, with a 15-day interval. Internal consistency, reliability, external validity, reproducibility, and sensitivity to change were tested. RESULTS A total of 38 children with IBD (sex: 20 boys, 18 girls; age: 13.90 [±2.88] years; 25 with Crohn's disease), 20 children in the control group, 58 parents (every child was included with one parent), and 62 health workers were included in the analysis. Intraclass correlation was 0.94 (95% confidence interval 0.83-0.98) for test-retest assessment. Readability using the Scolarius score corresponded to elementary school level. Among the children with IBD, 89.5% answered all 24 questions. For 23 questions, the mean score of children with IBD was higher than among children in the control group: 9.58 (±3.01) versus 5.47 (±3.56), respectively (P<0.01). Parents of children with IBD scored higher than parents of children in the control group: 10.63 (±3.16) versus 8.4 (±3.07), respectively (P=0.012). In the health workers' group, pediatric residents (17.82±3.46) scored higher than nurses 11.75 (±3.4) and ward clerks (8.67±2.40; P<0.01). Patients' knowledge score was significantly related to their parents' knowledge score (r=0.402, P=0.012) for 23 questions. CONCLUSION The French version of the IBD-KID showed satisfactory psychometric properties to assess knowledge about the disease in French-speaking children.
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Affiliation(s)
- C Cousin
- Service de pédiatrie multidisciplinaire, Timone Pediatric Hospital, 13385 Marseille, France
| | - C Bevilacqua
- Pédiatrie maladies des enfants, Centre Hospitalier Sainte-Musse, 83100 Toulon, France
| | - C Roman
- Service de pédiatrie multidisciplinaire, Timone Pediatric Hospital, 13385 Marseille, France
| | - B Roquelaure
- Service de pédiatrie multidisciplinaire, Timone Pediatric Hospital, 13385 Marseille, France
| | - A Loundou
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseille University, 13385 Marseille, France
| | - K Baumstarck
- EA 3279, Self-perceived Health Assessment Research Unit, School of Medicine, Aix-Marseille University, 13385 Marseille, France
| | - A Fabre
- Service de pédiatrie multidisciplinaire, Timone Pediatric Hospital, 13385 Marseille, France; Aix-Marseille University, Inserm, GMGF, 13385 Marseille, France.
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Birru Talabi M, Clowse MEB, Blalock SJ, Switzer G, Yu L, Chodoff A, Borrero S. Development of ReproKnow, a reproductive knowledge assessment for women with rheumatic diseases. BMC Rheumatol 2019; 3:40. [PMID: 31660532 PMCID: PMC6805554 DOI: 10.1186/s41927-019-0091-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to develop an assessment tool, ReproKnow, to evaluate the reproductive health knowledge of women with a wide range of rheumatic diseases. Methods The 10-item multiple-choice questionnaire was developed with feedback from a panel of content experts and female patients with rheumatic diseases. Construct validity using known-groups analysis was evaluated through comparison of median total ReproKnow scores between rheumatology fellows and nurses. Female patients aged 18–50 years were recruited to take ReproKnow and demographic questionnaires in two outpatient clinics. Associations between patients’ mean total knowledge scores and demographic characteristics were assessed using independent-sample t-tests. Questions were also categorized by topical area, and the percentages were calculated. Results The completion rate of questions in ReproKnow was 100% across all users. Median ReproKnow scores were significantly higher among rheumatology fellows than among nurses (p = 0.045). The 153 patients recruited to the study had at least one of 15 rheumatic diseases. Patients’ mean knowledge score was 5.05 (SD 2.24) out of a possible high score of 10. Patients who were younger, White, and more educated had significantly higher scores than did other patients (p’s < 0.05). Patients who bore children after their disease diagnosis had higher knowledge scores than did women whose children were born prior to their diagnosis; in contrast, women with histories of surgical sterilization or hysterectomy had lower knowledge scores than other women. Knowledge scores of women who used potentially fetotoxic medications did not vary from the remainder of the sample. Patients demonstrated gaps in knowledge about birth outcomes, contraceptive efficacy, and breastfeeding safety. Conclusions Initial testing of ReproKnow suggests that it may be a promising tool to assess the reproductive health knowledge of women with diverse rheumatic diseases. Specific knowledge deficits elicited from ReproKnow may be important targets for future educational interventions.
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Affiliation(s)
- Mehret Birru Talabi
- 1Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3500 Terrace Street, Pittsburgh, PA 15261 USA
| | | | - Susan J Blalock
- 3University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC USA
| | - Galen Switzer
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Lan Yu
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Alaina Chodoff
- 5Division of General Internal Medicine, University of Pittsburgh and UPMC, Pittsburgh, PA USA
| | - Sonya Borrero
- 4Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA.,Veteran's Affairs Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA USA
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Alharbi R, Almahmudi F, Makhdoom Y, Mosli M. Knowledge and attitudes of primary healthcare physicians toward the diagnosis and management of inflammatory bowel disease following an educational intervention: A comparative analysis. Saudi J Gastroenterol 2019; 25:277-285. [PMID: 31187783 PMCID: PMC6784430 DOI: 10.4103/sjg.sjg_169_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS Inflammatory bowel disease (IBD) is a chronic inflammatory condition that requires early diagnosis and proper management. Patients with early symptoms of IBD are typically evaluated first by primary healthcare (PHC) physicians, who in turn refer patients with suspected IBD to specialists. Therefore, we aimed to assess the knowledge and attitude of PHC physicians toward IBD. MATERIALS AND METHODS We conducted a comparative cross-sectional survey of PHC physicians practicing at the Ministry of Health PHC centers in Jeddah, KSA. Demographics and data on the knowledge and practices of physicians were collected through a predefined and tested questionnaire that included three domains (Eaden, Leong, and Sign/Symptom Awareness). A subgroup of the cohort was educated about IBD referral criteria (group A, n = 65) prior to study initiation and their responses were compared with those from the remaining group (group B, n = 135). Regression analysis was used to test associations with the significance threshold set at 5%. RESULTS A total of 211 PHC physicians were surveyed with a response rate of 95%. Female physicians comprised 66.5% of the cohort and the mean age was 32.26 ± 6.6 years. About 91% of physicians were Saudi nationals, and 75.5% were MBBS degree holders. The majority of the respondents (93%) reported seeing zero to five patients with IBD per month, and almost half of the physicians preferred to always refer patients to specialists (49.5%). Most of the respondents were uncomfortable (3.27 ± 1.4 to 4.35 ± 1.2) with initiating or managing specific medical therapies (maintenance therapy, therapy for acute flare, corticosteroids, immunomodulators, and biologics) for patients with IBD. With regard to knowledge, group A had higher scores in all three domains especially in the Sign/Symptom Awareness domain (mean score 6.17 ± 1.1 vs. 3.5 ± 1.01, P < 0.001). According to multivariate analyses, both groups' knowledge showed no significant relationship with any of the medical therapies, except for the Sign/Symptom Awareness domain which was shown to be significantly affecting the comfort of doctors in managing maintenance therapy among patients with IBD [odds ratio (OR) =1.61, P = 0.008]. Gender, nationality, and qualifications were found to have a significant influence on the comfort in initiating specific medical therapies. Group A was identified as a significant factor in predicting comfort with managing corticosteroids (OR = 8.25, P = 0.006) and immunomodulators (OR = 6.03, P = 0.02) on patients with IBD. CONCLUSION The knowledge and comfort of PHC physicians with IBD medication prescription appears to be higher when education is provided. This observation is important, since PHC physicians are responsible for early identification and referral of patients suspected of having IBD, to specialists.
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Affiliation(s)
- Rwan Alharbi
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faizah Almahmudi
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yahya Makhdoom
- The Joint Program of Family Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Yin AL, Hachuel D, Pollak JP, Scherl EJ, Estrin D. Digital Health Apps in the Clinical Care of Inflammatory Bowel Disease: Scoping Review. J Med Internet Res 2019; 21:e14630. [PMID: 31429410 PMCID: PMC6718080 DOI: 10.2196/14630] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Digital health is poised to transform health care and redefine personalized health. As Internet and mobile phone usage increases, as technology develops new ways to collect data, and as clinical guidelines change, all areas of medicine face new challenges and opportunities. Inflammatory bowel disease (IBD) is one of many chronic diseases that may benefit from these advances in digital health. This review intends to lay a foundation for clinicians and technologists to understand future directions and opportunities together. Objective This review covers mobile health apps that have been used in IBD, how they have fit into a clinical care framework, and the challenges that clinicians and technologists face in approaching future opportunities. Methods We searched PubMed, Scopus, and ClinicalTrials.gov to identify mobile apps that have been studied and were published in the literature from January 1, 2010, to April 19, 2019. The search terms were (“mobile health” OR “eHealth” OR “digital health” OR “smart phone” OR “mobile app” OR “mobile applications” OR “mHealth” OR “smartphones”) AND (“IBD” OR “Inflammatory bowel disease” OR “Crohn's Disease” (CD) OR “Ulcerative Colitis” (UC) OR “UC” OR “CD”), followed by further analysis of citations from the results. We searched the Apple iTunes app store to identify a limited selection of commercial apps to include for discussion. Results A total of 68 articles met the inclusion criteria. A total of 11 digital health apps were identified in the literature and 4 commercial apps were selected to be described in this review. While most apps have some educational component, the majority of apps focus on eliciting patient-reported outcomes related to disease activity, and a few are for treatment management. Significant benefits have been seen in trials relating to education, quality of life, quality of care, treatment adherence, and medication management. No studies have reported a negative impact on any of the above. There are mixed results in terms of effects on office visits and follow-up. Conclusions While studies have shown that digital health can fit into, complement, and improve the standard clinical care of patients with IBD, there is a need for further validation and improvement, from both a clinical and patient perspective. Exploring new research methods, like microrandomized trials, may allow for more implementation of technology and rapid advancement of knowledge. New technologies that can objectively and seamlessly capture remote data, as well as complement the clinical shift from symptom-based to inflammation-based care, will help the clinical and health technology communities to understand the full potential of digital health in the care of IBD and other chronic illnesses.
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Affiliation(s)
- Andrew Lukas Yin
- Medical College, Weill Cornell Medicine, New York, NY, United States.,Cornell Tech, New York, NY, United States
| | - David Hachuel
- Cornell Tech, New York, NY, United States.,augGI Technologies, New York, NY, United States
| | | | - Ellen J Scherl
- Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, New York, NY, United States
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Casellas F, Navarro E, Amil P, Barber C, Marín L, Guardiola J, Espín E, Sainz E, Aldeguer X, Gallego M, Murciano F, García-Planella E, Martín-de-Carpi J, Mendive JM, González-Mestre A. Development and validation of the QUECOMIICAT questionnaire: a tool to assess disease-related knowledge in patients with inflammatory bowel disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2019; 111:586-592. [PMID: 31317762 DOI: 10.17235/reed.2019.6298/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION adequate knowledge of inflammatory bowel disease (IBD) is essential for a successful patient-centered management of IBD. OBJECTIVE due to the scarcity of up-to-date tools for measuring IBD literacy, this single-center, prospective study aimed to develop and validate a new questionnaire to assess IBD-related knowledge. MATERIAL AND METHODS the study included patients followed up at the Crohn-Colitis Care Unit (UACC) at the Hospital Vall d'Hebron (Barcelona, Spain). Patients admitted to the UACC for the first time were subsequently enrolled into a standard IBD educational program. A pilot questionnaire was developed and validated in 92 IBD patients by determining the internal consistency reliability (Cronbach's α test), feasibility, construct validity (correlation with the Crohn's and Colitis Knowledge [CCKNOW] questionnaire and a knowledge visual analog scale [VAS]) and sensitivity (score change before and after a standard IBD educational program). The questionnaire, named "Qüestionari Coneixements Malaltia Inflamatòria Intestinal Catalunya" (IBD-knowledge questionnaire Catalonia) (QUECOMIICAT) was written in Spanish and had 25 items addressing six dimensions: general concepts, clinic, treatment, surgery, habits and social context. RESULTS the median (interquartile range) completion time was 15 (10-20) minutes and the floor and ceiling effects were 1.1% and 2.1%, respectively. The Cronbach's α coefficient was α = 0.75. QUECOMIICAT significantly correlated with the VAS (rho = 0.34, p < 0.01) and CCKNOW questionnaires (rho = 0.74, p < 0.01). Patient knowledge significantly increased 24 hours after attending a standard IBD educational program and remained statistically significant one month later (Pearson's test-retest correlation coefficient r = 0.81, p < 0.001). CONCLUSION in conclusion, the QUECOMIICAT questionnaire is a new up-to-date tool to assess IBD-related knowledge with good feasibility and validation results for use in the routine clinical practice.
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Affiliation(s)
| | - Ester Navarro
- Unitat Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebrón
| | - Paloma Amil
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
| | - Claudia Barber
- Unitat Atenció Crohn-Colitis. , Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Laura Marín
- Hospital Universitari Germans Trias i Pujol. Badalona, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge. L'Hospitalet de Llobregat, Spain
| | - Eloy Espín
- Unitat d'Atenció Crohn-Colitis, Hospital Universitari Vall d'Hebron. Barcelona, Spain
| | - Empar Sainz
- Hospital Universitari Arnau de Vilanova. Lleida, Spain
| | | | - Marta Gallego
- Hospital Clínic i Provincial de Barcelona. Barcelona, Spain
| | | | | | | | - Juan Manuel Mendive
- CAP la Mina. SAP Litoral. Gerència d'Atenció Primària de Barcelona. Barcelona, Spain
| | - Assumpció González-Mestre
- Programa Pacient Expert Catalunya®. Programa de pr, Direcció General de Planificació en Salut. Departament de Salut, Generalitat de Catalunya, Spain
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Blackburn DF, Fowler S, Crawley A, Gerwing S, Alcorn J, Mansell H, Evans C, Mansell K, Taylor J, Jorgenson D, Larocque D, Rotter T, Shevchuk Y. An Advanced Pharmacy Practice Experience for Community Pharmacies Based on a Clinical Intervention Targeting Patients With Inflammatory Bowel Disease. J Pharm Pract 2019; 34:51-57. [PMID: 31238777 DOI: 10.1177/0897190019857410] [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: 11/16/2022]
Abstract
Experiential education is a critical component of any pharmacy undergraduate curriculum. Establishing new, high-quality practice sites can be challenging. We designed a new advanced pharmacy practice experiential rotation suitable for implementation in most community pharmacy settings. The aim of this article is to describe the design of this rotation entitled the Targeted Pharmacy Intervention in Inflammatory Bowel Disease (TPI-IBD) and to determine its impact on student knowledge and confidence using a before-after survey design. The TPI-IBD utilizes a student-delivered intervention as a platform for experiential learning in community pharmacy practice. The TPI was focused on patients with IBD, and implementation was guided by a co-preceptor from the university in collaboration with onsite-preceptors at each pharmacy. The TPI-IBD rotation was delivered from 6 community pharmacies during 5 weeks in 2018. Students conducted standardized monitoring on patients with IBD and met weekly with the university preceptor for case presentations and therapeutic discussions. Electronic charts were maintained by students who were responsible for ensuring detailed documentation on each patient. Knowledge, confidence, and overall satisfaction were assessed by a survey given to students before and after the rotation. Students were highly satisfied with the learning experience and improvements in knowledge and confidence were clearly demonstrated. The TPI strategy was an effective way to expand rotation options in community pharmacy sites with minimal burden on local preceptors.
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Affiliation(s)
- David F Blackburn
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle Fowler
- The College of Medicine, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alex Crawley
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Shauna Gerwing
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jane Alcorn
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Charity Evans
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kerry Mansell
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jeff Taylor
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Derek Jorgenson
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Danielle Larocque
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Thomas Rotter
- Healthcare Quality Programs, School of Nursing, 4257Queen's University, Kingston, Ontario, Canada
| | - Yvonne Shevchuk
- College of Pharmacy & Nutrition, 7235University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Ewais T, Begun J, Kenny M, Chuang KH, Barclay J, Hay K, Kisely S. Protocol for a pilot randomised controlled trial of mindfulness-based cognitive therapy in youth with inflammatory bowel disease and depression. BMJ Open 2019; 9:e025568. [PMID: 31005923 PMCID: PMC6500357 DOI: 10.1136/bmjopen-2018-025568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is a chronic autoinflammatory disease of the gastrointestinal tract with peak age of onset during adolescence and young adulthood. Adolescents and young adults (AYAs) with IBD experience higher depression rates compared with peers who are well or have other chronic conditions. Mindfulness-based interventions are of particular interest because of their potential to improve both the course of IBD and depression. METHODS AND ANALYSIS This study is a parallel design, single-blind, pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) in AYAs with IBD and depression. The trial aims to recruit 64 participants who will be randomly allocated to MBCT or treatment as usual. The primary outcome measure is the depression subscale score from the Depression, Anxiety and Stress Scale. Secondary outcomes include anxiety, stress, post-traumatic growth, IBD-related quality of life, illness knowledge, medication adherence, mindfulness, IBD activity, inflammatory markers, microbiome and brain neuroconnectivity changes. All outcomes other than neuroimaging will be collected at three time points: at baseline, at therapy completion and at 20 weeks. Neuroimaging will be conducted at baseline and at therapy completion. Mixed-effects linear and logistic regression modelling will be used to analyse continuous and dichotomous outcomes, respectively. Participants' experiences will be explored through focus groups, and thematic analysis will be used to generate relevant themes. ETHICS AND DISSEMINATION The protocol has been approved by the Mater Hospital Human Research Ethics Committee (HREC) and University of Queensland HREC. Trial findings will be published in peer-reviewed journals and will be presented at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12617000876392, U1111-1197-7370; Pre-results.
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Affiliation(s)
- Tatjana Ewais
- Mater Young Adult Health Centre, Mater Misericordiae Brisbane Ltd, South Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jake Begun
- Mater Young Adult Health Centre, Mater Misericordiae Brisbane Ltd, South Brisbane, Queensland, Australia
- Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia
| | - Maura Kenny
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Teaching Faculty, Mindfulness Training Institute, Sydney, New South Wales, Australia
| | - Kai-Hsiang Chuang
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Johanna Barclay
- Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia
| | - Karen Hay
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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Yoon H, Yang SK, So H, Lee KE, Park SH, Jung SA, Choh JH, Shin CM, Park YS, Kim N, Lee DH. Development, validation, and application of a novel tool to measure disease-related knowledge in patients with inflammatory bowel disease. Korean J Intern Med 2019; 34:81-89. [PMID: 29172400 PMCID: PMC6325432 DOI: 10.3904/kjim.2017.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/07/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/AIMS The Crohn's and Colitis Knowledge (CCKNOW) score does not reflect updated knowledge relating to inflammatory bowel disease (IBD). The aim of this study was to develop, validate, and apply a novel tool to measure disease-related knowledge in IBD patients. METHODS A questionnaire composed of 24 items regarding knowledge of IBD was developed: Inflammatory Bowel Disease Knowledge (IBD-KNOW). Discriminate ability of IBD-KNOW was validated in three occupational groups (14 doctors, 20 nurses, and 19 clerks). The CCKNOW and IBD-KNOW were administered to IBD patients. Factors affecting the level of IBD-related knowledge were analyzed. RESULTS The median Inflammatory Bowel Disease Knowledge (IBD-KNOW) score was significantly different among the three groups for validation (22 doctors, 20 nurses, and five clerks; p < 0.001). The IBD-KNOW showed excellent internal consistency (Cronbach α = 0.952) and high correlation with CCKNOW (Spearman ρ = 0.827, p = 0.01). A total of 200 IBD patients (120 Crohn's disease, 80 ulcerative colitis) completed questionnaires. Multivariate analysis showed that a higher IBDKNOW score than the median was associated with hospitalization history (odds ratio [OR], 2.625; p = 0.003), high education level (OR, 2.498; p = 0.012), and information acquired from patient organization (OR, 3.305, p = 0.035). CONCLUSION The IBD-KNOW demonstrated excellent test characteristics. Hospitalization history, education level, and information acquired from patient organization play an important role in correct IBD-related knowledge.
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Affiliation(s)
- Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Suk-Kyun Yang, M.D. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3901 Fax: +82-2-476-0824 E-mail:
| | - Hoonsub So
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ko Eun Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Joong Haeng Choh
- International Healthcare Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Purewal S, Chapman S, Czuber‐Dochan W, Selinger C, Steed H, Brookes MJ. Systematic review: the consequences of psychosocial effects of inflammatory bowel disease on patients' reproductive health. Aliment Pharmacol Ther 2018; 48:1202-1212. [PMID: 30411389 PMCID: PMC6587548 DOI: 10.1111/apt.15019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 07/25/2018] [Accepted: 09/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND High levels of voluntary childlessness and pregnancy-related fears have been reported amongst inflammatory bowel disease (IBD) patients. AIMS To investigate what factors determine IBD patients' childbearing decisions; and to examine psychosocial consequences of IBD on various aspects of patients' reproductive health. METHODS Six electronic databases were searched in a pre-specified and structured manner. RESULTS A total of 41 articles with data on 7122 patients were included. Between one-fifth to one-third of IBD patients had chosen voluntary childlessness. Around 50% of all IBD patients have poor knowledge of pregnancy-related issues in IBD. Poor knowledge of pregnancy-related issues in IBD was associated with voluntary childlessness. Observational studies have found preconception counselling is associated with patients choosing parenthood. Pregnancy-related fears and concerns are multifaceted, stemming partly from lack of knowledge of pregnancy-related issues in IBD. Many female patients are considered at increased risk for pregnancy because between one-fifth to one-third of patients do not use contraception. Research evidence for sexual dysfunction after disease diagnosis and treatment is inconsistent. There are limited data on patients' pregnancy, postpartum and parenting experiences. A few shortcomings of the literature are evident; sample sizes were small, participation rates were low, use of non-validated questionnaires was common, and few studies included men and/or ethnic minority groups. The design of intervention studies is also weak. CONCLUSION This review recommends pre-conception counselling for all IBD patients of childbearing age to tackle poor knowledge and allow patients to make an informed decision on their reproductive health.
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Affiliation(s)
- Satvinder Purewal
- Institute of Sport and Human Science, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Sarah Chapman
- Department of Pharmacy & PharmacologyUniversity of BathBathUK
| | | | | | - Helen Steed
- The Royal Wolverhampton NHS Trust, New Cross HospitalWolverhamptonUK
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Britton J, Hamdy S, McLaughlin J, Horne M, Ang Y. Barrett's oesophagus: A qualitative study of patient burden, care delivery experience and follow-up needs. Health Expect 2018; 22:21-33. [PMID: 30430714 PMCID: PMC6351418 DOI: 10.1111/hex.12817] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 12/19/2022] Open
Abstract
Background Barrett's oesophagus (BO), a precursor to oesophageal adenocarcinoma, requires long‐term endoscopic surveillance. The rising incidence of this chronic disease has implications for service provision and patient burden. Few studies have explored BO patients’ personal burden, care delivery experience and participation in health‐care delivery decisions. Objective To identify and explore factors impacting BO patients’ health‐related quality of life, follow‐up needs and views on new models of follow‐up care. Design An exploratory qualitative approach was adopted using semi‐structured, in‐depth, one‐to‐one interviews, audio‐recorded and transcribed verbatim. Patients undergoing BO surveillance, at a single NHS hospital, were recruited using purposive sampling with the aim of achieving maximum variation. Data were analysed using framework analysis approach, supported by NVivo Pro 11. Results Data saturation occurred after 20 participant interviews. Ten subthemes and three main themes emerged from the analysis: (a) burden of disease—symptom control, worry of oesophageal cancer and surveillance endoscopy; (b) follow‐up experiences—follow‐up care, at this NHS hospital, was found to be inconsistent and often inadequate to meet patients’ needs, in particular a lack of disease‐specific information; and (c) follow‐up needs—participants sought enhanced communication, organization and structure of care. They highly valued face‐to‐face interaction with a specialist, and the concept of direct secondary care access in‐between endoscopies was reassuring to participants. Conclusions This qualitative research provides an in‐depth account of the patients’ perspective of BO, the effectiveness of follow‐up care and patient opinion on new follow‐up systems.
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Affiliation(s)
- James Britton
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Wrightington, Wigan and Leigh NHS Trust, Wigan, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Salford, UK
| | - Maria Horne
- Faculty of Medicine and Health, Leeds University School of Healthcare, University of Leeds, Leeds, UK
| | - Yeng Ang
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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Martín Fernández C, Maroto Martín C, Fernández Salazar L. Using the internet to evaluate the opinion of patients with inflammatory bowel disease with regard to the available information. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018. [PMID: 29527904 DOI: 10.17235/reed.2018.5331/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS patients need information for shared decision making. The aims of the study were to ascertain how patients with inflammatory bowel disease (IBD) felt about the information available and the way that their doctors informed them. In addition, how patients used the internet and factors that predicted a positive information evaluation were also assessed. METHOD a 39-item survey was designed that was distributed via the internet, principally using a Spanish Facebook site. RESULTS four hundred and twenty completed surveys were received. Patients rated the information available with a mean of 8 points (maximum of 10) and 71% felt that their doctor informed them well or very well. Various deficiencies were found such as little information available at the time of diagnosis (58%); doubts after seeing the specialist (70%); insufficient information about IBD complications, disease course and dietary aspects; and a lack of appropriate internet webpage recommendations from specialists or pharmacists. Patients ranked the internet fourth as an information source, followed by their specialist, patient associations and other patients. Independent predictive factors of feeling well informed (≥ 8) included age, OR 1.539 (CI 1.047-2.261), p = 0.028; education, OR 1.544 (CI 1.110-2.147), p = 0,010; IBD evolution time, OR 1.267 (CI 1.003-1,601), p = 0.047; and good or very good information from the specialist, OR 3.262 (CI 2.425-4.388), p < 0.001. CONCLUSIONS patients generally felt that they were well informed. However, there were aspects that needed improvement, such as information for younger patients or a lower education level, the information provided at diagnosis, information about specific or insufficiently covered IBD aspects and suggestions from doctors about high quality websites.
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Abutaleb A, Buchwald A, Chudy-Onwugaje K, Langenberg P, Regueiro M, Schwartz DA, Tracy JK, Ghazi L, Patil SA, Quezada SM, Russman KM, Quinn CC, Jambaulikar G, Beaulieu DB, Horst S, Cross RK. Inflammatory Bowel Disease Telemedicine Clinical Trial: Impact of Educational Text Messages on Disease-Specific Knowledge Over 1 Year. Inflamm Bowel Dis 2018; 24:2191-2197. [PMID: 29788137 PMCID: PMC7190916 DOI: 10.1093/ibd/izy149] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Effective treatments are available for patients with inflammatory bowel disease (IBD); however, suboptimal outcomes occur and are often linked to patients' limited disease knowledge. The aim of this analysis was to determine if delivery of educational messages through a telemedicine system improves IBD knowledge. METHODS TELEmedicine for Patients with IBD (TELE-IBD) was a randomized controlled trial with visits at baseline, 6 months, and 12 months; patient knowledge was a secondary aim of the study. Patients were randomized to receive TELE-IBD every other week (EOW), weekly (TELE-IBD W), or standard of care. Knowledge was assessed at each visit with the Crohn's and Colitis Knowledge (CCKNOW) survey. The primary outcome was change in CCKNOW score over 1 year compared between the TELE-IBD and control groups. RESULTS This analysis included 219 participants. Participants in the TELE-IBD arms had a greater improvement in CCKNOW score compared with standard care (TELE-IBD EOW +2.4 vs standard care +1.8, P = 0.03; TELE-IBD W +2.0 vs standard care +1.8, P = 0.35). Participants with lower baseline CCKNOW scores had a greater change in their score over time (P < 0.01). However, after adjusting for race, site, and baseline knowledge, there was no difference in CCKNOW score change between the control and telemedicine arms. CONCLUSIONS Telemedicine improves IBD-specific knowledge through text messaging, although the improvement is not additive with greater frequency of text messages. However, after adjustment for confounding variables, telemedicine is not superior to education given through standard visits at referral centers. Further research is needed to determine if revised systems with different modes of delivery and/or frequency of messages improve disease knowledge.
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Affiliation(s)
- Ameer Abutaleb
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Buchwald
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Miguel Regueiro
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Leyla Ghazi
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Seema A Patil
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Dawn B Beaulieu
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Sara Horst
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Raymond K Cross
- University of Maryland School of Medicine, Baltimore, Maryland,Address correspondence to: Raymond K. Cross, MD, MS, AGAF, 685 West Baltimore Street, Suite 8-00, Baltimore, MD 21201 ()
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Danion P, Buisson A, Roblin X, Mathieu N, Charlois AL, Borgerding JN, Williet N, Del Tedesco E, Flourié B, Nancey S, Boschetti G. IBD-INFO Questionnaire: A Multicenter French Up-to-Date Survey of Patient Knowledge in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:943-952. [PMID: 29506217 DOI: 10.1093/ibd/izx073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND It has been demonstrated in many chronic conditions, including inflammatory bowel disease (IBD), that better patient knowledge about pathology and treatment improves the course and management of disease. The aim of this study was to develop an updated self-questionnaire to assess patients' level of knowledge of IBD. METHODS The IBD-INFO included 3 parts: an original part (Q1) and 2 parts from the translation of the preexisting questionnaires Crohn's and Colitis Knowledge score (CCKNOW) (Q2) and Crohn's and Colitis Pregnancy Knowledge score (CCPKNOW) (Q3). The reliability and discriminatory ability of the questionnaire were validated in 3 groups of non-IBD volunteers with various theoretical knowledge levels. The final questionnaire (64 validated questions) was then tested on 364 in- and out- IBD patients from 4 French university hospitals. The score for each part of the questionnaire was calculated, and factors associated with low scores were identified by univariate and multivariate logistic regression analyses. RESULTS The scores obtained by the 3 non-IBD volunteer groups differed significantly (P < 0.0001), and the IBD-INFO questionnaire showed excellent internal reliability and consistency (α = 0.98). The median total score obtained by the IBD patients was 27/64 (range, 0-59), and scores for Q1, Q2, and Q3 were, respectively, 10/23 (range, 0-21), 11/24 (range, 0-23), and 4/17 (range, 0-16). In multivariate analysis, lack of a university degree, not being a member of a patient association, not receiving anti-tumor necrosis factor alpha (anti-TNFα) treatment, duration of IBD ≤3 years, male sex, and age >38 years were independent risk factors of a poor IBD-INFO knowledge score. The areas of knowledge least mastered were vaccination, IBD-related cancers, treatments, and pregnancy. CONCLUSIONS Using the IBD-INFO, an updated self-administered questionnaire built to assess IBD patients' knowledge, several risk factors have been highlighted that allow better targeting of patients and areas requiring an improvement in the level of information.
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Affiliation(s)
- Pauline Danion
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Anthony Buisson
- Department of Gastroenterology, Université Clermont Auvergne, Inserm U1071 M2iSH, 3iHP, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne Hospital, Saint-Etienne, France
| | - Nicolas Mathieu
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France
| | - Anne-Laure Charlois
- Department of Gastroenterology, Saint-Etienne Hospital, Saint-Etienne, France
| | | | - Nicolas Williet
- Department of Gastroenterology, Saint-Etienne Hospital, Saint-Etienne, France
| | - Emilie Del Tedesco
- Department of Gastroenterology, Saint-Etienne Hospital, Saint-Etienne, France
| | - Bernard Flourié
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France.,INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France.,INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
| | - Gilles Boschetti
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon, Lyon, France.,INSERM U1111, Centre International de Recherche en Infectiologie, Lyon, France
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Gumidyala AP, Greenley RN, Plevinsky JM, Poulopoulos N, Cabrera J, Lerner D, Noe JD, Walkiewicz D, Werlin S, Kahn SA. Moving On: Transition Readiness in Adolescents and Young Adults With IBD. Inflamm Bowel Dis 2018; 24:482-489. [PMID: 29462383 DOI: 10.1093/ibd/izx051] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel diseases (IBD) often begins early in life. Adolescents and young adults (AYA) with IBD have to acquire behaviors that support self-care, effective healthcare decision-making, and self-advocacy to successfully transition from pediatric to adult health care. Despite the importance of this critical time period, limited empirical study of factors associated with transition readiness in AYA exists. This study aimed to describe transition readiness in a sample of AYA with IBD and identify associated modifiable and nonmodifiable factors. METHODS Seventy-five AYA (ages 16-20) and their parents participated. AYA and parents reported on demographics, patient-provider transition-related communication, and transition readiness. AYA self-reported on disease self-efficacy. Disease information was abstracted from the medical record. RESULTS Deficits in AYA responsibility were found in knowledge of insurance coverage, scheduling appointments, and ordering medication refills. Older AYA age, higher AYA disease-management self-efficacy, and increased patient-provider transition communication were each associated with higher overall transition readiness and AYA responsibility scores. Regression analyses revealed that older AYA age and increased patient-provider transition-related communication were the most salient predictors of AYA responsibility for disease management and overall transition readiness across parent and AYA reports. CONCLUSIONS AYA with IBD show deficits in responsibility for their disease management that have the potential to affect their self-management skills. Findings suggest provider communication is particularly important in promoting transition readiness. Additionally, it may be beneficial to wait to transition patients until they are older to allow them more time to master skills necessary to responsibly manage their own healthcare.
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Affiliation(s)
| | - Rachel N Greenley
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jill M Plevinsky
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Natasha Poulopoulos
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Jose Cabrera
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Diana Lerner
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Joshua D Noe
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Dorota Walkiewicz
- Department of Pediatric Gastroenterology, UW Health, American Family Children's Hospital, Madison, WI
| | - Steven Werlin
- Gastroenterology, Liver and Nutrition Program, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Stacy A Kahn
- Inflammatory Bowel Disease Center, Boston's Children's Hospital, Boston, MA
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Literature review: impacts of socioeconomic status on the risk of inflammatory bowel disease and its outcomes. Eur J Gastroenterol Hepatol 2017; 29:879-884. [PMID: 28471825 DOI: 10.1097/meg.0000000000000899] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The relationship between socioeconomic status (SES) and inflammatory bowel disease (IBD) is controversial. To date, research has focused on effects on incidence and prevalence, disease management and clinical outcomes; however, conclusions remain uncertain. This review examines current evidence, identifies what remains to be understood and explores the practical implications this has for today. A structured literature search in Ovid, Medline, the Cochrane library, Google Scholar and clinicaltrials.gov was performed using defined key words, including all articles up until 5 October 2016 assessing SES as a primary or secondary outcome measure. Twenty-one studies were identified, investigating incidence and prevalence (n=13), disease outcomes (n=5) and mortality (n=3). Data linking SES with IBD incidence are conflicting, with studies citing both positive and negative trends. Patients with low SES, particularly those with Crohn's disease, show higher rates of hospitalization, service usage and IBD-associated mortality. On the basis of the available study data, it is difficult to relate SES with the risk of IBD. For Crohn's disease, in particular, the link between deprivation and increased hospitalization and mortality observed from world-wide studies is alarming. It seems most likely that the cause links to well-documented behavioural, materialistic, psychosocial and life-course models used to explain social class inequalities in other diseases.
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Kim MC, Jung YS, Song YS, Lee JI, Park JH, Sohn CI, Choi KY, Park DI. Factors Associated with Anxiety and Depression in Korean Patients with Inactive Inflammatory Bowel Disease. Gut Liver 2017; 10:399-405. [PMID: 26470768 PMCID: PMC4849693 DOI: 10.5009/gnl15188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/AIMS Psychological distress is highly prevalent in patients with inflammatory bowel disease (IBD). We evaluated the disease characteristics and socioeconomic factors associated with anxiety and depression in Korean patients with quiescent IBD. METHODS In total, 142 IBD patients (67 with Crohn's disease [CD] and 75 with ulcerative colitis [UC]) completed self-report questionnaires, including the Hospital Anxiety and Depression Score, the Modified Morisky Adherence Scale-8, the socioeconomic deprivation score, and the Crohn's and Colitis Knowledge Score questionnaires. RESULTS In the CD group, 30 patients (44%) were anxious, and 10 patients (15%) were depressed; in the UC group, 31 patients (41%) were anxious, and 18 patients (24%) were depressed. Using multivariate analysis, in the CD group, socioeconomic deprivation was associated with anxiety (p=0.03), whereas disease duration (p=0.04) and socioeconomic deprivation (p=0.013) were associated with depression. In the UC group, there was no significant independent predictor of anxiety and/or depression; however, low income tended to be associated with depression (p=0.096). CONCLUSIONS Despite clinical remission, a significant number of IBD patients present with anxiety and depression. IBD patients in remission, particularly those who are socioeconomically deprived, should be provided with appropriate psychological support.
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Affiliation(s)
- Min Chul Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Seok Song
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung In Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu Yong Choi
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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49
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Gerfaud A, Bridoux-Henno L, Bretagne JF, Siproudhis L, Bouguen G, Dabadie A. Évaluation de la transition pédiatrie-gastroentérologie d’adultes des enfants atteints de maladie inflammatoire cryptogénique intestinale. Arch Pediatr 2017; 24:534-541. [DOI: 10.1016/j.arcped.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/26/2017] [Accepted: 03/10/2017] [Indexed: 01/28/2023]
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Abstract
Transition is the long process of developing independent self-management skills whereas transfer is the actual move from pediatric to adult-centered provider. Structured anticipated transition works best with timelines of tasks to master and discussion of the stylistic differences between pediatric and adult practices. Disease-specific issues need to be addressed, such as earlier timelines for diet-based therapies, parental support for critical illnesses, and differences in therapeutic strategies.
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Affiliation(s)
- Punyanganie S A de Silva
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Laurie N Fishman
- Division of Pediatric Gastroenterology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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