1
|
Bujanda-Sainz de Murieta A, Soto-Ruiz N, García-Vivar C, San Martín-Rodríguez L, Escalada-Hernández P. Use of Online Communities among People with Type 2 Diabetes: A Scoping Review. Curr Diab Rep 2024; 24:96-107. [PMID: 38457015 PMCID: PMC11043193 DOI: 10.1007/s11892-024-01538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE OF REVIEW People with diabetes require continuous self-monitoring and face numerous decisions in their day-to-day lives. Therefore, on many occasions, they need more support than that provided by health professionals. In this context, peer support in online diabetes communities could be a useful tool. The purpose of the review is to describe, analyze and synthesize the available evidence on the use and health out-comes of online communities for people with type 2 diabetes mellitus. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines. Searches were performed PubMed, Web of Science, CINHAL, Scopus and Cochrane databases. RECENT FINDINGS From 1821 identified documents, 6 articles were included. These studies explored the characteristics of diabetes online communities and the population features. Besides, the results were classified according to whether they were clinical, psychosocial, or addressed people's experiences with the online community. The analysis underscores their value in facilitating communication, improving diabetes management, and enhancing psychosocial well-being. Future investigations should prioritize longitudinal assessments to elucidate the sustained impact of community engagement and optimize user participation for enhanced patient outcomes. The growing relevance of new technologies has led to a significant number of individuals with chronic illnesses seeking peer support. Online health communities have emerged as virtual spaces where individuals with shared health interests interact and form relationships. Within these digital spaces, individuals can engage in peer interaction, observe behaviors, and mutually benefit, potentially leading to improved attitudes toward the disease.
Collapse
Affiliation(s)
- Arantxa Bujanda-Sainz de Murieta
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/N, 31008, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Nelia Soto-Ruiz
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/N, 31008, Pamplona, Navarra, Spain.
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
| | - Cristina García-Vivar
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/N, 31008, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Leticia San Martín-Rodríguez
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/N, 31008, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Paula Escalada-Hernández
- Department of Health Sciences, Public University of Navarre (UPNA), Avda. Barañain S/N, 31008, Pamplona, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| |
Collapse
|
2
|
Dineen-Griffin S, Benrimoj SI. The landscape of self-care in Australia: A pharmacy perspective. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100396. [PMID: 38174289 PMCID: PMC10762451 DOI: 10.1016/j.rcsop.2023.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
Collapse
Affiliation(s)
- Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Spain
| |
Collapse
|
3
|
Stevenson RDM, Chowdhury EA, Lobo J, Western MJ, Bilzon JLJ. Influence of the intelligent knee osteoarthritis lifestyle app (iKOALA) on knee joint pain. BMC Musculoskelet Disord 2024; 25:90. [PMID: 38263125 PMCID: PMC10807134 DOI: 10.1186/s12891-024-07198-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The intelligent knee osteoarthritis lifestyle app (iKOALA) has been co-developed with target users to extend the support for physical activity (PA) and musculoskeletal health, beyond short-term structured rehabilitation, using personalised PA guidance, education, and social support. The purpose of this study was to assess the preliminary effectiveness and usability of the iKOALA digital intervention on indices of musculoskeletal (MSK) health, symptoms, and physical activity levels in a broad range of individuals with knee osteoarthritis (KOA) over 12 weeks to inform the design of a larger randomised controlled trial. METHODS Thirty-eight (33 female) participants living in the UK with a mean (SD) age of 58 (± 9) years diagnosed radiographically or clinically with KOA completed a 12-week user trial of the iKOALA. Participants completed an in-app physical activity questionnaire which intelligently recommended suitable strengthening and aerobic based activities to individuals. Throughout the trial, participants wore a physical activity monitor and were given access to functions within the app (physical activity (PA) reminders, information and education, symptom and PA tracking as well as social support forums) to support them in maintaining their PA plan. Participants completed a MSK questionnaire for chronic symptoms and quality of life (MSK-HQ) as well as an acute iKOALA symptoms questionnaire (confidence, fatigue, mood, pain during the day/night, sleep and ability to walk) in the week prior to starting and following completion of the trial. RESULTS Physical activity levels were consistent over the 12 weeks with total daily steps of 9102 (± 3514) in week 1, 9576 (± 4214) in week 6 and 9596 (± 3694) in week 12. Group mean changes in all iKOALA MSK symptom scores and the total MSK-HQ (pre 33.1 (7.6) vs. post 40.2 (7.6)) score improved significantly (p < .001, 95% CI [-8.89, -5.16]) over the 12-week period. CONCLUSIONS Physical activity levels were maintained at a high level throughout the 12 weeks. Significant improvements in mean MSK symptom scores and the total MSK-HQ score were also observed. Efforts to ensure more generalised reach amongst sex and socioeconomic status of the digital intervention in a randomised controlled clinical trial are warranted.
Collapse
Affiliation(s)
- Richard D M Stevenson
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK
| | - Enhad A Chowdhury
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK
| | - Jesudas Lobo
- Department of Computer Science, The University of Bath, Bath, BA2 7AY, UK
| | - Max J Western
- Department for Health, The University of Bath, Bath, BA2 7AY, UK
| | - James L J Bilzon
- Department for Health, The University of Bath, Bath, BA2 7AY, UK.
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Bath, BA2 7AY, UK.
| |
Collapse
|
4
|
Truscott A, Hayes D, Bardsley T, Choksi D, Edbrooke-Childs J. Defining young people's mental health self-care: a systematic review and co-development approach. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02320-7. [PMID: 37947894 DOI: 10.1007/s00787-023-02320-7] [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: 04/16/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.
Collapse
Affiliation(s)
- Alex Truscott
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK.
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Tom Bardsley
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Disha Choksi
- Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| |
Collapse
|
5
|
Delaney S, Cronin P, Huntley-Moore S. Conceptualisations of COPD self-management: A narrative review of the research literature. Chronic Illn 2023; 19:514-528. [PMID: 35876320 DOI: 10.1177/17423953221115441] [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] [Indexed: 11/15/2022]
Abstract
AIM To examine how self-management is conceptualised in the research literature on chronic obstructive pulmonary disease (COPD). METHODS A narrative review was undertaken to search the research literature on COPD self-management. Ten databases (2000-2021) were searched for published texts. Sixty-two articles met the inclusion criteria. A thematic analysis was conducted of the literature. RESULTS Three conceptualisations of COPD self-management were identified: 1) a dominant medicocentric conceptualisation which represented self-management as medical in focus; 2) a less dominant experiential conceptualisation that viewed it as arising from the experiences of people living with COPD; and 3) a smaller body of literature that attempted to integrate medicocentric and experiential conceptualisations of self-management. DISCUSSION The dominance of the medicocentric conceptualisation of self-management and the polarisation of medicocentric and experiential perspectives were striking. An integrated conceptualisation of self-management has the potential to unite these competing perspectives and promote collaborative relationships between individuals and professionals, so long as the underlying values informing it are made explicit. However, there is a dearth of literature on this approach and it would benefit from more attention. Methods such as Co-production and the Personal Outcomes Approach offer the potential to support an integrated perspective in clinical practice.
Collapse
Affiliation(s)
- Sarah Delaney
- Health Research Charities Ireland, Digital Office Centre, 12 Camden Row, Dublin, Ireland
| | - Patricia Cronin
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| | - Sylvia Huntley-Moore
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, Ireland
| |
Collapse
|
6
|
Timmermans L, Golder E, Decat P, Foulon V, Van Hecke A, Schoenmakers B. Characteristics of self-management support (SMS) interventions and their impact on Quality of Life (QoL) in adults with chronic diseases: An umbrella review of systematic reviews. Health Policy 2023; 135:104880. [PMID: 37536047 DOI: 10.1016/j.healthpol.2023.104880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To provide an overview of types and characteristics of self-management support (SMS) interventions in adults with chronic disease and to assess the impact on the patient reported outcome Quality of Life (QoL). METHODS An umbrella review of systematic reviews was conducted. We searched PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from January 2016 to November 2020 for reviews on SMS interventions for chronic diseases, assessing the impact on the patient reported outcome QoL. Quality assessment was based on the JBI Critical Appraisal Checklist for Systematic reviews and Research Syntheses tool. RESULTS 28 reviews were included. The extensive literature review revealed a variety of SMS interventions. The most frequently cited target group for the interventions were individuals with diabetes. Interventions primarily took place in the home setting. Interventional components that were often incorporated were education, eHealth and mHealth technologies, and coaching techniques. Telephone communication was regularly reported as a type of intervention follow-up. The impact on QoL was mixed and no firm conclusions can be drawn. However, our review revealed a beneficial effect of education. CONCLUSIONS AND PRACTICAL IMPLICATIONS Interventions including educational components seem promising for supporting self-management and showed a beneficial effect on QoL. More research is needed to explore where, by whom and how interventions are ideally delivered.
Collapse
Affiliation(s)
- Lotte Timmermans
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7 -Box 7001, Leuven 3000 Belgium.
| | - Elena Golder
- Health and Wellbeing, Plymouth Marjon University, Plymouth, UK
| | - Peter Decat
- General Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member of the Department Nursing Director, Ghent University Hospital, Ghent, Belgium
| | - Birgitte Schoenmakers
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7 -Box 7001, Leuven 3000 Belgium
| |
Collapse
|
7
|
Hagger V, J. Lake A, Singh T, Hamblin PS, Rasmussen B. The experiences and support needs of students with diabetes at university: An integrative literature review. Diabet Med 2023; 40:e14943. [PMID: 36001083 PMCID: PMC10087720 DOI: 10.1111/dme.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
Abstract
AIMS Commencing university presents particular challenges for young adults with diabetes. This integrative literature review aimed to synthesise the research exploring the experiences and support needs of university students with diabetes. METHODS Medline, CINAHL, PsychInfo and EMBASE databases were searched for quantitative and qualitative studies, among undergraduate and postgraduate students with type 1 or type 2 diabetes conducted in the university setting. Two reviewers independently screened titles, abstracts and full-text articles. Data were analysed thematically and synthesised narratively utilising the ecological model as a framework for interpreting findings and making recommendations. RESULTS We identified 25 eligible papers (20 studies) utilising various methods: individual interview, focus group, survey, online forum. Four themes were identified: barriers to self-care (e.g. lack of structure and routine); living with diabetes as a student; identity, stigma and disclosure; and strategies for managing diabetes at university. Students in the early years at university, recently diagnosed or moved away from home, reported more self-care difficulties, yet few accessed university support services. Risky alcohol-related behaviours, perceived stigma and reluctance to disclose diabetes inhibited optimal diabetes management. CONCLUSION Despite the heterogeneity of studies, consistent themes related to diabetes self-care difficulties and risky behaviours were reported by young adults with diabetes transitioning to university life. No effective interventions to support students with diabetes were identified in this setting. Multilevel approaches to support students to balance the competing demands of study and diabetes self-care are needed, particularly in the early years of university life.
Collapse
Affiliation(s)
- Virginia Hagger
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Amelia J. Lake
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Tarveen Singh
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
| | - Peter S. Hamblin
- Western HealthSt. AlbansVictoriaAustralia
- Department of Medicine, Western HealthUniversity of MelbourneSt. AlbansVictoriaAustralia
| | - Bodil Rasmussen
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Faculty of Health SciencesUniversity of Southern Denmark and Steno Diabetes CentreOdenseDenmark
| |
Collapse
|
8
|
Otter CEM, Keers JC, Reker C, Smit J, Schoonhoven L, de Man-van Ginkel JM. How nurses support self-management of hospitalized patients through verbal communication: a qualitative study. BMC Nurs 2022; 21:329. [PMID: 36443771 PMCID: PMC9703649 DOI: 10.1186/s12912-022-01099-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients' self-management of the implications of their disease(s) is becoming increasingly important. Research shows that hospitalization disrupts established self-management routines. Nurses can play an important role in supporting patients' self-management. The aim of this study is to describe how nurses support the self-management of hospitalized patients through verbal communication during routine nursing care. METHODS A qualitative descriptive study, using overt, non-participant observations was conducted on three wards of a general teaching hospital in the Netherlands. A total of 215 hours of nursing work during 49 shifts was observed. Data was analyzed using thematic analysis based on the six phases of Braun and Clarke. RESULTS Our observations showed that nurses discuss patients' self-management mainly in short conversations during the care provision. Nurses ask patients about their self-management at home and stimulate patients to express their opinions and to be involved in the care process. Three themes reflect how nurses support self-management: 'Discussing patient's self-management', 'Enhancing patient's involvement in care' and 'Focusing on patient's perspective'. CONCLUSION Hospital nurses have methods to support hospitalized patients' self-management but it does not seem to be an integral part of daily practice. Given current developments in healthcare, it is reasonable to argue that self-management should be given greater emphasis within the hospital setting, requiring a collaborative approach with patients and other healthcare professionals across the care continuum.
Collapse
Affiliation(s)
- Caroline E. M. Otter
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Joost C. Keers
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Celeste Reker
- grid.416468.90000 0004 0631 9063Martini Hospital, Van Swietenlaan 1, Groningen, 9728 NT The Netherlands
| | - Jakobus Smit
- grid.438049.20000 0001 0824 9343University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS The Netherlands
| | - Lisette Schoonhoven
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 6.131, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton, S017 1BJ UK
| | - Janneke M. de Man-van Ginkel
- grid.7692.a0000000090126352Julius Centre for Health Sciences and Primary Care, Nursing Science, University Medical Centre Utrecht, University Utrecht, HP Str. 6.131, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands ,grid.10419.3d0000000089452978Academic Nursing, Department of Gerontology and Geriatrics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA The Netherlands
| |
Collapse
|
9
|
Ryan S, Campbell P, Paskins Z, Hider S, Manning F, Rule K, Brooks M, Hassell A. Exploring the physical, psychological and social well-being of people with rheumatoid arthritis during the coronavirus pandemic: a single-centre, longitudinal, qualitative interview study in the UK. BMJ Open 2022; 12:e056555. [PMID: 35882463 PMCID: PMC9330330 DOI: 10.1136/bmjopen-2021-056555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is an autoimmune, inflammatory, systemic condition that requires specific drug treatment to suppress disease activity and prevent joint deformity. To manage the ongoing symptoms of joint pain and fatigue patients are encouraged to engage in self-management activities. People with RA have an increased incidence of serious illness and mortality, with the potential to impact on quality of life. This study explored patients' experiences of living with RA on physical, psychological and social well-being as well as their ability to employ self-management skills during the coronavirus pandemic. DESIGN Qualitative, longitudinal (baseline, 16 September to 23 November 2020 and after 2-4 months, 11 January to the 17 January 2021), semistructured telephone interviews. SETTING A rheumatology service based in a community hospital. PARTICIPANTS 15 adults with RA. MAIN OUTCOMES Data were analysed using interpretative phenomenological analysis. RESULTS Five themes were identified that related to impact on (1) fear: the dominant emotion, (2) social connections and work practices, (3) physical health, (4) identity and (5) self-management as a coping mechanism. The overriding emotion was one of fear, which remained high throughout both interviews. The negative impact on social well-being increased as the pandemic progressed. Conversely, physical health was not affected at either time point, although participants reported difficulty in interpreting whether physical symptoms were attributable to their RA or COVID-19. Recognition of increased vulnerability led to a reassessment of self-identity; however, respondents reported using previously learnt self-management techniques to cope in the context of the pandemic. CONCLUSIONS The main impact was on emotional and social well-being. Levels of fear and vulnerability which affected self-identity remained high throughout the pandemic and the impact on social well-being increased over time. Physical health remained largely unaffected. Self-management skills were used to maintain a sense of well-being.
Collapse
Affiliation(s)
- Sarah Ryan
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
- School of Nursing and Midwifery, Keele University Faculty of Health, Keele, Staffordshire, UK
| | - Paul Campbell
- Department of Research and Innovation, Midlands Partnership NHS Foundation Trust, Stafford, Staffordshire, UK
- School of Medicine, Keele University Faculty of Health, Keele, Staffordshire, UK
| | - Zoe Paskins
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
- School of Medicine, Keele University Faculty of Health, Keele, Staffordshire, UK
| | - Samantha Hider
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
- School of Medicine, Keele University Faculty of Health, Keele, Staffordshire, UK
| | - Fay Manning
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
- School of Medicine, Keele University Faculty of Health, Keele, Staffordshire, UK
| | - Katrina Rule
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
| | - Michael Brooks
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
| | - Andrew Hassell
- Department of Rheumatology, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke on Trent, UK
- School of Medicine, Keele University Faculty of Health, Keele, Staffordshire, UK
| |
Collapse
|
10
|
Roth EG, Chard S. Affective Practices of Diabetes Self-Management Among Older Adults: Cumulative Effects of Childhood Adversity. THE GERONTOLOGIST 2022; 62:568-576. [PMID: 34406388 PMCID: PMC9019651 DOI: 10.1093/geront/gnab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A strong correlation exists between Type 2 diabetes mellitus and adverse childhood experiences. How adverse childhood experiences inform later-life diabetes management is less understood. This article examines diabetes management from the perspective of affective practice to explore the lingering impact of trauma biographies in diabetes management. RESEARCH DESIGN AND METHODS This secondary narrative analysis of 15 in-depth interviews with community-dwelling older adults with diabetes (subsample of the Subjective Experiences of Diabetes Study) focuses on the ways their reported childhood adversity affects perceptions of and responses to diabetes self-management. RESULTS The experiences of adversity in childhood accumulate, throughout the life course, in the affective practices informing diabetes self-management, from blood glucose testing, to food consumption, to the emotions invested in body size. We identify 3 thematic areas that emerged across participants: (a) undermining self-worth, (b) (over)eating and food as comfort, and (c) weight and body size. DISCUSSION AND IMPLICATIONS Our findings highlight affective practices as a mechanism through which adverse events accumulate and shape well-being over the life course. This analysis also suggests the potential for (de)accumulation of affective practices to improve diabetes management. The findings support recent calls for trauma-informed clinical care.
Collapse
Affiliation(s)
- Erin G Roth
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Baltimore, Maryland, USA
| | - Sarah Chard
- Center for Aging Studies, University of Maryland Baltimore County, Baltimore, Maryland, USA
- Department of Sociology, Anthropology, and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
| |
Collapse
|
11
|
Chala MB, Miller J, Ghahari S, Wondie Y, Abebe A, Donnelly C. Health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia: an interpretive description. BMC Health Serv Res 2022; 22:194. [PMID: 35164738 PMCID: PMC8842538 DOI: 10.1186/s12913-022-07610-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare providers play a key role in supporting people with chronic low back pain to self-manage their condition. The study aimed at exploring how health care providers understand and conceptualize self-management and how they provide self-management support for people with chronic low back pain in Ethiopia. METHODS Health care providers who have supported people with low back pain, including medical doctors and physiotherapists, were approached and recruited from three hospitals in Ethiopia. This study employed an interpretive descriptive approach using semi-structured interviews. FINDINGS Twenty-four participants (7 women; 17 men) with a median age of 28 (range 24 to 42) years and a median of 9.5 years (range 1 to 11 years) of helping people with chronic low back pain were interviewed. Seven major themes related to health care providers' understanding of self-management support for people with chronic low back pain in Ethiopia emerged. The findings show that self-management was a new concept to many and health care providers' had a fragmented understanding of self-management. They used or suggested several self-management support strategies to help people with CLBP self-manage their condition without necessarily focusing on enhancing their self-efficacy skills. The participants also discussed several challenges to facilitate self-management support for people with chronic low back pain. Despite the lack of training on the concept, the providers discussed the potential of providing self-management support for people with the condition. CONCLUSIONS Self-management was a new concept to health care providers. The providers lack the competencies to provide self-management support for people with chronic low back pain. There is a need to enhance the health care providers' self-management support competencies through training.
Collapse
Affiliation(s)
- Mulugeta Bayisa Chala
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada. .,Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Jordan Miller
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
| | - Setareh Ghahari
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
| | - Yemataw Wondie
- Department of Psychology, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
| | - Abey Abebe
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada.,Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Catherine Donnelly
- Queen's University, School of Rehabilitation Therapy, Kingston, ON, Canada
| |
Collapse
|
12
|
Otter CEM, Keers JC, Smit J, Schoonhoven L, de Man-van Ginkel JM. 'Nurses' self-management support to hospitalised patients: A scoping review. J Clin Nurs 2022; 32:2270-2281. [PMID: 35118738 DOI: 10.1111/jocn.16242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/10/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To review the current literature to map and explore the interventions that have been considered or used by nurses to support adult patients' self-management during hospitalisation. BACKGROUND Nurses can play an important role in supporting patients' self-management. Currently, however, it is unclear how nurses perform this task during a patient's stay in hospital. Traditionally, nurses take the primary role in managing patients' care during hospitalisation. Ideally, patients should have the opportunity to continue applying strategies to manage their health conditions as much as possible while in the hospital. This can increase patients' self-efficacy and decrease unnecessary readmissions. DESIGN Scoping review informed by the Joanna Briggs Institute methodology. METHODS A database search was undertaken using Pubmed, CINAHL, PsycInfo, Cochrane, Embase and grey literature sources. Data from the included studies were mapped and summarised in a narrative summary. To synthesise the information that was given about each intervention, we conducted a qualitative inductive content analysis. Results are reported in accordance with the guidelines for reporting Items for systematic review and meta-analyses extension for scoping review (PRISMA-ScR) (Supplementary File 1). RESULTS 83 documents were included in this review. Based on the information about the interventions, three themes were identified: 'self-management support activities', 'focus of self-management support' and the 'intervention procedure'. Five self-management support activities can be distinguished: 'giving education', 'counselling and coaching', 'enhancing responsibility', 'engaging family-caregivers' and 'supporting transition from hospital to home'. The interventions focused on improving disease-related knowledge and on strengthening several self-management skills. Information about the procedure, development and the theoretical underpinning of the intervention was often limited. CONCLUSIONS Most activities within the nursing interventions to support adult patients' self-management during hospitalisation are the part of regular nursing care. However, the transfer of responsibility for care task to the patient is relatively new. Further research could focus on developing interventions addressing all aspects of self-management and that are embedded in the patient's care pathway across settings. RELEVANCE TO CLINICAL PRACTICE Clinical nurses may improve nursing care by supporting all aspects of patients' self-management and facilitate patients as much as possible for taking responsibility for self-management tasks during hospitalisation.
Collapse
Affiliation(s)
| | | | - Jakobus Smit
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands.,School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Janneke M de Man-van Ginkel
- Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
13
|
Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial. Curr Oncol 2022; 29:785-804. [PMID: 35200566 PMCID: PMC8871005 DOI: 10.3390/curroncol29020067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients’ needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO—the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. Methods: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. Results: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. Conclusion: This pilot trial was successful, with minor modifications needed prior to a large trial.
Collapse
|
14
|
Byrne G, Keogh B, Daly L. Self-management support for older adults with chronic illness: implications for nursing practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:86-94. [PMID: 35094539 DOI: 10.12968/bjon.2022.31.2.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Self-management is a key skill that older adults with multiple comorbidities require. Self-management interventions include medication management, self-monitoring and self-awareness and self-management often requires the older adult to manage the emotional consequences of having multiple comorbidities. The benefits of self-management for older adults include reduced reliance on the health system, enhanced quality of life, empowerment of the individual and reduction in the burden associated with chronic illness. Many factors can influence an older adult's ability to self-manage, including health literacy, mental health difficulties and socio-economic factors. Self-management support is the provision of structures, services and programmes to support and enhance the skills of older adults in managing their own conditions. Nurses are in a pivotal position across the continuum of care, using both person-centred care and the 'Making Every Contact Count' approach, to support older adults to self-manage their conditions.
Collapse
Affiliation(s)
- Gobnait Byrne
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Brian Keogh
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Louise Daly
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| |
Collapse
|
15
|
Ould Brahim L, Lambert SD, Feeley N, Coumoundouros C, Schaffler J, McCusker J, Moodie EEM, Kayser J, Kolne K, Belzile E, Genest C. The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology: a systematic review and meta-analysis. BMC Psychiatry 2021; 21:584. [PMID: 34800995 PMCID: PMC8605588 DOI: 10.1186/s12888-021-03504-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 09/28/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). METHODS Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary 'snowball' search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. RESULTS Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was - 0.47 [95% CI -0.73, - 0.21] as compared to control groups for the primary outcome of depression and - 0.53 [95% CI -0.91, - 0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. CONCLUSION Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.
Collapse
Affiliation(s)
| | - Sylvie D. Lambert
- grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, Canada ,St. Mary’s Research Centre, Montreal, Canada
| | - Nancy Feeley
- grid.14709.3b0000 0004 1936 8649Ingram School of Nursing, McGill University, Montreal, Canada ,Centre for Nursing Research, Montreal, Canada
| | - Chelsea Coumoundouros
- grid.8993.b0000 0004 1936 9457Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | | | - Jane McCusker
- St. Mary’s Research Centre, Montreal, Canada ,grid.14709.3b0000 0004 1936 8649Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Erica E. M. Moodie
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Montreal, Montreal, Canada
| | - John Kayser
- grid.459278.50000 0004 4910 4652CIUSSS du Centre-Sud-de-l’Île-de-Montréa, Montreal, Canada
| | - Kendall Kolne
- Trillium Lakelands District School Board, Lindsay, Canada
| | | | - Christine Genest
- grid.14848.310000 0001 2292 3357Faculty of Nursing Sciences, Université de Montreal, Montreal, Quebec Canada
| |
Collapse
|
16
|
Chard S, Henderson L, Wallace BH, Roth EG, Eckert JK. 'How I Can Help Me': Self-Care Priorities and Structural Pressures Among Black Older Adults With Diabetes. THE GERONTOLOGIST 2021; 62:751-761. [PMID: 34698832 DOI: 10.1093/geront/gnab157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Disparities in Type 2 diabetes mellitus (diabetes) represent an ongoing public health challenge. Black older adults are at high risk of diabetes and diabetes' complications. Diet, physical activity, and medication can control these risks, yet disease rates remain elevated. Utilizing an Intersectionality framework, we seek to extend understanding of the social dimensions of diabetes through an examination of the diabetes self-care process from the perspective of Black older adults. RESEARCH DESIGN AND METHODS This project involved a thematic analysis of diabetes illness narrative interviews with Black participants (N=41) in our National Institute on Aging-funded study of diabetes. In a narrative approach, the participant communicates the significance of actions and events. RESULTS The findings suggest that diabetes self-care involves interconnected struggles across four domains of care: 1) multimorbidity management, 2) financial well-being, 3) family support, and 4) formal health care. DISCUSSION AND IMPLICATIONS Black older adult self-care reflects an active process of pursuing meaningful social goals and critical health needs. An Intersectional framework, however, reveals the ongoing histories of inequity that shape this process. Further intervention to address the racist policies and practices found in Black older adults' communities and clinical care is needed to make true progress on diabetes disparities.
Collapse
Affiliation(s)
- Sarah Chard
- Department of Sociology, Anthropology and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Loren Henderson
- Department of Sociology, Anthropology and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Brandy Harris Wallace
- Department of Sociology, Anthropology and Public Health, University of Maryland Baltimore County, Baltimore, Maryland, USA
| | - Erin G Roth
- PATIENTS Program, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - J Kevin Eckert
- Department of Sociology, Anthropology and Public Health, Center for Aging Studies, University of Maryland Baltimore County, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
Collapse
Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| |
Collapse
|
18
|
Liu CK, Seo J, Lee D, Wright K, Tamura MK, Moye JA, Bean JF, Weiner DE. Mobility in Older Adults Receiving Maintenance Hemodialysis: A Qualitative Study. Am J Kidney Dis 2021; 79:539-548.e1. [PMID: 34419517 DOI: 10.1053/j.ajkd.2021.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/10/2021] [Indexed: 12/13/2022]
Abstract
RATIONALE & OBJECTIVE For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the factors affecting mobility in older adults receiving maintenance hemodialysis is limited. STUDY DESIGN Descriptive qualitative study. SETTING AND PARTICIPANTS Using purposive sampling, we recruited 1) persons aged ≥ 60 years receiving maintenance hemodialysis and 2) care partners (≥ 18 years) providing regular support to an older adult receiving hemodialysis. During a single in-person home visit, we assessed mobility using the Short Physical Performance Battery (SPPB) and conducted individual one-on-one interviews regarding important personal factors related to mobility. ANALYTIC APPROACH Descriptive statistics were used for demographic and SPPB data. Transcripts underwent thematic coding, informed by the International Classification of Function framework of mobility. We used conceptual content analysis to inductively extract themes and subthemes. RESULTS We enrolled 31 older adults receiving hemodialysis (42% female, 68% Black) with mean age of 73±8 years and mean dialysis duration of 4.6±3.5 years; mean SPPB was 3.6±2.8 points. Among 12 care partners (75% female, 33% Black), mean age was 54±16 years and mean SPPB was 10.1±2.4 points. Major themes extracted were: 1) mobility represents independence; 2) mobility is precarious; 3) limitations in mobility cause distress; 4) sources of encouragement and motivation are critical; and 5) adaptability is key. LIMITATIONS Modest sample from single geographic area. CONCLUSIONS For older adults receiving hemodialysis, mobility is severely limited and is often precarious in nature, causing distress. Older adults receiving hemodialysis and their care partners have identified sources of encouragement and motivation for mobility, and cite an adaptable mindset as important. Future studies should conceptualize mobility as a variable condition, and build upon this outlook of adaptability in the development of interventions.
Collapse
Affiliation(s)
- Christine K Liu
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Janet Seo
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dayeun Lee
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Section of Pediatric Infectious Diseases, Boston University School of Medicine and Boston Medical Center, Boston, MD
| | - Kristen Wright
- Section of Geriatrics, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Manjula Kurella Tamura
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California; Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Jennifer A Moye
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts; Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel E Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
19
|
Hudon É, Hudon C, Lambert M, Bisson M, Chouinard MC. Generic Self-Reported Questionnaires Measuring Self-Management: A Scoping Review. Clin Nurs Res 2021; 30:855-865. [PMID: 33252267 PMCID: PMC8216317 DOI: 10.1177/1054773820974149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O'Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics.
Collapse
Affiliation(s)
- Émilie Hudon
- Université de Sherbrooke, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | - Catherine Hudon
- Université de Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | | | - Maud-Christine Chouinard
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
- Université de Montréal, Québec, Canada
| |
Collapse
|
20
|
Donnelly S, Wilson AG, Mannan H, Dix C, Whitehill L, Kroll T. (In)Visible illness: A photovoice study of the lived experience of self-managing rheumatoid arthritis. PLoS One 2021; 16:e0248151. [PMID: 33684123 PMCID: PMC7939378 DOI: 10.1371/journal.pone.0248151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/19/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic illnesses, such as Rheumatoid Arthritis (RA), are a growing burden on health care systems worldwide. Self-management emphasises the patient's central role in managing their illness. This is pertinent given the majority of care is provided by the individual themselves; yet how individuals make sense of self-management in everyday life is largely unseen. OBJECTIVE The purpose of this study was to capture the strengths and concerns of individuals with RA in self-managing their illness, raise awareness of their lived experience and spark a dialogue among stakeholders. METHODS A community-based participatory approach, Photovoice, was adopted. A purposive sample of participants were tasked with taking photographs to represent the challenges and solutions to living with RA. Group workshops and semi-structured interviews were conducted to facilitate reflection, dialogue and analysis. Data analysis followed Braun and Clarke's thematic analysis. Public exhibitions were held throughout the Autumn of 2019. RESULTS Eight women and three men (n = 11) across suburban and urban regions of Ireland were recruited (mean age 57 years, disease duration 4-21 years). Participants identified four main themes which reflected the lived experience of self-managing RA: (i) I'm Here but I'm Not, (ii) Visible Illness, (iii) Medicine in All its Forms, (iv) Mind Yourself. These themes captured the challenge of reduced agency, limited contribution and participation, and a complex relationship between visible and invisible illness. Solutions focused on improving psychological and emotional resilience, particularly through personal reflection and increased agency. CONCLUSIONS Our findings suggest that RA is experienced as a fluid relationship between states of masking and surfacing of illness shaped by contextual and situational factors. Photovoice was a highly effective tool to capture and communicate this complexity. Supporting increased agency among individuals with RA to control the (in)visibility of illness and disability can inform the development of future self-management support.
Collapse
Affiliation(s)
- Susie Donnelly
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Anthony G. Wilson
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Hasheem Mannan
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- FLAME University, Pune, India
| | | | - Laura Whitehill
- School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
21
|
McCusker J, Jones JM, Li M, Faria R, Yaffe MJ, Lambert SD, Ciampi A, Belzile E, de Raad M. CanDirect: Effectiveness of a Telephone-Supported Depression Self-Care Intervention for Cancer Survivors. J Clin Oncol 2021; 39:1150-1161. [PMID: 33555912 DOI: 10.1200/jco.20.01802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Depression in post-treatment cancer survivors is common and can impair quality of life. CanDirect is a novel, telephone-delivered depression self-care intervention for cancer survivors. We conducted a randomized controlled superiority trial to compare CanDirect with usual care (UC) in this population. METHODS Participants completing cancer treatment within the past 10 years who had mild-moderate depressive symptoms with or without major depression were recruited from clinical and community settings in Quebec and Ontario. Permuted block random assignment allocated participants to CanDirect plus UC or to UC alone. Assessments of depression severity (Center for Epidemiological Studies-Depression scale [CES-D]; primary outcome) and secondary outcomes health-related quality of life (Short Form Survey-12 mental and physical component summaries), anxiety symptoms (Hospital Anxiety and Depression Scale), activation (Patient Activation Measure), depression diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV), and health services (self-report) were conducted at baseline, as well as 3 and 6 months (primary time point). Analyses of outcomes were adjusted for covariates using linear regression and missing data by inverse probability weighting. RESULTS Participants recruited between September 2016 and October 2018 were randomly assigned to CanDirect (n = 121) or UC (n = 124). Among 245 participants randomly assigned, 218 (89.0%) completed the primary outcome at 6 months. CanDirect participants reported less severe depressive symptoms on the CES-D than UC participants at 6 months, adjusted effect size (ES) 0.61 (95% CI, 0.33 to 0.88). CanDirect participants also had significantly greater quality of life, lower anxiety, more activation, and lower rates of depression diagnoses, compared with UC. Exploratory analysis suggested that sex was a modifier of the primary outcome (interaction term P value = .03); the intervention was less effective in men (ES, 0.12; 95% CI, -0.45 to 0.69). CONCLUSION The findings suggest that CanDirect is an effective method of managing mild-moderate depression symptoms in cancer survivors.
Collapse
Affiliation(s)
| | | | - Madeline Li
- Princess Margaret Cancer Centre, UHN, Toronto, ON, Canada
| | | | | | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | | | | |
Collapse
|
22
|
Self-Management Components as Experienced by People with Parkinson's Disease and Their Carers: A Systematic Review and Synthesis of the Qualitative Literature. PARKINSONS DISEASE 2020; 2020:8857385. [PMID: 33489082 PMCID: PMC7787805 DOI: 10.1155/2020/8857385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 01/13/2023]
Abstract
Background Self-management strategies are important in healthcare for people with Parkinson's to improve daily living. There is limited evidence on effectiveness in Parkinson's, and the active components of effective self-management strategies are uncertain. This review aims to identify and synthesise the qualitative evidence regarding the experiences of self-management components by people with Parkinson's and their carers. Methods MEDLINE, PsycINFO, Embase, Web of Science, and CINAHL were searched from inception to July 8, 2020, for qualitative research concerning self-management for people with Parkinson's. Data were coded and thematically synthesised using NVivo. Findings. Of 9547 search results, six papers were included in the final thematic synthesis. The studies reviewed consisted of 147 participants: 104 were people with Parkinson's and 43 were carers. Seven main themes were derived concerning self-management of people with Parkinson's: (1) medication management, (2) physical exercise, (3) self-monitoring techniques, (4) psychological strategies, (5) maintaining independence, (6) encouraging social engagement, and (7) providing knowledge and information. These components should be incorporated as relevant strategies and techniques and should be specific as well as tailored to different stages of the disease. Discussion. Self-management programmes for people with Parkinson's should include the seven themes presented as part of this review and pay particular attention to presenting relevant information and skills as they relate to different stages of the disease. Tailoring information and social engagement were two components that required specific attention in order to engage people with Parkinson's effectively.
Collapse
|
23
|
Donnelly J, Dykes M, Griffioen R, Moore J, Hale L, Wilkinson A. Self-management support training for undergraduate and graduate entry healthcare professional students: an integrative review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1832720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jace Donnelly
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Michelle Dykes
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rosie Griffioen
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jessie Moore
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
24
|
Merdsoy L, Lambert S, Sherman J. Perceptions, needs and preferences of chronic disease self-management support among men experiencing homelessness in Montreal. Health Expect 2020; 23:1420-1430. [PMID: 32965730 PMCID: PMC7752203 DOI: 10.1111/hex.13106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023] Open
Abstract
Objective This study explored the perceptions, needs and preferences for chronic disease self‐ management (SM) and SM support among men experiencing homelessness. Design A qualitative interpretive approach was used. Eighteen semi‐structured interviews were conducted with 18 homeless men with a chronic disease at an emergency overnight shelter of Welcome Hall Mission (WHM) in Montreal, Quebec. Interviews were audio‐recorded, transcribed verbatim and thematically analysed. Results The majority of participants perceived SM as important, described confidence to perform medical SM behaviours, and creatively adapted their SM behaviours to homelessness. Emotional SM was described as most challenging, as it was intertwined with the experience of homelessness. Three vulnerable groups were identified: (a) those with no social networks, (b) severe physical symptoms and/or (c) co‐morbid mental illness. The preferred mode of delivery for SM support was through consistent contacts with health‐care providers (HCPs) and peer‐support initiatives. Discussion and Conclusions Despite competing demands to fulfill basic needs, participants valued chronic disease SM and SM support. However, SM support must address complex challenges relating to homelessness including emotional SM, multiple vulnerabilities and barriers to forming relationships with HCPs.
Collapse
Affiliation(s)
- Laura Merdsoy
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,St. Mary's Research Centre, Montreal, QC, Canada
| | | |
Collapse
|
25
|
Donnelly S, Manning M, Mannan H, Wilson AG, Kroll T. Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self-managing rheumatoid arthritis. Health Expect 2020; 23:1388-1411. [PMID: 32869404 PMCID: PMC7752197 DOI: 10.1111/hex.13122] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/25/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background As chronic illnesses, such as rheumatoid arthritis (RA), place an increased burden on health‐care systems, the ability of individuals to self‐manage these diseases is crucial. Objective To identify and synthesize the lived experience of self‐management described by adults living with RA. Design A systematic search of five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and ASSIA) was undertaken to identify relevant studies. Data were extracted and quality‐assessed using CASP guidelines. A meta‐synthesis was conducted based on Thomas and Harden's thematic synthesis approach. Results The search identified 8423 publications. After removing duplicates, 6527 records remained of which 32 studies met the inclusion criteria. Quality of studies was moderate to high, yet a considerable lack of reflection on researcher bias was evident. Our analysis identified 28 dimensions of self‐management RA across six domains: (a) cognitive‐emotional, (b) behavioural, (c) social, (d) environmental, (e) physical and (f) technological. Cognitive‐emotional experiences dominated the analysis. Renegotiating ‘the self’ (self‐concept, self‐esteem, self‐efficacy) was a key focus of self‐management among individuals with RA. Conclusion Our findings highlight the focus of ‘the self’ as a central concern in the self‐management of RA. Standardized self‐management programmes may primarily focus on disease management and daily functioning. However, we suggest that personal biographies and circumstances should move to the fore of self‐management support. Registration PROSPERO International Prospective Register of Systematic Reviews 2018: CRD42018100450. Patient or Public Contribution Patient and public involvement was not explicit in this review. However, three authors provided a patient perspective on the self‐management of arthritis and autoimmune disease.
Collapse
Affiliation(s)
- Susie Donnelly
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Hasheem Mannan
- Department of Social Sciences, School of Liberal Education, FLAME University, Pune, India
| | - Anthony G Wilson
- Centre for Arthritis Research, School of Medicine and Medical Science, Conway Institute, University College Dublin, Dublin, Ireland
| | - Thilo Kroll
- Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
26
|
Lee EH, Lee YW, Chae D, Lee KW, Chung JO, Hong S, Kim SH, Kang EH. A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:249-256. [PMID: 32861873 DOI: 10.1016/j.anr.2020.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/10/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. METHOD The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. RESULTS Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test-retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. CONCLUSION The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.
Collapse
Affiliation(s)
- Eun-Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
| | - Young Whee Lee
- Department of Nursing, Inha University, Incheon, Republic of Korea.
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea.
| | - Kwan-Woo Lee
- Department of Endocrinology and Metabolism, School of Medicine, Ajou University, Suwon, Republic of Korea.
| | - Jin Ook Chung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Seongbin Hong
- Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea.
| | - So Hun Kim
- Department of Internal Medicine, School of Medicine, Inha University, Incheon, Republic of Korea.
| | - Eun Hee Kang
- Graduate School of Public Health, Ajou University, Suwon, Republic of Korea.
| |
Collapse
|
27
|
Ould Brahim L. Reconsidering the 'self' in self-management of chronic illness: Lessons from relational autonomy. Nurs Inq 2019; 26:e12292. [PMID: 31020781 DOI: 10.1111/nin.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 01/12/2023]
Abstract
Self-management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self-management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self-interested, and self-governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self-management and the traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self-management will be valuable in guiding its progression and elaborate ways in which self-management research and practice could benefit from incorporating a relational approach to autonomy.
Collapse
Affiliation(s)
- Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
28
|
Manning M, MacFarlane A, Hickey A, Franklin S. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PLoS One 2019; 14:e0214200. [PMID: 30901359 PMCID: PMC6430359 DOI: 10.1371/journal.pone.0214200] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/08/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is increased focus on supporting people with chronic conditions to live well via person-centred, integrated care. There is a growing body of qualitative literature examining the insider perspectives of people with post-stroke aphasia (PWA) on topics relating to personal recovery and living successfully (PR-LS). To date no synthesis has been conducted examining both internal and external, structural influences on living well. In this study, we aimed to advance theoretical understanding of how best to promote and support PR-LS by integrating the perspectives of PWA on a wide range of topics relating to PR-LS. This is essential for planning and delivering quality care. METHODS AND FINDINGS We conducted a systematic review, following PRISMA guidelines, and thematic synthesis. Following a search of 7 electronic databases, 31 articles were included and critically appraised using predetermined criteria. Inductive and iterative analysis generated 5 analytical themes about promoting PR-LS. Aphasia occurs in the context of a wider social network that provides valued support and social companionship and has its own need for formal support. PWA want to make a positive contribution to society. The participation of PWA is facilitated by enabling environments and opportunities. PWA benefit from access to a flexible, responsive, life-relevant range of services in the long-term post-stroke. Accessible information and collaborative interactions with aphasia-aware healthcare professionals empower PWA to take charge of their condition and to navigate the health system. CONCLUSION The findings highlight the need to consider wider attitudinal and structural influences on living well. PR-LS are promoted via responsive, long-term support for PWA, friends and family, and opportunities to participate autonomously and contribute to the community. Shortcomings in the quality of the existing evidence base must be addressed in future studies to ensure that PWA are meaningfully included in research and service development initiatives. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews PROSPERO 2017: CRD42017056110.
Collapse
Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Republic of Ireland
| | - Anne Hickey
- Dept Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| |
Collapse
|
29
|
Nalugya R, Russell S, Zalwango F, Seeley J. The role of children in their HIV-positive parents' management of antiretroviral therapy in Uganda. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:37-46. [PMID: 29504506 DOI: 10.2989/16085906.2017.1394332] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adjustment to life on antiretroviral therapy (ART) and living with HIV as a long-term chronic condition, pose significant medical, social and economic challenges. We investigated children's role in supporting HIV-positive parents to self-manage life on ART. Between 2010 and 2012, we conducted a qualitative study using semi-structured interviews with 38 HIV-positive parents who had been on ART for over a year. They were randomly selected from people accessing ART from three delivery sites in Wakiso district, Uganda. Data were analysed thematically. Participants reported children between the ages of 1 and 47 years providing support. Children were a source of happiness, self-worth, encouragement, and comfort. Both younger and older children supported parents' adherence to treatment through reminding them to take the drugs and honour clinic appointments. Older children provided money to buy medication, food and shelter. Parents reported that the encouragement they received after they disclosed to their children enhanced their survival. After HIV disclosure to their children many of their fears about the future were allayed. Thinking about their children's future brought hope. However, looking after younger children while on ART could be burdensome since some parents could not work to their full capacity due to reduced physical health. Children are an important resource in their parents' adjustment to living with HIV while taking ART. There is a need for children to be supported by appropriate policy and other social and health development structures.
Collapse
Affiliation(s)
- Ruth Nalugya
- a Medical Research Council/Uganda Virus Research Institute , Uganda Research Unit of AIDS , Entebbe , Uganda
| | - Steven Russell
- b School of International Development , University of East Anglia , Norwich , UK
| | - Flavia Zalwango
- a Medical Research Council/Uganda Virus Research Institute , Uganda Research Unit of AIDS , Entebbe , Uganda
| | - Janet Seeley
- a Medical Research Council/Uganda Virus Research Institute , Uganda Research Unit of AIDS , Entebbe , Uganda.,c Global Health Department , London School of Hygiene & Tropical Medicine , London , UK
| |
Collapse
|
30
|
Been‐Dahmen JMJ, Grijpma JW, Ista E, Dwarswaard J, Maasdam L, Weimar W, Van Staa A, Massey EK. Self‐management challenges and support needs among kidney transplant recipients: A qualitative study. J Adv Nurs 2018; 74:2393-2405. [DOI: 10.1111/jan.13730] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Janet M. J. Been‐Dahmen
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Jan Willem Grijpma
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Erwin Ista
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
- Intensive Care Unit Erasmus MC University Medical Center‐Sophia Children's Hospital Rotterdam The Netherlands
| | - Jolanda Dwarswaard
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Louise Maasdam
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| | - AnneLoes Van Staa
- Research Center Innovations in Care Rotterdam University of Applied Sciences Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The Netherlands
| |
Collapse
|
31
|
Hughes S, Lewis S, Willis K, Rogers A, Wyke S, Smith L. The experience of facilitators and participants of long term condition self-management group programmes: A qualitative synthesis. PATIENT EDUCATION AND COUNSELING 2017; 100:2244-2254. [PMID: 28711415 DOI: 10.1016/j.pec.2017.06.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/21/2017] [Accepted: 06/26/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Our aim was to systematically review the qualitative literature about the experiences of both facilitators and participants in a range of group-based programmes to support the self-management of long-term conditions. METHODS We searched 7 databases using the terms 'self-management', 'group' and 'qualitative'. Full text articles meeting the inclusion criteria were retrieved for review. A thematic synthesis approach was used to analyse the studies. RESULTS 2126 articles were identified and 24 were included for review. Group participants valued being with similar others and perceived peer support benefits. Facilitators (HCP and lay) had limited group specific training, were uncertain of purpose and prioritised education and medical conformity over supportive group processes and the promotion of self-management agency and engagement. Overall, studies prioritised positive descriptions. CONCLUSION Group programmes' medical self-management focus may reduce their ability to contribute to patient-valued outcomes. Further research is needed to explore this disconnect. PRACTICE IMPLICATIONS This review supports broadening the scope of group-based programmes to foreground shared learning, social support and development of agency. It is of relevance to developers and facilitators of group self-management programmes and their ability to address the burden of long-term conditions.
Collapse
Affiliation(s)
| | - Sophie Lewis
- Faculty of Arts and Social Sciences, University of NSW, Australia
| | - Karen Willis
- Royal Melbourne Hospital, LaTrobe University, Australia
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Sally Wyke
- Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, United Kingdom
| | | |
Collapse
|
32
|
Schneider A, Rosenberger S, Bobardt J, Bungartz-Catak J, Atmann O, Haller B, Kennedy A, Enck P. Self-help guidebook improved quality of life for patients with irritable bowel syndrome. PLoS One 2017; 12:e0181764. [PMID: 28742808 PMCID: PMC5526555 DOI: 10.1371/journal.pone.0181764] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022] Open
Abstract
Background The primary aim of our study was to evaluate the impact of a comprehensive self-help guidebook on the disease related quality of life for patients with irritable bowel syndrome (IBS). The secondary aim was to evaluate whether the guidebook is less effective in IBS patients with depression, somatization disorder or panic disorder as a psychiatric comorbidity. Methods Prospective observational study. At baseline (t1), patients filled in the ´Functional Digestive Disorders Quality of Life´ (FDDQL) questionnaire and received the IBS guidebook together with an explanation of its content and use. Depression, anxiety and somatization were evaluated with the Patient Health Questionnaire (PHQ). Three (t2) and six months (t3) later, the questionnaire was sent by mail to the patients for follow-up evaluation. Data were analyzed with repeated measures ANOVA. Results 71 patients participated (74.6% female). 53 (74.6%) completed the final assessment at t3 after 6 months. The global FDDQL score increased from 49.3 (SD 12.7) at t1 to 64.3 (SD 16.0) at t3 (p < 0.001). There was a significant between-subjects effect on the global FDDQL score related to depression (p = 0.001), anxiety (p = 0.001) and somatization (p = 0.011). Thus, the quality of life of patients with psychosomatic comorbidity was lower at baseline, but showed a similar increase within the following six months. Conclusion The self-help guidebook significantly improved measured quality of life for IBS patients. The use of screening questionnaires like PHQ might be valuable to identify patients with more complex problems. This might be helpful for them to intensify and adapt therapy. Further research has to evaluate if patients with psychological comorbidity are treated more effectively when they receive psychotherapy or specific medication in addition to the self-management guidebook.
Collapse
Affiliation(s)
- Antonius Schneider
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
- * E-mail:
| | - Stefanie Rosenberger
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Johanna Bobardt
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jessica Bungartz-Catak
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Oxana Atmann
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bernhard Haller
- Institute for Medical Statistics and Epidemiology, University Hospital Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield Campus, Southampton, United Kingdom
| | - Paul Enck
- Department of Internal, Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital, Tübingen, Germany
| |
Collapse
|
33
|
van de Bovenkamp HM, Dwarswaard J. The complexity of shaping self-management in daily practice. Health Expect 2017; 20:952-960. [PMID: 28152248 PMCID: PMC5600231 DOI: 10.1111/hex.12536] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022] Open
Abstract
Background and context Many countries are giving patients a more active role in health care, on both the individual and collective level. This study focuses on one aspect of the participation agenda on the individual level: self‐management. The study explores self‐management in practice, including the implications of the difficulties encountered. Objective To gain insight into the complexity of self‐management practice. This is crucial for developing both self‐management interventions and the participation policy agenda. Methods Qualitative semi‐structured interviews with experts (n=6) and patients with a chronic condition (n=20). Results In terms of level of involvement and type of activity, shaping self‐management in practice depends on personal and social dynamics, patients’ ideas of the good life and their interactions with care professionals. Clashes can arise when patients and professionals hold differing ideas, based on different values, about the level and type of patient involvement. Discussion The discussion on self‐management should account for the fact that how we define self‐management is very much a normative issue. It depends on the norms and values of patients, professionals and underlying health‐care policies. Differing ideas present professionals with ethical dilemmas which they should reflect on. However, professional reflection alone is not enough to deal with these dilemmas. The participation agenda needs far wider ranging reflection on how participation relates to other values in health care.
Collapse
Affiliation(s)
| | - Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| |
Collapse
|
34
|
van Hooft SM, Dwarswaard J, Bal R, Strating MM, van Staa A. What factors influence nurses’ behavior in supporting patient self-management? An explorative questionnaire study. Int J Nurs Stud 2016; 63:65-72. [DOI: 10.1016/j.ijnurstu.2016.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
|
35
|
Eller LS, Lev EL, Yuan C, Watkins AV. Describing Self-Care Self-Efficacy: Definition, Measurement, Outcomes, and Implications. Int J Nurs Knowl 2016; 29:38-48. [PMID: 27245100 DOI: 10.1111/2047-3095.12143] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The pragmatic utility method of concept analysis was used to explore the usefulness of the concept self-care self-efficacy. DATA SOURCES Empirical studies across disciplines published between 1996 and 2015 were used as data. DATA SYNTHESIS A data matrix was developed. Analytical questions and responses were derived from the data to understand patterns, develop new knowledge and achieve synthesis. CONCLUSION Usefulness of the concept is contingent on how it is defined and measured. Self-care self-efficacy is associated with performance of self-care activities and positive health outcomes in diverse populations. IMPLICATIONS Research can guide development of targeted interventions to increase patients' self-care self-efficacy, thus reducing costs, and assisting people to achieve optimal health.
Collapse
Affiliation(s)
- Lucille S Eller
- Professor Emeritus at the School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Elise L Lev
- Professor Emeritus at the School of Nursing, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Changrong Yuan
- Professor at the School of Nursing, Second Military University, Shanghai, China
| | - Ann Vreeland Watkins
- Life Sciences Librarian at the John Cotton Dana Library, Rutgers, The State University of New Jersey, Newark, New Jersey
| |
Collapse
|
36
|
Ogunbayo OJ, Schafheutle EI, Cutts C, Noyce PR. A qualitative study exploring community pharmacists' awareness of, and contribution to, self-care support in the management of long-term conditions in the United Kingdom. Res Social Adm Pharm 2015; 11:859-79. [DOI: 10.1016/j.sapharm.2014.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/30/2014] [Accepted: 12/31/2014] [Indexed: 10/24/2022]
|
37
|
MacNab M, Lee SH, McCloughan L, Hanley J, McKinstry B, Pinnock H. Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project. BMC Health Serv Res 2015; 15:485. [PMID: 26503028 PMCID: PMC4624181 DOI: 10.1186/s12913-015-1135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background Pulse oximetry could potentially contribute to self-monitoring. NHS Lothian’s ‘Light Touch’ service provided COPD patients with a self-management plan based on symptoms and oximetry. The service was overseen (though not actively monitored) by respiratory-trained community teams who were contactable by a telephone helpline. We aimed to assess the feasibility, perceived utility and impact of the ‘Light Touch’ service. Methods A before-and-after assessment of St George’s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS) and use of healthcare resources during the 6-month feasibility study compared to the previous corresponding 6-months. Paired semi-structured interviews with patients at baseline and 6-months, interviews with managers and a focus group of professionals explored perceptions of the service and self-management. Transcripts were coded, and analysed thematically. Results We recruited 51 participants (mean age 69.7 years (SD 8.4); 21 (46 %) male). 46 participants completed quantitative follow up (2 died, 2 were unwell, 1 refused). SGRQ: 21 (46 %) participants improved by 4 or more (the minimum important difference); 12 (26 %) deteriorated by 4 or more. HADS: more participants had normal scores for anxiety (65 %) and depression (80 %) at 6-months than at baseline (51 and 64 %). More emergency therapy was prescribed during the study period compared to the previous year. Only 18 participants (39 %) contacted the Light Touch Helpline during the 6-month study. Twenty patients provided a total of 36 interviews, 8 clinicians contributed to a focus group and 6 managers were interviewed. Patients considered that the oximetry readings heightened awareness of their condition and gave them confidence to make self-management decisions. Healthcare professionals valued oximetry as a tool for teaching people self-management skills, but were concerned that patients rarely contacted the teams for help or advice during the study. Conclusions ‘Light Touch’ shows promise as a low-cost strategy for empowering patients’ self-management skills and reducing reliance on clinical supervision. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1135-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michele MacNab
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Siew Hwa Lee
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
| | - Lucy McCloughan
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Janet Hanley
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK.
| | - Brian McKinstry
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
| |
Collapse
|
38
|
Khair K, Meerabeau L, Gibson F. Self-management and skills acquisition in boys with haemophilia. Health Expect 2015; 18:1105-13. [PMID: 23711015 PMCID: PMC5060849 DOI: 10.1111/hex.12083] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is an increasing prevalence of children/young people with long-term conditions (LTC) in the UK due to improvements in health-care management and delivery. These children are often involved, from an early age, in their own care and management; yet, there are little data to support how or when they develop the necessary skills and knowledge to become competent at this care. OBJECTIVE This study aimed to understand self-management of haemophilia, from a child's perspective, in the 21st century in the UK where intensive prophylactic therapy is given from early childhood. DESIGN A qualitative study using grounded theory to evaluate life-experiences of children and young people with haemophilia. SETTING AND PARTICIPANTS Thirty boys aged 4-16 with severe haemophilia treated at a single paediatric haemophilia care centre were interviewed at home or in a focus group. INTERVENTION/VARIABLES Multimethod qualitative research including age-appropriate research tools (draw and write, photo-elicitation and interviews) to facilitate data collection from children. RESULTS Boys develop self-management skills over time. They learn from health-care professionals, their parents and other family members with haemophilia. DISCUSSION Self-management skills (bleed recognition, self-infusion, self and medicines management, pain and risk management and conceptualizing preventative therapy) are developed through experiential learning and individualized education, and not through formalized expert patient programmes. CONCLUSION The boys in this study have benefited from early prophylactic factor replacement therapy. They develop skills in haemophilia and self-management at a relatively young age and are experts in their own haemophilia care.
Collapse
Affiliation(s)
- Kate Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust LondonLondonUK
- University of GreenwichLondonUK
| | | | - Faith Gibson
- Great Ormond Street Hospital for Children NHS Foundation Trust and London South Bank UniversityLondonUK
| |
Collapse
|
39
|
Been-Dahmen JM, Dwarswaard J, Hazes JM, van Staa A, Ista E. Nurses' views on patient self-management: a qualitative study. J Adv Nurs 2015; 71:2834-45. [DOI: 10.1111/jan.12767] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Janet M.J. Been-Dahmen
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus Medical Center; Rheumatology Department; The Netherlands
| | - Jolanda Dwarswaard
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
| | | | - AnneLoes van Staa
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus University Rotterdam; Institute of Health Policy & Management; The Netherlands
| | - Erwin Ista
- Erasmus Medical Center-Sophia Children's Hospital; Intensive Care Unit; Rotterdam The Netherlands
| |
Collapse
|
40
|
Dwarswaard J, van de Bovenkamp H. Self-management support: A qualitative study of ethical dilemmas experienced by nurses. PATIENT EDUCATION AND COUNSELING 2015; 98:1131-1136. [PMID: 26070469 DOI: 10.1016/j.pec.2015.05.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/11/2015] [Accepted: 05/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Policymakers increasingly focus their attention on stimulating patients' self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses' activities, but also the values underlying the nurse-patient relationship. The latter can result in ethical dilemmas. METHODS In order to identify possible dilemmas a qualitative study consisting of semi-structured interviews was conducted. Six experts on self-management and medical ethics and 15 nurses participated. RESULTS Nurses providing self-management support were at risk of facing three types of ethical dilemmas: respecting patient autonomy versus reaching optimal health outcomes, respecting patient autonomy versus stimulating patient involvement, and a holistic approach to self-management support versus safeguarding professional boundaries. CONCLUSION The ethical dilemmas experienced by nurses rest on different views about what constitutes good care provision and good self-management. Interviewed nurses had a tendency to steer patients in a certain direction. They put great effort into convincing patients to follow their suggestions, be it making the 'right choice' according to medical norms or becoming actively involved patients. PRACTICE IMPLICATIONS Because self-management support may result in clashing values, the development and implementation of self-management support requires deliberation about the values underlying the relationship between professionals and patients.
Collapse
Affiliation(s)
- Jolanda Dwarswaard
- Research Centre Innovations of Care, Rotterdam University of Applied Sciences, The Netherlands; Department of Health Policy & Management, Erasmus University Rotterdam, The Netherlands.
| | | |
Collapse
|
41
|
Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One 2015; 10:e0130990. [PMID: 26162086 PMCID: PMC4498685 DOI: 10.1371/journal.pone.0130990] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Self-management has received growing attention as an effective approach for long-term condition management. Little is known about which outcomes of supported self-management are valued by patients, their families, health professionals and those who commission self-management services. This study systematically reviewed published empirical evidence in accordance with PRISMA guidelines to determine the outcomes of self-management valued by these key stakeholder groups, using three prominent exemplar conditions: colorectal cancer, diabetes and stroke. AIM To systematically review the literature to identify which generic outcomes of self-management have been targeted and are considered important using three exemplar conditions (colorectal cancer, diabetes and stroke), which collectively have a range of features that are likely to be representative of generic self-management issues. METHODS Systematic searching of nine electronic databases was conducted in addition to hand searches of review articles. Abstracts were identified against inclusion criteria and appraised independently by two reviewers, using a critical appraisal tool. Synthesis of findings was conducted using mixed research synthesis. RESULTS Over 20,536 abstracts were screened. 41 studies which met the review criteria were fully retrieved and appraised. The majority of evidence related to diabetes. Few studies directly focussed on stakeholders' views concerning desired self-management outcomes; the majority of evidence was derived from studies focusing upon the experience of self-management. The views of health care commissioners were absent from the literature. We identified that self-management outcomes embrace a range of indicators, from knowledge, skills, and bio-psychosocial markers of health through to positive social networks. CONCLUSIONS Patients', families', health professionals' and commissioners' views regarding which outcomes of self-management are important have not been clearly elicited. The extent to which bio-psychosocial indicators relate to successful self-management from the perspectives of all groups of stakeholders is unknown. Further investigation regarding which self-management outcomes are considered important by all stakeholders is necessary to guide the commissioning and design of future self-management services.
Collapse
Affiliation(s)
- Emma Boger
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jaimie Ellis
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sue Latter
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Kennedy
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Fiona Jones
- Department of Social Care and Education, St George’s and Kingston University of London, London United Kingdom
| | - Vicky Fenerty
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Ian Kellar
- Institute of Psychological Sciences, University of Leeds, Leeds, United Kingdom
| | - Sara Demain
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
42
|
Lenzen SA, Daniëls R, van Bokhoven MA, van der Weijden T, Beurskens A. Setting goals in chronic care: Shared decision making as self-management support by the family physician. Eur J Gen Pract 2014; 21:138-44. [DOI: 10.3109/13814788.2014.973844] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Johnston B, Rogerson L, Macijauskiene J, Blaževičienė A, Cholewka P. An exploration of self-management support in the context of palliative nursing: a modified concept analysis. BMC Nurs 2014; 13:21. [PMID: 25120381 PMCID: PMC4129427 DOI: 10.1186/1472-6955-13-21] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/26/2014] [Indexed: 11/29/2022] Open
Abstract
Background The role of self-management is often ambiguous, yet, it is an important area in clinical practice for palliative nurses. A clear conceptual understanding, however, of what it represents is lacking. Method This paper reports an analysis of the concept of self-management support in palliative nursing. Avant and Walker’s method was used to guide this concept analysis. A search of electronic databases (1990–2013), use of internet search engines and supplementary hand searching produced an international data set of reviews, empirical research, editorials, protocols and guidelines. Results Based on the analysis self-management support in palliative nursing has been defined as assessing, planning, and implementing appropriate care to enable the patient to live until they die and supporting the patient to be given the means to master or deal with their illness or their effects of their illness themselves. Conclusions Clarity with the concept of self-management support and palliative nursing could enable nurses to provide more patient and family centred care to people facing life threatening illnesses.
Collapse
Affiliation(s)
- Bridget Johnston
- Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2HA, UK
| | - Liz Rogerson
- School of Nursing and Midwifery, University of Dundee, 11 Airlie Place, Dundee Scotland, DD1 4HJ, UK
| | - Jurate Macijauskiene
- Faculty of Nursing, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas, LT-44307, Lithuania
| | - Aurelija Blaževičienė
- Faculty of Nursing, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas, LT-44307, Lithuania
| | - Patricia Cholewka
- Department of Nursing, New York City College of Technology, CUNY, 300 Jay Street, P-505, Brooklyn, NY 11201, USA
| |
Collapse
|
44
|
Paterson C, Jones M, Rattray J, Lauder W. Identifying the self-management behaviours performed by prostate cancer survivors: a systematic review of the evidence. J Res Nurs 2014. [DOI: 10.1177/1744987114523976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Prostate cancer survivors are keen to engage as active partners in the management of their condition but have voiced a number of unmet support needs that make effective self-management problematic. Identifying self-management behaviours and evaluating how self-management changes over time may provide valuable insights into how men can be better supported to self-manage. Our systematic review aimed to identify the self-management behaviours for prostate cancer survivors and to evaluate whether these change over time. Methods Using the PRISMA statement we performed a systematic review of studies that identified the self-management behaviours of prostate cancer survivors. Databases searched included: DARE, CDSR, Medline, CINAHL, PsycINFO and ASSIA. Studies were classified by levels of evidence and quality assessment. Results 111 publications were retrieved from the search and 5 publications were included. Men performed a variety of self-management behaviours for psychological and physical problems. Only one study assessed changes in self-management behaviours over time and was limited to men treated by radiotherapy. Conclusion Despite the recent political drive for cancer survivors to self-manage, this review has demonstrated the evidence base is under-developed and a wide range of research is needed to address the unmet supportive care needs of prostate cancer survivors. Practically, this review has identified that Dodd’s Self-Care Log was found to have the strongest psychometric properties for additional research in this area.
Collapse
Affiliation(s)
- Catherine Paterson
- Research Fellow (RAII) in Cancer Care, Faculty of Health and Medical Sciences, School of Health and Social Care, University of Surrey, UK
| | - Martyn Jones
- Professor of Healthcare Research in School of Nursing and Midwifery, University of Dundee, UK
| | - Janice Rattray
- Reader in Acute and Critical Care Nursing, School of Nursing and Midwifery, University of Dundee, UK
| | - William Lauder
- Professor of Nursing at the University of Stirling, UK; Visiting Professor at the University of South Florida, USA
| |
Collapse
|
45
|
Martin F, Kiwanuka T, Kawuma R, Zalwango F, Seeley J. Tasks and strategies of self-management of living with antiretroviral therapy in Uganda. AIDS Patient Care STDS 2013; 27:697-706. [PMID: 24219780 DOI: 10.1089/apc.2013.0254] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is increasing interest in promoting and supporting self-management of HIV and antiretroviral treatment (ART), including in resource-limited settings. Although the impact of HIV and ART on people in Uganda has been explored, little attention has been paid to how people self-manage. This qualitative study collected data from 20 participants on ART in Wakiso district, Uganda, using in-depth interviews, life histories, and observations to explore the tasks and strategies of living with ART. The identified strategies were compared to two existing self-management frameworks. Results highlighted a range of tasks including obtaining, taking, and adhering to ART medication, monitoring their condition, living with stigma and managing disclosure, maintaining general health, and adjusting to new roles. Participants described a range of strategies or behaviors to manage, which they actively created and used, tailored to their needs and environment. Comparison with existing frameworks revealed many similarities, with some local differences in enactment, and greater emphasis in our sample on obtaining the medication. Interventions to support people with self-management in Uganda, and possibly other resource-limited settings, require careful adaptation to local settings. The degree to which each of these strategies may improve health and quality of life requires further investigation.
Collapse
Affiliation(s)
- Faith Martin
- School of International Development, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Thadeus Kiwanuka
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Rachel Kawuma
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Flavia Zalwango
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| | - Janet Seeley
- School of International Development, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda
| |
Collapse
|
46
|
Owens J, Cribb A. Beyond Choice and Individualism: Understanding Autonomy for Public Health Ethics. Public Health Ethics 2013. [DOI: 10.1093/phe/pht038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
47
|
Patterns of symptom recognition, interpretation, and response in heart failure patients: an integrative review. J Cardiovasc Nurs 2013; 28:348-59. [PMID: 22580629 DOI: 10.1097/jcn.0b013e3182531cf7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heart failure (HF) is a chronic illness affecting more than 5 million Americans, and it continues to lead healthcare-related expenditures in the United States. Hospitalization rates remain high and are caused by many factors, including poor self-care behaviors. Self-care research is growing, and a situation-specific theory for the HF population is now published. Self-care management, which is part of self-care, includes a series of responses and actions that the individual living with HF assumes in response to a change in baseline health. A critical aspect of enacting a self-care management plan is the ability to recognize changes in baseline health as being related to HF. PURPOSE This integrative review examined research to date on self-reported patterns of symptom recognition, an antecedent to self-care management, and treatment-seeking behaviors in HF patients. CONCLUSIONS Descriptive research strategies were predominantly used to examine symptom recognition, interpretation, and response in HF patients. Seven studies used retrospective approaches, such as chart review or patient recall, to collect data, and 7 studies collected data from the patient prospectively. The quantitative portion of 2 mixed-methods study was also analyzed. Dyspnea was the most frequently reported symptom across all studies reviewed. Dyspnea was characterized in terms of duration and was defined inconsistently across studies. In some studies, duration of dyspnea was associated with treatment-seeking delays. Elderly patients and newly diagnosed HF patients are more likely to delay treatment seeking for onset of symptoms. CLINICAL IMPLICATIONS Research is limited on symptom recognition and treatment-seeking behaviors in HF patients. Evidence suggests that symptom recognition may be impaired in the elderly population. Research studies to date on symptom recognition have largely been descriptive; no studies in this review followed patients' ability to recognize and respond to symptoms prospectively in their home environment. Symptoms may vary and their pattern may influence patients' recognition and/or response patterns.
Collapse
|
48
|
Pickens JM. Self-Care, Nursing Theory, and Evidence-Based Practice, by S. G. Taylor and K. Renpenning. (New York: Springer, 2011). Nurs Sci Q 2013. [DOI: 10.1177/0894318413489159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Judith M. Pickens
- Clinical Associate Professor, Arizona State University, College of Nursing & Health Innovation, Melrose Park, IL, USA
| |
Collapse
|