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Woodward A, Davies N, Walters K, Nimmons D, Stevenson F, Protheroe J, Chew-Graham CA, Armstrong M. Self-management of multiple long-term conditions: A systematic review of the barriers and facilitators amongst people experiencing socioeconomic deprivation. PLoS One 2023; 18:e0282036. [PMID: 36809286 PMCID: PMC9942951 DOI: 10.1371/journal.pone.0282036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Multiple long-term conditions are rising across all groups but people experiencing socioeconomic deprivation are found to have a higher prevalence. Self-management strategies are a vital part of healthcare for people with long-term conditions and effective strategies are associated with improved health outcomes in a variety of health conditions. The management of multiple long-term conditions are, however, less effective in people experiencing socioeconomic deprivation, leaving them more at risk of health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management on long-term conditions in those experiencing socioeconomic deprivation. METHODS MEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions among socioeconomically disadvantaged populations. Data were coded and thematically synthesised using NVivo. FINDINGS From the search results, 79 relevant qualitative studies were identified after the full text screening and 11 studies were included in the final thematic synthesis. Three overarching analytical themes were identified alongside a set of sub-themes: (1) Challenges of having multiple long-term conditions; prioritisation of conditions, impact of multiple long-term conditions on mental health and wellbeing, polypharmacy, (2) Socioeconomic barriers to self-management; financial, health literacy, compounding impact of multiple long-term conditions and socioeconomic deprivation, (3) Facilitators of self-management in people experiencing socioeconomic deprivation; maintaining independence, 'meaningful' activities, support networks. DISCUSSION Self-management of multiple long-term conditions is challenging for people experiencing socioeconomic deprivation due to barriers around financial constraints and health literacy, which can lead to poor mental health and wellbeing. To support targeted interventions, greater awareness is needed among health professionals of the barriers/challenges of self-management among these populations.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Danielle Nimmons
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Joanne Protheroe
- School of Medicine, Keele University, Staffordshire, United Kingdom
| | | | - Megan Armstrong
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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Roberto KA, Savla J, McCann BR, Blieszner R, Knight AL. Dementia Family Caregiving in Rural Appalachia: A Sociocultural Model of Care Decisions and Service Use. J Gerontol B Psychol Sci Soc Sci 2022; 77:1094-1104. [PMID: 34951643 PMCID: PMC9159069 DOI: 10.1093/geronb/gbab236] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Examinations of cultural variations in caregiving experiences and practices tend to focus on racially and ethnically diverse family caregivers. We extended this research by exploring the role of place-based cultural constructs on care decisions of family caregivers for persons living with dementia in rural Appalachia whose experiences and backgrounds dwell outside the lines of dominant culture. METHODS Guided by our sociocultural conceptual model of service use and a descriptive qualitative study design, we conducted in-depth interviews with 30 caregivers for persons living with dementia to understand how predisposing and enabling factors influence caregiving decisions, including the use of services to care for persons living with dementia. RESULTS Three predisposing factors reflecting the culture of rural Appalachian counties in Virginia (reasons for becoming a caregiver, previous caregiving experience, and deference to the person living with dementia) shaped decisions about caregiving responsibilities and service use. Three place-based enabling factors (a personal sense of belonging, knowledge of services, and family support for service use) played an important role in facilitating access to services. DISCUSSION Findings revealed subtle variation across caregivers in this study and in comparison, to caregivers' experiences more generally. We interpret these variations in light of culturally influenced attitudes, family norms, and sources of information about formal services. Place-based cultural experience influenced dementia family caregivers' behaviors and choices regarding formal service use, suggesting that investigators should pay more attention to cultural influences in future caregiving research.
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Affiliation(s)
- Karen A Roberto
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
- Institute for Society, Culture, and Environment, Virginia Tech, Blacksburg, Virginia, USA
| | - Jyoti Savla
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | | | - Aubrey L Knight
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Madabhushi V, McLouth CJ, King R, Bhakta A, Beck S, Patel JA. Age and Medicare Insurance are Barriers to Telemedicine Access—A Quality Improvement Project. Am Surg 2022:31348221074234. [DOI: 10.1177/00031348221074234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Telehealth use has had widespread expansion and adoption over the past two years. This study aims to evaluate access to telehealth essentials (TE) using a novel metric. Methods This single institute study surveyed outpatient surgical patients to determine their access to TE. Generalized linear mixed models were used to determine the relationship of demographic and county-level variables on access to four TE. Results 138 patients were surveyed. Sixty-six (47.8%) were from Appalachian Kentucky. In the survey cohort, 122 (88.4%) had smart phones, 109 (80.7%) had devices with video messaging capabilities, 106 (80.9%) had cellular reception, and 112 (82.4%) had access to WiFi. Increasing age and Medicare insurance were the most consistent predictors of lack of access to TE. Conclusion Rural Appalachian Kentucky has access to TE. Telehealth has the potential to decrease the healthcare inequity in rural populations, but incompletely address this inequity for the aging population.
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Affiliation(s)
- Vashisht Madabhushi
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Christopher J. McLouth
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Robert King
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Avinash Bhakta
- Division of Colon and Rectal Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Sandra Beck
- Division of Colon and Rectal Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Jitesh A. Patel
- Division of Colon and Rectal Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
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Savla J, Roberto KA, Blieszner R, Knight AL. Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use. Innov Aging 2021; 6:igab055. [PMID: 35146130 PMCID: PMC8824523 DOI: 10.1093/geroni/igab055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. RESEARCH DESIGN AND METHODS The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver's rural community identity and attitude toward services were moderators. RESULTS Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. DISCUSSION AND IMPLICATIONS Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
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Affiliation(s)
- Jyoti Savla
- Virginia Tech Center for Gerontology, Blacksburg, Virginia, USA
| | - Karen A Roberto
- Virginia Tech Center for Gerontology, Blacksburg, Virginia, USA
| | | | - Aubrey L Knight
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Rogvi SÁ, Guassora AD, Tvistholm N, Wind G, Christensen U. "It Is a Full-time Job to Be Ill": Patient Work Involved in Attending Formal Diabetes Care Among Socially Vulnerable Danish Type 2 Diabetes Patients. QUALITATIVE HEALTH RESEARCH 2021; 31:2629-2640. [PMID: 34612745 DOI: 10.1177/10497323211041590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Previous research has shown social inequality in type 2 diabetes prevalence and that socially vulnerable type 2 diabetes patients benefit less than average from health services. Based on ethnographic fieldwork carried out between February 2017 and March 2018 in a Danish specialized outpatient clinic, this article focuses on patient work among socially vulnerable type 2 diabetes patients. Through attending to the border zone between formal health care and self-care, we show that patients do a lot of work requiring skills, resources, and initiative, to access and benefit from formal care. This work is complex and implicit in the organization of care. Patients' social situations, especially their employment situation, complicate getting patient work done. Attending to patient work and implicit tasks in care organization may help us to see how social inequality in type 2 diabetes outcomes develops, and may be combated.
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Affiliation(s)
- Sofie Á Rogvi
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Tvistholm
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Gitte Wind
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Daccarett S, Wiese LK, Ángeles Ordóñez ML. Enhancing Dementia Education and Cognitive Screening in A Haitian Population: A Faith-based Approach. J Community Health Nurs 2021; 38:103-119. [PMID: 33949259 DOI: 10.1080/07370016.2021.1887566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ethnically diverse Americans experience 1.8-2.5 times higher risk of developing Alzheimer's disease than Whites (Mayeda, et al., 2016), yet cognitive screening is not routinely conducted among Haitian American communities. Dementia risk awareness is beneficial for improving management of chronic illness and behaviors that impact risk of cognitive decline. A quasiexperimental paired samples t-test design was employed to test the effectiveness of an educational intervention among 50 older faith- based Haitian adults using the Basic Knowledge of Alzheimer's Disease (BKAD) scale, cognitive screening using the Cognitive State Test (COST), and referrals to a local memory/wellness center. A significant difference was seen in knowledge scores: pre-test (M = 18.5, SD = 3.12) and post-test (M = 23.1, SD = 2.42); conditions t(41.9) = -9.5, p = .000. All of those who volunteered for screening completed follow-up neuropsychological evaluations. Outreach to faith-based settings is suggested as an avenue for improving dementia knowledge and detection.
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Affiliation(s)
- Sandra Daccarett
- Nurse Practitioner Louis and Anne Green Memory & Wellness Center, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - Lisa Kirk Wiese
- Assistant Professor of Nursing C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA
| | - María Los Ángeles Ordóñez
- Louis and Anne Green Memory and Wellness Center FAU Memory Disorder Clinic Coordinator, Alzheimer's Disease Initiative Member, Federal Advisory Council on Alzheimer's Research, Care, and Services, Associate Professor of the Christine E. Lynn College of Nursing Assistant Professor of Clinical Biomedical Science (Secondary) Charles E. Schmidt College of Medicine Florida Atlantic University, Boca Raton, USA
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Schulman-Green D, Feder SL, Montano AR, Batten J, Tan H, Hoang K, Grey M. Use of the self- and family management framework and implications for further development. Nurs Outlook 2021; 69:991-1020. [PMID: 34183187 DOI: 10.1016/j.outlook.2021.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/20/2021] [Accepted: 05/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Self- and Family Management Framework (SFMF) was created in 2006 and revised in 2015 to guide research on self- and family management of chronic conditions. There has been no review of use of the SFMF. PURPOSE We reviewed articles citing the SFMF to identify the frequency and nature of use. METHOD We conducted a citation analysis, searching Web of Science, Scopus, and Google Scholar databases and extracted key data from identified articles. FINDINGS Of 126 articles, 84(66%) cited the 2006 SFMF, 37(29%) cited the 2015 SFMF, and 6(5%) cited both. The SFMF was used most to inform study design. Users noted strengths (e.g., considers family context) and limitations (e.g., non-specification of patient- family caregiver synergies) of the framework. DISCUSSION The SFMF has been used broadly to guide research on self- and family management of chronic conditions. Findings will inform development of a third version of the SFMF.
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Affiliation(s)
| | | | | | | | - Hui Tan
- Yale New Haven Health Bridgeport Hospital, Bridgeport, CT
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Assessing health disparities in breast cancer incidence burden in Tennessee: geospatial analysis. BMC WOMENS HEALTH 2021; 21:186. [PMID: 33941168 PMCID: PMC8091807 DOI: 10.1186/s12905-021-01274-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
Background Tennessee women experience the 12th highest breast cancer mortality in the United States. We examined the geographic differences in breast cancer incidence in Tennessee between Appalachian and non-Appalachian counties from 2005 to 2015. Methods We used ArcGIS 10.7 geospatial analysis and logistic regression on the Tennessee Cancer Registry incidence data for adult women aged ≥ 18 years (N = 59,287) who were diagnosed with breast cancer from 2005 to 2015 to evaluate distribution patterns by Appalachian county designation. The Tennessee Cancer Registry is a population-based, central cancer registry serving the citizens of Tennessee and was established by Tennessee law to collect and monitor cancer incidence. The main outcome was breast cancer stage at diagnosis. Independent variables were age, race, marital status, type of health insurance, and county of residence. Results Majority of the sample were White (85.5%), married (58.6%), aged ≥ 70 (31.3%) and diagnosed with an early stage breast cancer (69.6%). More than half of the women had public health insurance (54.2%), followed by private health insurance coverage (44.4%). Over half of the women resided in non-Appalachian counties, whereas 47.6% were in the Appalachian counties. We observed a significant association among breast cancer patients with respect to marital status and type of health insurance coverage (p = < 0.0001). While the logistic regression did not show a significant result between county of residence and breast cancer incidence, the spatial analysis revealed geographic differences between Appalachian and non-Appalachian counties. The highest incidence rates of 997.49–1164.59/100,000 were reported in 6 Appalachian counties (Anderson, Blount, Knox, Rhea, Roane, and Van Buren) compared to 3 non-Appalachian counties (Fayette, Marshall, and Williamson). Conclusions There is a need to expand resources in Appalachian Tennessee to enhance breast cancer screening and early detection. Using geospatial techniques can further elucidate disparities that may be overlooked in conventional linear analyses to improve women’s cancer health and associated outcomes.
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Rasmussen B, Wynter K, Rawson HA, Skouteris H, Ivory N, Brumby SA. Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review. Aust J Prim Health 2021; 27:243-254. [PMID: 34229829 DOI: 10.1071/py20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Department of Public Health, University of Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Denmark; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Helen A Rawson
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Nicola Ivory
- Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Susan A Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia; and National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia
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Sand CD, Rahbek K, Willadsen TG, Jønsson AR. Prioritizing social identities: Patients' perspective on living with multimorbidity. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211009375. [PMID: 33996614 PMCID: PMC8107931 DOI: 10.1177/26335565211009375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article explores experiences of people with multimorbidity, and attempts to advance understandings of the complexity of living with multimorbidity outside the medical encounter in a social identity theoretical framework. METHOD This is a qualitative study using individual semi-structured interviews among nine persons living with multimorbidity. The interviews are analysed inductively according to thematic content analysis. RESULTS The emerging themes are: 1) Impact on daily life, 2) Professional life and 3) Capacity for handling multimorbidity. People with multimorbidity experience physical limitations and psychological distress, which limits their ability to maintain social relations and affiliation to the labour market. Accordingly, they are challenged in their ability to retain a sense of normal everyday life, which is mediated by their capacity for handling multimorbidity. DISCUSSION Multimorbidity may compromise various social identities. The complexity of living with multimorbidity is increased by an aspiration to maintain valued social identities in order to preserve a coherent sense of self and a normal everyday life. This study suggests an increased focus on individual priorities and values outside the medical encounter, and argues in favour of recognizing the conflicts that people experience as they try to balance multimorbidity with other important aspects of their daily lives.
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Affiliation(s)
- Camilla Drivsholm Sand
- Section of General Practice, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark
| | - Keren Rahbek
- Section of General Practice, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora G Willadsen
- Section of General Practice, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R Jønsson
- Section of General Practice, Department of Public
Health, University of Copenhagen, Copenhagen, Denmark
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Barr ML, Tabone LE, Brode C, Szoka N, Olfert. Successful weight loss after bariatric surgery in Appalachian state regardless of food access ranking score. Surg Obes Relat Dis 2020; 16:1737-1744. [PMID: 32830059 DOI: 10.1016/j.soard.2020.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/18/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following bariatric surgery, an explicit dietary regimen is required to facilitate and maintain successful weight loss. Without adequate access to healthy foods, weight maintenance can be hindered. OBJECTIVE Examine influence degree of food access has on Appalachian bariatric surgery patient weight loss outcomes. SETTING Appalachian University hospital, United States. METHODS A retrospective chart review was used to examine the influence of food accessibility on weight loss outcomes in an Appalachian bariatric surgery patient population at a large tertiary hospital in West Virginia between 2013 and 2017. Demographic characteristics, health and family history, and 1-year surgery outcomes were collected. A state-specific food accessibility score was calculated for each patient address using the geographic information system. Patients were assigned a food access ranking score (FARS) between 0 (low food access) and 4 (high food access) based on criteria of quantity, quality, income, and vehicle access. RESULTS Patients (n = 369) were predominately married (60.5%), white (92.4%), female (77.8%), and underwent laparoscopic Roux-en-Y gastric bypass surgery (75.9%), with a mean age of 45 years. Most patients had low FARS (M = 1.67 ± .73; 72.6%). Nonwhite patients (P = .03) with a preoperative diagnosis of depression (P = .02) or without a family history of obesity (P = .01) were found to be in the lower FARS categories. FARS was not indicative of weight loss post surgery (P > .05). CONCLUSIONS Food accessibility in West Virginia was not associated with bariatric surgery weight outcomes at 1-year post operation. Lower food access was associated with nonwhite race/ethnicity, diagnosed depression at baseline, and no family history of obesity. Future studies should include more extended follow-up data collection and mixed-method approaches to capture perceptions of food access and its impact on the patients' postoperative journey.
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Affiliation(s)
- M L Barr
- Division of Animal and Nutritional Sciences in Department of Human Nutrition and Food, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, West Virginia
| | - L E Tabone
- Division of Bariatric Surgery, Department of Surgery, West Virgina University, Morgantown, West Virginia
| | - C Brode
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - N Szoka
- Division of Bariatric Surgery, Department of Surgery, West Virgina University, Morgantown, West Virginia
| | - Olfert
- Division of Animal and Nutritional Sciences in Department of Human Nutrition and Food, Davis College of Agriculture, Natural Resources, and Design, West Virginia University, Morgantown, West Virginia.
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Wiese LK, Williams CL, Tappen RM, Newman D. An updated measure for investigating basic knowledge of Alzheimer's disease in underserved rural settings. Aging Ment Health 2020; 24:1348-1355. [PMID: 30869990 PMCID: PMC8474126 DOI: 10.1080/13607863.2019.1584880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
Objective: Older rural adults face a higher burden of Alzheimer's disease (AD) and delayed detection. This risk is heightened in rural populations that are ethnically diverse. Patients and providers are often hesitant to participate in screening, partially due to gaps in knowledge of the current science. The purpose of this paper is to describe the results of administering the revised version of the Basic Knowledge of Alzheimer's Disease (BKAD) measure in small rural communities in five different states.Methods: The BKAD measure was revised after first being tested in rural Appalachia. Revisions including eliminating non-discriminating items and adding questions regarding early detection, sleep, head injury, and vision changes. Reliability and validity testing included Cronbach's alpha and Rasch item analysis, test-retest, and predictive validity. Descriptive measures and independent sample t-tests were used to analyze knowledge gaps and sociodemographics.Results: Tests for reliability and validity were highly favorable, including Cronbach's alpha = .85 and overall Rasch item analysis of .94. Three-fourths of participants knew that annual cognitive screening was recommended for older adults, but only one-fourth had been previously screened. Sociodemographic findings revealed that a majority of participants (86%) would participate in annual memory screening if offered, regardless of education or health literacy level.Conclusion: The BKAD measure is a good fit for use in rural and underserved populations. BKAD results can inform the design of culturally relevant programs for raising awareness of the importance of early AD detection and treatment.
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Affiliation(s)
- Lisa Kirk Wiese
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | | | - Ruth M Tappen
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- C. E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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Elewonibi B, Nkwonta C. The association of chronic diseases and mammography among Medicare beneficiaries living in Appalachia. ACTA ACUST UNITED AC 2020; 16:1745506520933020. [PMID: 32538325 PMCID: PMC7297020 DOI: 10.1177/1745506520933020] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assessed the relationship between presence and number of chronic disease and reception of mammogram in women 65 years and older, and how this relationship is influenced by primary care provider visits. METHODS A total of 3306 women diagnosed with breast cancer from 2006 to 2008 from cancer registries in four Appalachian states were analyzed. RESULTS Having a mammogram within the past 2 years was associated with having at least one chronic disease. The presence of a chronic disease was associated with an increased likelihood of breast cancer screening adherence but was not a strong predictor when demographic variables were added. CONCLUSION This study supports the findings that women with more primary care provider visits were more likely to adhere to breast cancer screening guidelines but having several chronic diseases presents a barrier to achieving guideline-concordant mammography screening, highlighting the importance of preventive screening for patients managing chronic diseases.
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Affiliation(s)
- Bilikisu Elewonibi
- Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chigozie Nkwonta
- Smart State Center for Heathcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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14
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Millar E, Stanley J, Gurney J, Stairmand J, Davies C, Semper K, Dowell A, Lawrenson R, Mangin D, Sarfati D. Effect of multimorbidity on health service utilisation and health care experiences. J Prim Health Care 2019; 10:44-53. [PMID: 30068451 DOI: 10.1071/hc17074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. AIM To understand the experiences of people with multimorbidity in the NZ health care system. METHODS A questionnaire was sent to 758 people with multimorbidity from two primary health care organisations (PHOs). Outcomes were compared to general population estimates from the NZ Health Survey. RESULTS Participants (n = 234, 31% response rate) reported that their general practitioners (GPs) respected their opinions, involved them in decision-making and knew their medical history well. The main barriers to effective care were short GP appointments, availability and affordability of primary and secondary health care, and poor communication between clinicians. Access issues were higher than for the general population. DISCUSSION Participants generally had very positive opinions of primary care and their GP, but encountered structural issues with the health system that created barriers to effective care. These results support the value of ongoing changes to primary care models, with a focus on patient-centred care to address access and care coordination.
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Affiliation(s)
- Elinor Millar
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
| | - James Stanley
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
| | - Jason Gurney
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
| | - Jeannine Stairmand
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
| | | | - Kelly Semper
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | | | - Dee Mangin
- Department of Family Medicine, McMaster University, Ontario, Canada
| | - Diana Sarfati
- Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand
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15
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What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective. Int J Integr Care 2019; 19:4. [PMID: 31367203 PMCID: PMC6659759 DOI: 10.5334/ijic.4655] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Health systems are striving to design and deliver care that is ‘person
centred’—aligned with the needs and preferences of those
receiving it; however, it is unclear what older people and their caregivers
value in their care. This paper captures attributes of care that are
important to older people and their caregivers. Methods: This qualitative descriptive study entailed 1–1 interviews with older
adults with multimorbidity receiving community based primary health care in
Canada and New Zealand and caregivers. Data were analyzed to identify core
attributes of care, important to participants. Findings: Feeling heard, appreciated and comfortable; having someone to count on;
easily accessing health and social care; knowing how to manage health and
what to expect; feeling safe; and being independent were valued. Each
attribute had several characteristics including: being treated like a
friend; having contact information of a responsive provider; being
accompanied to medical and social activities; being given clear treatment
options including what to expect; having homes adapted to support
limitations and having the opportunity to participate in meaningful
hobbies. Conclusions: Attributes of good care extend beyond disease management. While our findings
include activities that characterize these attributes, further research on
implementation barriers and facilitators is required.
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16
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Choi M, Schuster AM, Schoenberg NE. Solutions to the Challenge of Meeting Rural Transportation Needs: Middle-Aged and Older Adults' Perspectives. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2019; 62:415-431. [PMID: 30727857 DOI: 10.1080/01634372.2019.1575133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/28/2018] [Accepted: 12/30/2018] [Indexed: 06/09/2023]
Abstract
This study aimed to explore how the aging population in Appalachia manages its transportation and plans for the transition to non-driving and to seek possible solutions to the challenge of meeting rural transportation needs. Four focus groups (N = 38) were conducted, supplemented by a questionnaire, in Appalachian Kentucky. The results showed that few alternative transportation existed except a local paratransit service and informal transportation support. Compared to older adults, middle-aged adults reported a greater willingness to use mobile phones and the Internet to arrange transportation if they were available. Participants also recommended expanding the use of existing transportation in the community - such as church vans - to better meet the aging population's needs. The findings suggest that partnership between government, non-profit, and private sectors is needed, not solely focusing on a tax-dependent solution. Additionally, information and communication technology-based transportation management system would help maximize the use of scare but existing resources in rural areas.
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Affiliation(s)
- Moon Choi
- a Graduate School of Science and Technology Policy , Korea Advanced Institute of Science and Technology , Daejeon , South Korea
| | - Amy M Schuster
- b Graduate Center for Gerontology , University of Kentucky , Lexington , Kentucky , USA
| | - Nancy E Schoenberg
- c Department of Behavioral Science , University of Kentucky , Lexington , Kentucky , USA
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17
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Snell-Rood C, Feltner F, Schoenberg N. What Role Can Community Health Workers Play in Connecting Rural Women with Depression to the "De Facto" Mental Health Care System? Community Ment Health J 2019; 55:63-73. [PMID: 29299719 DOI: 10.1007/s10597-017-0221-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/26/2017] [Indexed: 01/18/2023]
Abstract
The prevalence of depression among rural women is nearly twice the national average, yet limited mental health services and extensive social barriers restrict access to needed treatment. We conducted key informant interviews with community health workers (CHWs) and diverse health care professionals who provide care to Appalachian women with depression to better understand the potential roles that CHWs may play to improve women's treatment engagement. In the gap created by service disparities and social barriers, CHWs can offer a substantial contribution through improving recognition of depression; deepening rural women's engagement within existing services; and offering sustained, culturally appropriate support.
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Affiliation(s)
- Claire Snell-Rood
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, 207H University Hall #7360, Berkeley, CA, 94720, USA.
| | | | - Nancy Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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18
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Millar E, Gurney J, Stanley J, Stairmand J, Davies C, Semper K, Dowell A, Lawrenson R, Mangin D, Sarfati D. Pill for this and a pill for that: A cross-sectional survey of use and understanding of medication among adults with multimorbidity. Australas J Ageing 2018; 38:91-97. [PMID: 30556358 DOI: 10.1111/ajag.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To understand the challenges managing medication use and knowledge of people living with multimorbidity. METHODS A cross-sectional survey of 234 adults with multimorbidity, identified using retrospective hospital discharge data. Participants were recruited from two primary health organisations in New Zealand. RESULTS Three quarters of participants (75%) were prescribed four or more medications, and one in four (27%) were prescribed eight or more medications. Participants reported knowing what their medications were for (88%, 95% CI 81.4-93.8) and when to take them (99%, 95% CI 97.5-99.9). However, over a fifth (22%, 95% CI 13.7-30.4) reported some problems managing multiple medications, and 40% (95% CI 30.2-50.2) reported a problem with side effects. CONCLUSION The results highlight the need to consider how prescribing can be adapted for people with multimorbidity and move beyond the application of multiple disease-specific guidelines.
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Affiliation(s)
- Elinor Millar
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Cheryl Davies
- Tū Kotahi Māori Asthma Trust, Lower Hutt, New Zealand
| | - Kelly Semper
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Ross Lawrenson
- University of Waikato and Waikato District Health Board, Hamilton, New Zealand
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
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19
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McGilton KS, Vellani S, Yeung L, Chishtie J, Commisso E, Ploeg J, Andrew MK, Ayala AP, Gray M, Morgan D, Chow AF, Parrott E, Stephens D, Hale L, Keatings M, Walker J, Wodchis WP, Dubé V, McElhaney J, Puts M. Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review. BMC Geriatr 2018; 18:231. [PMID: 30285641 PMCID: PMC6167839 DOI: 10.1186/s12877-018-0925-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the population is aging, the number of persons living with multiple chronic conditions (MCC) is expected to increase. This review seeks to answer two research questions from the perspectives of older adults with MCC, their caregivers and their health care providers (HCPs): 1) What are the health and social care needs of community-dwelling older adults with MCC and their caregivers? and 2) How do social and structural determinants of health impact these health and social care needs? METHODS We conducted a scoping review guided by a refinement of the Arksey & O'Malley framework. Articles were included if participants were 55 years or older and have at least two chronic conditions. We searched 7 electronic databases. The data were summarized using thematic analysis. RESULTS Thirty-six studies were included in this review: 28 studies included participants with MCC; 12 studies included HCPs; 5 studies included caregivers. The quality of the studies ranged from moderate to good. Five main areas of needs were identified: need for information; coordination of services and supports; preventive, maintenance and restorative strategies; training for older adults, caregivers and HCPs to help manage the older adults' complex conditions; and the need for person-centred approaches. Structural and social determinants of health such as socioeconomic status, education and access influenced the needs of older adults with MCC. CONCLUSION The review highlights that most of the needs of older adults with MCC focus on lack of access to information and coordination of care. The main structural and social determinants that influenced older adults' needs were their level of education/health literacy and their socioeconomic status.
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Affiliation(s)
- Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. .,Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M6K 2R7 416 597 3422 (2500), Canada.
| | - Shirin Vellani
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lily Yeung
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jawad Chishtie
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M6K 2R7 416 597 3422 (2500), Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Elana Commisso
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ana Patricia Ayala
- Gerstein Information Science Centre, University of Toronto, Toronto, ON, Canada
| | - Mikaela Gray
- Gerstein Information Science Centre, University of Toronto, Toronto, ON, Canada
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | - Amanda Froehlich Chow
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - Lori Hale
- The Change Foundation, Toronto, ON, Canada
| | | | | | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Veronique Dubé
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Janet McElhaney
- Health Sciences North Research Institute and Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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20
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Wiese LK, Williams CL. An Appalachian Perspective of Alzheimer's Disease: A Rural Health Nurse Opportunity. ONLINE JOURNAL OF RURAL NURSING AND HEALTH CARE 2018; 18:180-208. [PMID: 38239848 PMCID: PMC10795758 DOI: 10.14574/ojrnhc.v17i1.469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Predictions of the devastating impact of Alzheimer's disease (AD) are heightened in disadvantaged rural populations, yet studies investigating AD in this population are limited. Other researchers have shown that when rural Appalachian people are aware of their risk for a chronic illness, they are more willing to adopt healthy behaviors (Della, 2011; Schoenberg et al. 2011), suggesting that educational programs to increase knowledge and perception of risk are needed. The purpose of this article was to report findings from exploring knowledge of Alzheimer's disease in a southern rural West Virginia community of residents (N = 193) and a sample of caregivers (n = 20) using cognitive interview techniques of "Think-aloud" and "Laddering". The cultural fit and relevance of the "Knowledge of Alzheimer's Disease scale or KAD (Jang, Kim, Hansen, & Chiriboga, 2010) was also examined. Findings from the KAD included that an updated AD measure appropriate for use in rural settings is needed. Findings from the cognitive interview included that instead of fatalistic attitudes toward Alzheimer's disease, residents often viewed AD as something potentially preventable through healthier living, use of herbs as children, and eventual discovery of more effective treatment regimens. The themes that emerged were "preventing AD" and "personal knowing of AD". Considering cultural perceptions and determining knowledge gaps in the communities by rural providers is an important component of changing stigma regarding routine cognitive screening for rural older adults at increased risk for Alzheimer's disease.
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Affiliation(s)
- Lisa K Wiese
- Christine E. Lynn College of Nursing, Florida Atlantic University
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21
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Disparities in women's cancer-related quality of life by Southern Appalachian residence. Qual Life Res 2018; 27:1347-1356. [PMID: 29374856 PMCID: PMC5891549 DOI: 10.1007/s11136-018-1793-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/02/2022]
Abstract
PURPOSE The purpose was to determine whether Appalachian residence alone or in combination with violence was linked to poorer quality of life (QOL). METHODS Women recently diagnosed and included in either the Kentucky or North Carolina Cancer Registries were interviewed by phone between 2009 and 2015 (n = 3320; mean age = 56.74). Response rates were similar by state (40.1 in Kentucky and 40.9% in North Carolina). Appalachian (N = 990) versus non-Appalachian residents (N = 2330) were hypothesized to have poorer QOL defined as (a) lower Functional Assessment of Cancer Therapy-General (FACT-G) scores and (b) more symptoms of depression, stress, or comorbid physical conditions. Lifetime intimate partner or sexual violence was first investigated as a moderator then mediator of regional differences. Multiple analyses of covariance (MANCOVA) models were used. RESULTS Violence modified the effect of Appalachian residence on poorer QOL outcomes; FACT-G total scores (p = .02) were lowest for women living in Appalachia who had additionally experienced violence. Socioeconomic indicators appeared to mediate or explain differences in QOL outcomes by Appalachian residence such that when adjusting for income, education and insurance, Appalachian residence remained associated only with poorer physical QOL outcomes (p < .05). CONCLUSIONS While violence rates did not differ by residence, the combined effect of living in Appalachia and experiencing violence resulted in significantly greater impact on poorer QOL among women recently diagnosed with cancer. Clinical consideration of patients' residence, socioeconomic status and violence experienced may help identify and mitigate the longer-term impact of these identifiable factors associated with poorer QOL.
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22
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Sultan M, Kuluski K, McIsaac WJ, Cafazzo JA, Seto E. Turning challenges into design principles: Telemonitoring systems for patients with multiple chronic conditions. Health Informatics J 2018; 25:1188-1200. [PMID: 29320911 DOI: 10.1177/1460458217749882] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
People with multiple chronic conditions often struggle with managing their health. The purpose of this research was to identify specific challenges of patients with multiple chronic conditions and to use the findings to form design principles for a telemonitoring system tailored for these patients. Semi-structured interviews with 15 patients with multiple chronic conditions and 10 clinicians were conducted to gain an understanding of their needs and preferences for a smartphone-based telemonitoring system. The interviews were analyzed using a conventional content analysis technique, resulting in six themes. Design principles developed from the themes included that the system must be modular to accommodate various combinations of conditions, reinforce a routine, consolidate record keeping, as well as provide actionable feedback to the patients. Designing an application for multiple chronic conditions is complex due to variability in patient conditions, and therefore, design principles developed in this study can help with future innovations aimed to help manage this population.
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23
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Weaver RH, Roberto KA, Blieszner R. Older Adults in Rural Appalachia: Preference and Expectations for Future Care. Int J Aging Hum Dev 2017; 86:364-381. [PMID: 28814109 DOI: 10.1177/0091415017720891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how rural-dwelling older adults anticipate and plan for future care needs. Using a mixed-method explanatory design, structural equation modeling ( n = 535) revealed significant associations between concerns about using services on preference for type of help; preference was associated with likelihood of using future services. Content analysis of interview data from 19 older adults who needed but were not receiving help revealed how they conceptualize their need for assistance and anticipated future care arrangements. Nine older adults were not thinking about future care needs. While most older adults articulated preferences for informal help, they indicated some openness to formal assistance. Preferences did not always align with expectations for the future. Rather, concerns about burdening family and friends outweighed concerns about community services and influenced expectations of using formal services. Understanding rural older adults' expectations for future care arrangements is necessary for advancing policy and implementing successful services options.
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Ploeg J, Matthew-Maich N, Fraser K, Dufour S, McAiney C, Kaasalainen S, Markle-Reid M, Upshur R, Cleghorn L, Emili A. Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers. BMC Geriatr 2017; 17:40. [PMID: 28143412 PMCID: PMC5282921 DOI: 10.1186/s12877-017-0431-6] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 01/24/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings. METHODS Using Thorne's interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne's interpretive description approach. RESULTS Participants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home. CONCLUSIONS The experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.
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Affiliation(s)
- Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON L8S 4K1 Canada
- Department of Health, Aging and Society, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON L8S 4K1 Canada
| | - Nancy Matthew-Maich
- Health Science Research and Innovation, School of Nursing, Mohawk College of Applied Arts and Technology, 1400 Main Street West, IAHS - 354, Hamilton, ON L8S 1C7 Canada
| | - Kimberly Fraser
- Faculty of Nursing, University of Alberta, 5-185 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9 Canada
| | - Sinéad Dufour
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, 1400 Main Street West, IAHS Rm 403, Hamilton, ON L8S 4K1 Canada
| | - Carrie McAiney
- Department of Psychiatry & Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, St. Joseph’s Healthcare Hamilton, West 5th Campus, 100 West 5th Street, Room G102, Hamilton, ON L8N 3K7 Canada
| | - Sharon Kaasalainen
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25C, Hamilton, ON L8S 4K1 Canada
- Aging, Chronic Disease and Health Promotion Interventions, 1280 Main Street West, HSc3N25B, Hamilton, ON L8S 4K1 Canada
- Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, 1280 Main Street West, HSc3N25B, Hamilton, ON L8S 4K1 Canada
| | - Ross Upshur
- Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, M.33 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
- Bridgepoint Collaboratory for Research and Innovation, Sinai Health System, AM.33 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
| | - Laura Cleghorn
- School of Nursing and Department of Family Medicine, Health TAPESTRY, McMaster University, 1280 Main Street West, David Braley Health Science Centre, 5th Floor, Hamilton, ON L9S 4K1 Canada
| | - Anna Emili
- McMaster University, Main West Medical Group, 1685 Main Street West, Hamilton, ON L8S 1G5 Canada
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25
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Wiese LK, Williams CL, Tappen R, Newman D, Rosselli M. Assessment of Basic Knowledge About Alzheimer’s Disease Among Older Rural Residents: A Pilot Test of a New Measure. J Nurs Meas 2017; 25:519-548. [DOI: 10.1891/1061-3749.25.3.519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Underserved rural populations face a higher risk of Alzheimer’s disease (AD), yet studies investigating AD knowledge in this population are lacking. The purpose of this research was to develop an AD basic knowledge measure that is appropriate for use with underserved populations. Method: A content domain map, content validity index, and cognitive interviews were used in developing the first version of the basic knowledge of Alzheimer’s disease (BKAD; Study 1). Reliability and validity of the measure in this descriptive study were examined using Rasch modeling and tests for construct, concurrent, and discriminate validity (Study 2). Multiple regression was employed to examine AD knowledge predictors. Results: Findings included that the BKAD instrument discriminated well between persons with varied education levels. Psychometric analysis yielded important information to guide revision of the BKAD measure. Conclusion: The BKAD measure shows promise in meeting the need for a culturally relevant measure to assess basic Alzheimer’s disease knowledge in underserved rural populations.
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26
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Rachael Whitley Starcher, Lynn Geurin, Lisa Shannon, Angela Whitley. Assessing the Likelihood of Seeking Health Care in Rural Kentucky: Applying the Barriers to Help Seeking Scale to Appalachian and Non-Appalachian Undergraduates. ACTA ACUST UNITED AC 2017. [DOI: 10.5406/jappastud.23.2.0239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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27
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Richardson LM, Hill JN, Smith BM, Bauer E, Weaver FM, Gordon HS, Stroupe KT, Hogan TP. Patient prioritization of comorbid chronic conditions in the Veteran population: Implications for patient-centered care. SAGE Open Med 2016; 4:2050312116680945. [PMID: 27928501 PMCID: PMC5131809 DOI: 10.1177/2050312116680945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022] Open
Abstract
Objective: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. Methods: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. Findings: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. Conclusion: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.
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Affiliation(s)
- Lorilei M Richardson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA
| | - Jennifer N Hill
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Pediatrics, Northwestern University, Evanston, IL, USA
| | - Erica Bauer
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Howard S Gordon
- Center of Innovation for Complex Chronic Health Care, Jesse Brown VHA Medical Center, Veterans Health Administration, Chicago, IL, USA; Division of Academic Internal Medicine, Department of Medicine, University of Illinois Chicago at College of Medicine, Chicago, IL, USA
| | - Kevin T Stroupe
- Center of Innovation for Complex Chronic Health Care, Edward Hines Jr. VHA Hospital, Veterans Health Administration, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Veterans Health Administration, Bedford, MA, USA; Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Snyder H, Engström J. The antecedents, forms and consequences of patient involvement: A narrative review of the literature. Int J Nurs Stud 2016; 53:351-78. [DOI: 10.1016/j.ijnurstu.2015.09.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/19/2022]
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Coventry PA, Small N, Panagioti M, Adeyemi I, Bee P. Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity. BMC FAMILY PRACTICE 2015; 16:171. [PMID: 26597934 PMCID: PMC4657350 DOI: 10.1186/s12875-015-0345-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases. Literature on the experience of living with multimorbidity is accumulating but has not yet been synthesised in a manner conducive to informing the design of self-management interventions for this population. This study aimed to systematically review and synthesise findings from published, in-depth qualitative studies about the experience of multimorbidity, with a view to identifying the components and motivation for successful self-management in this population. METHODS Systematic review of and meta-synthesis of qualitative studies that evaluated patient experience of living with and/or self-managing mental and/or physical multimorbidity. MEDLINE, Embase, PsycINFO, CINAHL, and ASSIA along with reference lists of existing reviews and content pages of non-indexed specialists comorbidity journals were searched. RESULTS Nineteen studies from 23 papers were included. A line of argument synthesis was articulated around three third-order constructs: 1) Encounters with complexity; 2) Marshalling medicines, emotions, and resources; and 3) Self-preservation and prevention. Our interpretation revealed how mental and physical multimorbidity is experienced as moments of complexity rather than mere counts of illnesses. Successful self-management of physical symptoms was contingent upon the tactical use of medicines, whilst emotional health was more commonly managed by engaging in behavioural strategies, commonly with a social or spiritual component. Motivations for self-management were underpinned by a sense of moral purpose to take responsibility for their health, but also by a desire to live a purposeful life beyond an immediate context of multimorbidity. CONCLUSIONS Understanding how people experience the complexities of mental and physical multimorbidity may be crucial to designing and delivering interventions to support successful self-management in this population. Future self-management interventions should aim to support patients to exert responsibility and autonomy for medical self-management and promote agency and self-determination to lead purposeful lives via improved access to appropriate social and psychological support.
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Affiliation(s)
- Peter A Coventry
- Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Nicola Small
- Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Maria Panagioti
- NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Isabel Adeyemi
- Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
| | - Penny Bee
- School of Nursing, Midwifery and Social Work and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
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Markle GL, Attell BK, Treiber LA. Dual, Yet Dueling Illnesses: Multiple Chronic Illness Experience at Midlife. QUALITATIVE HEALTH RESEARCH 2015; 25:1271-1282. [PMID: 25420479 DOI: 10.1177/1049732314559948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The prevalence of multiple chronic illnesses is increasing dramatically, especially among those in middle adulthood, yet much prior research has focused on the experience of multiple morbidity among older adults. We examined the online illness narratives (blogs) of 10 men and women aged 36 to 59 to better understand the experience of living with multiple chronic illnesses at midlife. Multiple morbidity presents distinct challenges to those at midlife: (a) diagnosis and management of multiple illnesses, (b) need for information, (c) identity dilemmas and threats to self-image, and (d) stigma and social rejection. Relinquishing the work identity was especially difficult for participants because it threatened to foreshorten middle adulthood and push them prematurely into late adulthood. Participants used their blogs to revise their identities, alleviate isolation, and inform and guide others.
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Liddy C. Challenges of self-management when living with multiple chronic conditions: systematic review of the qualitative literature. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2014; 60:1123-1133. [PMID: 25642490 PMCID: PMC4264810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the perspectives of patients who live with multiple chronic conditions as they relate to the challenges of self-management. DATA SOURCES On September 30, 2013, we searched MEDLINE, EMBASE, and CINAHL using relevant key words including chronic disease, comorbidity, multimorbidity, multiple chronic conditions, self-care, self-management, perspective, and perception. STUDY SELECTION Three reviewers assessed and extracted the data from the included studies after study quality was rated. Qualitative thematic synthesis method was then used to identify common themes. Twenty-three articles met the inclusion criteria, with most coming from the United States. SYNTHESIS Important themes raised by people living with multiple chronic conditions related to their ability to self-manage included living with undesirable physical and emotional symptoms, with pain and depression highlighted. Issues with conflicting knowledge, access to care, and communication with health care providers were raised. The use of cognitive strategies, including reframing, prioritizing, and changing beliefs, was reported to improve people's ability to self-manage their multiple chronic conditions. CONCLUSION This study provides a unique view into patients' perspectives of living with multiple chronic conditions, which are clearly linked to common functional challenges as opposed to specific diseases. Future policy and programming in self-management support should be better aligned with patients' perspectives on living with multiple chronic conditions. This might be achieved by ensuring a more patient-centred approach is adopted by providers and health service organizations.
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Affiliation(s)
- Clare Liddy
- Correspondence: Dr Clare Liddy, University of Ottawa, Family Medicine, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON K1N 5C8; e-mail
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Bratzke LC, Muehrer RJ, Kehl KA, Lee KS, Ward EC, Kwekkeboom KL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud 2014; 52:744-55. [PMID: 25468131 DOI: 10.1016/j.ijnurstu.2014.10.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 10/17/2014] [Accepted: 10/18/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. DESIGN A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. DATA SOURCES A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. REVIEW METHODS Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. RESULTS Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). CONCLUSIONS Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers need to develop and test interventions that support day-to-day priority setting and decision-making and improve health outcomes for individuals with multimorbidity.
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Affiliation(s)
- Lisa C Bratzke
- University of Wisconsin - Madison, School of Nursing, United States.
| | | | - Karen A Kehl
- University of Wisconsin - Madison, School of Nursing, United States
| | - Kyoung Suk Lee
- University of Wisconsin - Madison, School of Nursing, United States
| | - Earlise C Ward
- University of Wisconsin - Madison, School of Nursing, United States
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The experience of adults with multimorbidity: a qualitative study. JOURNAL OF COMORBIDITY 2014; 4:11-21. [PMID: 29090149 PMCID: PMC5556408 DOI: 10.15256/joc.2014.4.31] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 04/15/2014] [Indexed: 11/23/2022]
Abstract
Background Findings from several countries indicate that the prevalence of multimorbidity is very high among clients of primary healthcare. A deeper understanding of patients’ experiences from their own perspective can greatly enrich any intervention to help them live as well as possible with multimorbidity. Objective To describe the fundamental structure of adults’ experience with multimorbidity. Design A phenomenological study was undertaken to describe the experiences of 11 adults with multimorbidity. These adults participated in two semi-structured interviews, the content of which was rigorously analyzed. Results At the core of the study participants’ multimorbidity experience are the impression of aging prematurely, difficulties with self-care management, and issues with access to the healthcare system, which contribute to the problem’s complexity. Despite these issues, participants with multimorbidity report attempting to take control of their situation and adjusting to daily living. Conclusions The description of this experience, through the systemic vision of participants, provides a better understanding of the realities experienced by people with multimorbidity. Journal of Comorbidity 2014;4:11–21
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Janevic MR, Ellis KR, Sanders GM, Nelson BW, Clark NM. Self-management of multiple chronic conditions among African American women with asthma: a qualitative study. J Asthma 2013; 51:243-52. [PMID: 24161047 DOI: 10.3109/02770903.2013.860166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE African American women are disproportionately burdened by asthma morbidity and mortality and may be more likely than asthma patients in general to have comorbid health conditions. This study sought to identify the self-management challenges faced by African American women with asthma and comorbidities, how they prioritize their conditions and behaviors perceived as beneficial across conditions. METHODS In-depth interviews were conducted with 25 African-American women (mean age 52 years) with persistent asthma and at least one of the following: diabetes, heart disease or arthritis. Information was elicited on women's experiences managing asthma and concurrent health conditions. The constant-comparison analytic method was used to develop and apply a coding scheme to interview transcripts. Key themes and subthemes were identified. RESULTS Participants reported an average of 5.7 comorbidities. Fewer than half of the sample considered asthma their main health problem; these perceptions were influenced by beliefs about the relative controllability, predictability and severity of their health conditions. Participants reported ways in which comorbidities affected asthma management, including that asthma sometimes took a "backseat" to conditions considered more troublesome or worrisome. Mood problems, sometimes attributed to pain or functional limitations resulting from comorbidities, reduced motivation for self-management. Women described how asthma affected comorbidity management; e.g. by impeding recommended exercise. Some self-management recommendations, such as physical activity and weight control, were seen as beneficial across conditions. CONCLUSIONS Multiple chronic conditions that include asthma may interact to complicate self-management of each condition. Additional clinical attention and self-management support may help to reduce multimorbidity-related challenges.
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Affiliation(s)
- Mary R Janevic
- Department of Health Behavior and Health Education, Center for Managing Chronic Disease
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Tarasenko YN, Fleming ST, Schoenberg NE. The relationship between perceived burden of chronic conditions and colorectal cancer screening among Appalachian residents. J Rural Health 2013; 30:40-9. [PMID: 24383483 DOI: 10.1111/jrh.12035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE As the population living with several concurrent chronic conditions or multiple morbidity (MM) increases, understanding how to effectively fit prevention efforts into disease management becomes more important, particularly among rural, underserved populations. Compared to their urban counterparts, rural residents suffer higher rates of disease, receive fewer preventive services, and often live in environments limiting access to optimal medical care. This study describes rural residents' perceived burdens of disease management and explores the relationship between these burdens, as proxies of individuals' competing demands, and colorectal cancer screening (CRCS). METHODS We conducted a cross-sectional study, based on telephone survey data from 1,012 Appalachian residents, ages 50-75, with 1 or more chronic conditions. Measures of perceived MM burdens were developed based on 85 pilot interviews previously undertaken with providers and patients with MM residing in Appalachian Kentucky. RESULTS Many participants (81%) agreed with 1 or more statements indicating perceived burdens of disease management effects on receiving CRCS. A higher percentage of rural (vs nonrural) Appalachians perceived burdens related to physician's recommendation, preparation to colonoscopy, and time management and affordability of both current diseases and screening. These differences did not modify the overall association between perceiving MM as burdensome and forgoing CRCS. The negative effect on CRCS of perceived burdens related to interaction with physician and time management was lower for participants with multiple rather than single morbidity. CONCLUSION Future research designed to address perceived burdens of MM and improved interaction with health care providers may enhance critical prevention efforts among vulnerable populations.
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Affiliation(s)
- Yelena N Tarasenko
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
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Kuluski K, Hoang SN, Schaink AK, Alvaro C, Lyons RF, Tobias R, Bensimon CM. The care delivery experience of hospitalized patients with complex chronic disease. Health Expect 2013; 16:e111-23. [PMID: 23711085 PMCID: PMC5060688 DOI: 10.1111/hex.12085] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study investigated what is important in care delivery from the perspective of hospital inpatients with complex chronic disease, a currently understudied population. PARTICIPANTS AND SETTING One-on-one semi-structured interviews were conducted with inpatients at a continuing care/rehabilitation hospital (n = 116) in Canada between February and July 2011. DESIGN The study design was mixed methods and reports on patient characteristics and care delivery experiences. Basic descriptive statistics were run using SPSS version 17, and thematic analysis on the transcripts was conducted using NVivo9 software. RESULTS Patients had an average of 5 morbidities and several illness symptoms including activity of daily living impairments, physical pain and emotional disturbance. Three broad themes (each with one or more subthemes) were generated from the data representing important components of care delivery: components of the care plan (a comprehensive assessment, supported transitions and a bio-psycho-social care package); care capacity and quality (optimal staff to patient ratios, quicker response times, better patient-provider communication and consistency between providers) and the patient-provider relationships (characterized by respect and dignity). CONCLUSIONS As health systems throughout the industrialized world move to sustain health budgets while optimizing quality of care, it is critical to better understand this population, so that appropriate metrics, services and policies can be developed. The study has generated a body of evidence on the important components of care delivery from the perspectives of a diverse group of chronically ill individuals who have spent a considerable amount of time in the health-care system. Moving forward, exploration around the appropriate funding models and skill mix is needed to move the evidence into changed practice.
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Affiliation(s)
- Kerry Kuluski
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Health, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Gallagher N, MacFarlane A, Murphy AW, Freeman GK, Glynn LG, Bradley CP. Service users' and caregivers' perspectives on continuity of care in out-of-hours primary care. QUALITATIVE HEALTH RESEARCH 2013; 23:407-421. [PMID: 23258113 DOI: 10.1177/1049732312470521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues' Chronic Illness Trajectory Framework, we explored users' and caregivers' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.
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