Systematic review of perception of barriers and facilitators to chronic disease self-management among older adults: Implications for evidence-based practice

Association between experiencing low healthcare quality and developing dementia

BACKGROUND

Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older.

METHODS

Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors.

RESULTS

Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk.

CONCLUSIONS

As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

BACKGROUND

Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care.

METHODS

We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews.

RESULTS

From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion.

CONCLUSIONS

We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously.

TRIAL REGISTRATION

This study was registered in PROSPERO (CRD42022357583).

Barriers and facilitators to self-management in people living with a lower-grade glioma

PURPOSE

Self-management can have clinical and quality-of-life benefits. However, people with lower-grade gliomas (LGG) may face chronic tumour- and/or treatment-related symptoms and impairments (e.g. cognitive deficits, seizures), which could influence their ability to self-manage. Our study aimed to identify and understand the barriers and facilitators to self-management in people with LGG.

METHODS

We conducted semi-structured interviews with 28 people with LGG across the United Kingdom, who had completed primary treatment. Sixteen participants were male, mean age was 50.4 years, and mean time since diagnosis was 8.7 years. Interviews were audio-recorded and transcribed. Following inductive open coding, we deductively mapped codes to Schulman-Green et al.'s framework of factors influencing self-management, developed in chronic illness.

RESULTS

Data suggested extensive support for all five framework categories ('Personal/lifestyle characteristics', 'Health status', 'Resources', 'Environmental characteristics', 'Healthcare system'), encompassing all 18 factors influencing self-management. How people with LGG experience many of these factors appears somewhat distinct from other cancers; participants described multiple, often co-occurring, challenges, primarily with knowledge and acceptance of their incurable condition, the impact of seizures and cognitive deficits, transport difficulties, and access to (in)formal support. Several factors were on a continuum, for example, sufficient knowledge was a facilitator, whereas lack thereof, was a barrier to self-management.

CONCLUSIONS

People with LGG described distinctive experiences with wide-ranging factors influencing their ability to self-manage.

IMPLICATIONS FOR CANCER SURVIVORS

These findings will improve awareness of the potential challenges faced by people with LGG around self-management and inform development of self-management interventions for this population.

Evaluating the Effectiveness of a Self-Management Program on Patients Living with Chronic Diseases

Background

Chronic diseases are a major public health concern globally, and the position in Saudi Arabia is no exception. The Chronic Disease Self-Management Program (CDSMP) is a widely used intervention process to address care of chronic conditions. However, its effectiveness in a Saudi context has not been extensively studied. Therefore, this study aimed at evaluating the post-intervention outcomes of the CDSMP in Saudi Arabia.

Materials and Methods

The study utilized a qualitative design on patients with chronic conditions. Data were collected through two focus group sessions with 15 participants who had completed the CDSMP. A thematic analysis technique was used for data analysis.

Results

Three key themes emerged from analysis of the qualitative data obtained through the focus groups: the perceived benefits from participation in the CDSMP workshop; the impact of the CDSMP workshop on improving health status and quality of life; and, the cultural acceptability of the CDSMP. The study also found that the CDSMP was effective in improving participants' self-management skills and quality of life. Additional benefits included increased motivation for behavioral change, enhanced confidence regarding self-care of chronic conditions, improved communication with healthcare providers, and better coping strategies.

Conclusion

This study provides valuable insights into the effectiveness of the CDSMP in addressing chronic conditions in Saudi Arabia. The program's emphasis on self-management skills and peer support aligns with the cultural values of Saudi Arabia. However, applying the CDSMP across various chronic conditions should be addressed in future interventions.

Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study

Background

Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity.

Methods

The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics.

Results

Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions.

Conclusions

Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.

A short tool to screen self-care preparedness: cross-sectional study in general practice

BACKGROUND

Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care.

OBJECTIVES

This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes.

METHODS

A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI.

RESULTS

A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance.

CONCLUSIONS

SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.

Older person's experience of PT4Ageing-A programme on self-management «support» in chronic illness

OBJECTIVE

This study sought to describe the experience of a group of older adults who participated in a chronic illness self-management program.

METHODS

The study employed a qualitative phenomenological approach. Participants were eight elders and data collected using semi-structured interviews Data was analysed using thematic analysis.

RESULTS

Five themes emerged from the analysis: (1) Tips to improve our daily lives, (2) I was always motivated, (3) Sharing and mutual help, (4) They made us believe we were capable (5). It would be great if it did not end here. Globally, the participants of the program described their experience as very positive. They identified gains from participating in the program, such as learning strategies to help them cope with their health problems, improving their ability to manage their illnesses more autonomously and building social support, that even persisted after the conclusion of the intervention.

CONCLUSION

The findings of this study provide insight into how older adults experience a program for the self-management of chronic illness. For the development of future programs, support building must be considered. Older adults who participate in self-management programmes exhibit improved self-efficacy in relation to the management their chronic illnesses and greater autonomy in self-care.

Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study

Background

To identify gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases.

Methods

A total of 471 hospitalized older patients with chronic diseases in four hospitals were investigated from May 2019 to June 2020. The self-developed demographic information questionnaire, the "Health Literacy Scale for Patients with Chronic Diseases" and the "Self-Efficacy for Managing Chronic Diseases 6-item Scale" were applied in this study. Multiple linear regression was used to assess the factors influencing health literacy among older patients with chronic diseases by gender.

Results

The factors influencing health literacy differed by gender. Male health literacy was related to education background, number of children, monthly income, duration of chronic disease and chronic disease self-efficacy. For females, health literacy was associated with age, education background, monthly income, duration of chronic disease and chronic disease treatment.

Conclusion

Healthcare providers should focus on the above-mentioned factors that could help identify those with low health literacy differ base on gender. Gender-specific strategies should be developed to improve the health literacy of older patients with chronic diseases and strengthen their chronic disease management.