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Blytt KM, Kolltveit BCH, Graue M, Robberstad M, Ternowitz T, Carlsen S, Iversen MM. The implementation of telemedicine in wound care: a qualitative study of nurses' and patients' experiences. BMC Health Serv Res 2024; 24:1146. [PMID: 39343892 PMCID: PMC11439246 DOI: 10.1186/s12913-024-11620-w] [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: 04/17/2023] [Accepted: 09/20/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The increasing use of telemedicine (TM) represents a major shift for health workers and patients alike. Thus, there is a need for more knowledge on how these interventions work and are implemented. We conducted a qualitative process-evaluation alongside a larger randomized controlled trial designed to evaluate a telemedicine follow-up intervention for patients with a leg- or foot-ulcer, who either have or do not have diabetes. Accordingly, the aim of this study was to explore how both health care professionals and patients experienced the implementation of TM follow-up in primary care. METHODS The intervention comprised an interactive TM platform facilitating guidance and counselling regarding wound care between nurses in primary care and nurses in specialist health care in Norway. Nurses and patients from seven clusters in the intervention arm were included in the study. We conducted 26 individual interviews (14 patients and 12 nurses) in primary care between December 2021 and March 2022. Thematic analyses were conducted. RESULTS The analyses revealed the following themes: (1) enhancing professional self-efficacy for wound care, (2) a need to redesign the approach to implementing TM technology and (3) challenging to facilitate behavioral changes in relation to preventive care. As to patients' experiences with taking part in the intervention, we found the following three themes: (1) experience with TM promotes a feeling of security over time, (2) patients' preferences and individual needs on user participation in TM are not met, and (3) experiencing limited focus on prevention of re-ulceration. CONCLUSIONS TM presents both opportunities and challenges. Future implementation should focus on providing nurses with improved technological equipment and work on how to facilitate the use of TM in regular practice in order to fully capitalize on this new technology. Future TM interventions need to tailor the level of information and integrate a more systematic approach for working with preventive strategies. CLINICAL TRIAL REGISTRATION NCT01710774. Registration Date 2012-10-17.
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Affiliation(s)
- Kjersti Marie Blytt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway.
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
| | - Mari Robberstad
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Carlsen
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Marjolein Memelink Iversen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, P.O. Box 7030, Bergen, 5020, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
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Kim HJ, Lee KE, Yang E, Chang SJ. A Tailored Intervention for Improving Diabetes Self-care Among Adults With Visual Impairment: A Pilot Study. Can J Diabetes 2024:S1499-2671(24)00106-0. [PMID: 38795828 DOI: 10.1016/j.jcjd.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES Our aim in this study was to develop and evaluate a tailored intervention for improving diabetes self-care among people with visual impairment (TID-VI) in South Korea. METHODS The TID-VI program was designed around the barriers, resources, and perceptual factors to promote diabetes self-care in those with visual impairment (VI). A single-arm pilot study was conducted to evaluate the feasibility and preliminary effects of the intervention. Diabetes self-efficacy, self-care behaviours, depression, health-related quality of life, and clinical outcomes (fasting blood glucose, glycated hemoglobin [A1C], lipids, and blood pressure) were measured before, and up to 2 months after the 12-week intervention. RESULTS All 14 participants completed TID-VI. Diabetes self-efficacy, diabetes self-care behaviours, depression, and health-related quality of life showed improvement from baseline that was sustained at 2 months. Although high- and low-density lipoprotein also improved, there were no differences in blood glucose, A1C, total cholesterol, or blood pressure at 2 months. CONCLUSIONS A theory-driven, tailored intervention specific to the needs of adults with VI can produce substantial improvements in patient-reported quality of life and health status outcomes, although the benefits are yet to be confirmed in a controlled study.
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Affiliation(s)
- Hee Jung Kim
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Kyoung-Eun Lee
- Department of Nursing Science, SunMoon University, Chungnam, South Korea
| | - Eunjin Yang
- College of Nursing, Research Institute of AI and Nursing Science, Gachon University, Incheon, South Korea
| | - Sun Ju Chang
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, South Korea.
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Jandaghian Bidgoli M, Jamalnia S, Pashmforosh M, Shaterian N, Darabiyan P, Rafi A. The effect of Orem self-care model on the improvement of symptoms and quality of life in patients with diabetes: A scoping review. INVESTIGACION Y EDUCACION EN ENFERMERIA 2024; 42:e08. [PMID: 39083820 PMCID: PMC11290896 DOI: 10.17533/udea.iee.v42n1e08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/02/2024] [Indexed: 08/02/2024]
Abstract
Objective to evaluate the association of Orem self-care model improvement of symptoms and quality of life in patients with diabetes. Methods A scoping review was carried on bibliographic databases: PubMed-Medline, Scopus, SID and Magiran. The inclusion criteria encompassed studies examining the impact of the Orem self-care model on diabetic patients. Studies considered for inclusion needed to have full-text availability and be written in either English or Persian, with key words including "Models", "Nursing", "Quality of Life", and "Diabetes Mellitus". CONSORT checklist and STROBE statement were selected for quality assessment. Results A total of 9 studies were included, all using quantitative methodology and focusing on adults or older adults. The majority of articles focused on quality of life and diabetic symptoms. 8 studies showed positive outcomes after implementation of the model. The findings indicate that this model led to an enhanced level of self-efficacy, improved quality of life, and better self-care practices among diabetic patients. Conclusion Orem self-care model can reduce the diabetic symptoms and improve the quality of life, self-efficacy and self-care in these patients.
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Affiliation(s)
| | - Sheida Jamalnia
- Department of Nursing and Midwifery, Kazeroun Branch, Islamic Azad University, Kazeroun, Iran. 3 Ph.D student of e-Learning, virtual School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Negin Shaterian
- Student Research Committee, Kashan University of Medical Sciences, Kashan, Iran.
| | - Pouriya Darabiyan
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Ahvaz, Iran.
| | - Alireza Rafi
- M.Sc of Nursing, Behbahan Faculty of Medical Sciences, Behbahan, Iran.
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Health Education Programmes to Improve Foot Self-Care Knowledge and Behaviour among Older People with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis (A Systematic Review). Healthcare (Basel) 2022; 10:healthcare10061143. [PMID: 35742194 PMCID: PMC9222212 DOI: 10.3390/healthcare10061143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: ESKD is a total or near-permanent failure in renal function. It is irreversible, progressive and ultimately fatal without peritoneal dialysis (PD), haemodialysis (HD) or kidney transplantation. Dialysis treatments can create new and additional problems for patients, one of which is foot amputation, as a result of non-healing wounds and vascular complications. The association between dialysis therapy and foot ulceration is linked to several factors: physical and psychological health; peripheral arterial disease (PAD); mobility; tissue oxygenation; manual dexterity; neuropathy; visual acuity; anaemia; nutrition; leg oedema; hypoalbuminemia; infection; inadequacy of dialysis; and leg/foot support during dialysis. The potential risk factors for foot ulceration may include: not routinely receiving foot care education; incorrect use of footwear; diabetes duration; neuropathy; and peripheral arterial disease. Aim: The aim of this review is to examine the factors that help or hinder successful implementation of foot care education programmes for ESKD patients receiving haemodialysis. Method: A comprehensive literature search was completed using five electronic databases. Medline; CINAHL; Embase; PsycINFO; and Cochrane Library. The Joanna Briggs Institute checklist (JBI) was used to quality appraise full text papers included in the review. The systematic review was not limited to specific categories of interventions to enable optimal comparison between interventions and provide a comprehensive overview of the evidence in this important field of foot care. Results: We found no previously published studies that considered foot care education programmes for haemodialysis patients who are not diabetic; thus, the present systematic review examined four studies on diabetic patients receiving haemodialysis exposed to foot care education programmes from various types of intervention designs. Conclusions: This systematic review has provided evidence that it is possible to influence foot care knowledge and self-care behaviours in both diabetic patients receiving haemodialysis and healthcare professionals.
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Suglo JN, Winkley K, Sturt J. Prevention and Management of Diabetes-Related Foot Ulcers through Informal Caregiver Involvement: A Systematic Review. J Diabetes Res 2022; 2022:9007813. [PMID: 35462785 PMCID: PMC9021995 DOI: 10.1155/2022/9007813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/27/2022] Open
Abstract
Background The literature remains unclear whether involving informal caregivers in diabetes self-care could lead to improved diabetic foot outcomes for persons at risk and/or with foot ulcer. In this review, we synthesized evidence of the impact of interventions involving informal caregivers in the prevention and/or management of diabetes-related foot ulcers. Methods A systematic review based on PRISMA, and Synthesis Without Meta-analysis (SWiM) guidelines was conducted. MEDLINE (Ovid), Embase (Ovid), PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trial of the Cochrane Library databases were searched from inception to February 2021. The following MESH terms were used: diabetic foot, foot ulcer, foot disease, diabetes mellitus, caregiver, family caregiver ,and family. Experimental studies involving persons with diabetes, with or at risk of foot ulcers and their caregivers were included. Data were extracted from included studies and narrative synthesis of findings undertaken. Results Following the search of databases, 9275 articles were screened and 10 met the inclusion criteria. Studies were RCTs (n = 5), non-RCTs (n = 1), and prepoststudies (n = 4). Informal caregivers through the intervention programmes were engaged in diverse roles that resulted in improved foot ulcer prevention and/or management outcomes such as improved foot care behaviors, increased diabetes knowledge, decreased HbA1c (mmol/mol or %), improved wound healing, and decreased limb amputations rates. Engaging both caregivers and the person with diabetes in education and hands-on skills training on wound care and foot checks were distinctive characteristics of interventions that consistently produced improved foot self-care behavior and clinically significant improvement in wound healing. Conclusion Informal caregivers play diverse and significant roles that seem to strengthen interventions and resulted in improved diabetes-related foot ulcer prevention and/or management outcomes. However, there are multiple intervention types and delivery strategies, and these may need to be considered by researchers and practitioners when planning programs for diabetes-related foot ulcers.
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Affiliation(s)
- Joseph Ngmenesegre Suglo
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
- Department of Nursing, Presbyterian University College Ghana, Ghana
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
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Costa MSA, Vilhena E, Leite Â, Almeida AC, Pereira MG. Quality of Life in Caregivers of Type 2 Diabetes Patients After Patient's Surgery: a Path Analysis. Int J Behav Med 2021; 29:438-447. [PMID: 34608592 DOI: 10.1007/s12529-021-10028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type 2 diabetes Mellitus is a chronic disease, and one of its complications may result in amputation. The goal of this study was to evaluate the impact of psychosocial variables, over time, on quality of life (QoL) of caregivers of patients (N = 110) who had undergone a recent amputation. METHOD A longitudinal design was employed: (T1) 1 month after the patient's surgery; (T2) 7 months after; and (T3) 10 months after. Burden Assessment Scale, Family Assessment Device, Revised Impact of Events Scale, Family Disruption from Illness Scale, and Short Form Health Survey were used. A path analysis model was tested. RESULTS Burden, perception of family functioning, and traumatic symptoms at T1 showed a positive impact on the perception of family functioning, at T2. Traumatic symptoms, at T1, predicted traumatic symptoms at T2 being also a mediator between those symptoms (T1) and physical QoL (T3). Physical and traumatic symptoms, at T1 predicted physical symptoms, at T2 affecting both mental and physical QoL (T3), being also a mediator in these relationships. Burden (T1) also had a direct effect on mental QoL (T3) and at T2 had an impact on physical QoL (T3) mediating also the relationship between burden/physical symptoms at T1 and physical QoL, at T3. CONCLUSION Intervention should focus on physical and traumatic symptoms as well as burden since they were both mediators regarding mental and physical QoL.
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Affiliation(s)
- M Suely Alves Costa
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-245, Braga, Portugal
| | - Estela Vilhena
- 2Ai School of Technology, IPCA, 4750-810, Barcelos, Portugal
| | - Ângela Leite
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-245, Braga, Portugal
| | - Ana C Almeida
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-245, Braga, Portugal
| | - M Graça Pereira
- Research Center in Psychology (CIPsi), School of Psychology, University of Minho, Campus de Gualtar, 4710-245, Braga, Portugal.
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Ikura K, Kato H, Azuma H, Oda Y, Kato Y, Miura J, Babazono T. A fact-finding survey on self-efficacy of foot care behaviour in patients with diabetes: Analysis using the Diabetes Study from the Center of Tokyo Women's Medical University 2017 (DIACET 2017). ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00219. [PMID: 33855219 PMCID: PMC8029546 DOI: 10.1002/edm2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022]
Abstract
Aim We aimed to determine the association between self‐efficacy of foot care behaviour and chronic complications in Japanese patients with diabetes. Methods We conducted a cross‐sectional study based on a questionnaire survey of 4571 patients with type 1 and type 2 diabetes who had (a) given consent to participate in the Diabetes Study from the Center of Tokyo Women's Medical University: DIACET 2017, and (b) completed all the questions of the Japanese Version of Foot Care Confidence Scale (J‐FCCS), consisting of 12 statements. Results A greater proportion of respondents answered that they were not confident in determining the condition of corns and/or calluses and the condition of toenails. The J‐FCCS total scores of the patients with retinopathy (p <.001) and numbness or pain in the feet (p <.001) were significantly lower than those of the patients without these complications. In both the multiple regression analysis and logistic regression analysis, lower J‐FCCS was significantly associated with retinopathy and numbness or pain in the feet. Conclusion Foot care education that emphasizes a psychological approach in improving confidence associated with foot self‐care is important for patients with advanced complications of diabetes.
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Affiliation(s)
- Kazuki Ikura
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Hayato Kato
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Haruna Azuma
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Yuri Oda
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Yuka Kato
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Junnosuke Miura
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Tetsuya Babazono
- Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
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Paton J, Abey S, Hendy P, Williams J, Collings R, Callaghan L. Behaviour change approaches for individuals with diabetes to improve foot self-management: a scoping review. J Foot Ankle Res 2021; 14:1. [PMID: 33407755 PMCID: PMC7788877 DOI: 10.1186/s13047-020-00440-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research. METHODOLOGY Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function. RESULTS In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes. CONCLUSION This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.
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Affiliation(s)
- Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK.
| | - Sally Abey
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Phil Hendy
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Jennifer Williams
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Richard Collings
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Lynne Callaghan
- Penninsula Medical School, Faculty of Health, University of Plymouth, John Bull Building Plymouth Science Park, Plymouth, PL6 8BT, UK
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