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Kee D, O'Conor R, Wisnivesky JP, Wolf MS, Federman AD. Patient characteristics associated with retention in an asthma self-management trial for older adults. J Asthma 2021; 59:1652-1660. [PMID: 34112032 DOI: 10.1080/02770903.2021.1941090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE New self-management interventions are being developed for older adults who suffer from worse asthma morbidity than their younger counterparts, but high rates of study drop out have hampered these efforts and there is limited literature on what factors may influence retention in behavioral intervention studies with older adults. This study analyzed illness beliefs and patient characteristics that may contribute to retention in an asthma self-management trial for older adults. METHODS This is a secondary analysis of data from a randomized controlled trial of a self-management support intervention for adults 60 years and older with persistent, uncontrolled asthma. Multivariable logistic regression was used to evaluate the association of medication and illness beliefs, and other subject characteristics with study retention, which was defined as completion of the research study interview at 6 and 12 months. RESULTS The randomized trial enrolled 388 individuals; 261 (67.3%) completed the 12-month interview. Higher perceived threat of chronic diseases relative to asthma was associated with higher study retention (OR = 1.11, 95% CI = 1.00-1.24) at 12 months. Other variables including asthma beliefs, age, cognitive function, health literacy, and asthma symptoms were not significantly associated with retention. CONCLUSIONS Concern about non-asthma chronic conditions, but no other illness beliefs, or patient characteristics, were associated with retention in an asthma self-management support intervention. Further research, including qualitative studies, is needed to better understand why patients drop out of asthma behavioral intervention studies.
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Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael S Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex D Federman
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Rodriguez Hermosa JL, Fuster Gomila A, Puente Maestu L, Amado Diago CA, Callejas González FJ, Malo De Molina Ruiz R, Fuentes Ferrer ME, Álvarez Sala-Walther JL, Calle Rubio M. Compliance and Utility of a Smartphone App for the Detection of Exacerbations in Patients With Chronic Obstructive Pulmonary Disease: Cohort Study. JMIR Mhealth Uhealth 2020; 8:e15699. [PMID: 32191213 PMCID: PMC7118552 DOI: 10.2196/15699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/14/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background In recent years, mobile health (mHealth)–related apps have been developed to help manage chronic diseases. Apps may allow patients with a chronic disease characterized by exacerbations, such as chronic obstructive pulmonary disease (COPD), to track and even suspect disease exacerbations, thereby facilitating self-management and prompt intervention. Nevertheless, there is insufficient evidence regarding patient compliance in the daily use of mHealth apps for chronic disease monitoring. Objective This study aimed to provide further evidence in support of prospectively recording daily symptoms as a useful strategy to detect COPD exacerbations through the smartphone app, Prevexair. It also aimed to analyze daily compliance and the frequency and characteristics of acute exacerbations of COPD recorded using Prevexair. Methods This is a multicenter cohort study with prospective case recruitment including 116 patients with COPD who had a documented history of frequent exacerbations and were monitored over the course of 6 months. At recruitment, the Prevexair app was installed on their smartphones, and patients were instructed on how to use the app. The information recorded in the app included symptom changes, use of medication, and use of health care resources. The patients received messages on healthy lifestyle behaviors and a record of their cumulative symptoms in the app. There was no regular contact with the research team and no mentoring process. An exacerbation was considered reported if medical attention was sought and considered unreported if it was not reported to a health care professional. Results Overall, compliance with daily records in the app was 66.6% (120/180), with a duration compliance of 78.8%, which was similar across disease severity, age, and comorbidity variables. However, patients who were active smokers, with greater dyspnea and a diagnosis of depression and obesity had lower compliance (P<.05). During the study, the patients experienced a total of 262 exacerbations according to daily records in the app, 99 (37.8%) of which were reported exacerbations and 163 (62.2%) were unreported exacerbations. None of the subject-related variables were found to be significantly associated with reporting. The duration of the event and number of symptoms present during the first day were strongly associated with reporting. Despite substantial variations in the COPD Assessment Test (CAT), there was improvement only among patients with no exacerbation and those with reported exacerbations. Nevertheless, CAT scores deteriorated among patients with unreported exacerbations. Conclusions The daily use of the Prevexair app is feasible and acceptable for patients with COPD who are motivated in their self-care because of frequent exacerbations of their disease. Monitoring through the Prevexair app showed great potential for the implementation of self-care plans and offered a better diagnosis of their chronic condition.
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Affiliation(s)
- Juan Luis Rodriguez Hermosa
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Luis Puente Maestu
- Pulmonology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Antonio Amado Diago
- Pulmonology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.,Medical Department, School of Medicine, Universidad de Cantabria, Santander, Spain
| | | | | | - Manuel E Fuentes Ferrer
- Departament of Preventive Medicine, Hospital Clínico San Carlos, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Jose Luis Álvarez Sala-Walther
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Myriam Calle Rubio
- Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.,Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Baker E, Fatoye F. Patient perceived impact of nurse-led self-management interventions for COPD: A systematic review of qualitative research. Int J Nurs Stud 2018; 91:22-34. [PMID: 30669076 DOI: 10.1016/j.ijnurstu.2018.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Self-management interventions are increasingly implemented to manage the health impact and economic burden of the growing prevalence of chronic obstructive pulmonary disease. Nurses are the primary providers of self-management education, yet there have been few attempts to assess their contribution in delivering these programmes. Qualitative evidence that explores patients' perceptions of the benefits of self-management is limited. OBJECTIVE To synthesize qualitative evidence on patient perceived benefits of nursing interventions to support self-management. DESIGN Systematic review and qualitative synthesis. METHODS Data were collected from six electronic databases: British Nursing Index (BNI, Proquest), MEDLINE (Ovid), CINAHL (EBSCO), AMED (Ovid), Embase (Ovid), and PsycINFO (Ovid). Pre-defined keywords were used to identify qualitative or mixed methods English-language studies published in any year. The included studies were selected by screening titles, abstracts and full-texts against inclusion and exclusion criteria that were established a priori. The Critical Appraisal Skills Programme tool was used to undertake a quality review. Data were analysed with a framework approach using categories of self-management outcomes reported in a previous review as a coding structure. RESULTS Fourteen articles were included in the review. Four key themes were identified from the original research: Empowerment through new knowledge, Psychological wellbeing, Expanding social worlds and Increased physical activity. CONCLUSIONS When provided with adequate knowledge and support, patients gained self-confidence and their coping behaviour increased. Social and psychological support were identified as key aspects of self-management interventions that patients found improved their sense of wellbeing. Group exercise components of self-management programmes were also favourably evaluated due to a perceived sense of increased well-being and enhanced social interaction.
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Affiliation(s)
- Elizabeth Baker
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom.
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, United Kingdom
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Theory and Practice in Digital Behaviour Change: A Matrix Framework for the Co-Production of Digital Services That Engage, Empower and Emancipate Marginalised People Living with Complex and Chronic Conditions. INFORMATICS-BASEL 2018. [DOI: 10.3390/informatics5040041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The WHO framework on integrated people-centred health services promotes a focus on the needs of people and their communities to empower them to have a more active role in their own health. It has advocated five strategies including: Engaging and empowering people and communities; co-ordinating services within and across sectors; and, creating an enabling environment. Any implementation of these strategies needs to occur at individual, community, and health service levels. Useful steps to reorganising health service provision are already being guided by existing models of care linked to increased adoption and use of digital technologies with examples including: Wagner’s Chronic Care Model (CCM); Valentijn’s Rainbow Model of Integrated Care (RMIC); and Phanareth’s et al.’s Epital Care Model (ECM). However, what about individuals and the communities they live in? How will strategies be implemented to address known inequities in: the social determinants of health; access to, and use of digital technologies, and individual textual, technical, and health literacies? Proposal of a matrix framework: This paper argues that people with complex and chronic conditions (PwCCC) living in communities that are at risk of being under-served or marginalised in health service provision require particular attention. It articulates a step-by-step process to identify these individuals and co-produce mechanisms to engage, empower and ultimately emancipate these individuals to become activated in living with their conditions and in their interactions with the health system and community. This step-by-step process focuses on key issues related to the design and role of digital services in mitigating the effects of the health service inequity and avoiding the creation of an e-health divide amongst users when advocating digital behaviour change initiatives. This paper presents a matrix framework providing a scaffold across three inter-related levels of the individual; the provider, and the health and care system. The matrix framework supports examination of and reflection on the design and role of digital technologies in conjunction with pre-existing motivational instruments. This matrix framework is illustrated with examples from practice. Conclusion: It is anticipated that the matrix framework will evolve and can be used to map and reflect on approaches and practices aiming to enrich and stimulate co-production activities supported by digital technology focused on enhancing people-centred health services for the marginalised.
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Goytia CN, Kastenbaum I, Shelley D, Horowitz CR, Kaushal R. A Tale of 2 Constituencies: Exploring Patient and Clinician Perspectives in the Age of Big Data. Med Care 2018; 56 Suppl 10 Suppl 1:S64-S69. [PMID: 30074954 PMCID: PMC6136960 DOI: 10.1097/mlr.0000000000000786] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient and clinician stakeholders are inadequately engaged in key aspects of research, particularly regarding use of Big Data to study and improve patient-centered outcomes. Little is known about the attitudes, interests, and concerns of stakeholders regarding such data. RESEARCH DESIGN The New York City Clinical Data Research Network (NYC-CDRN), a collaboration of research, clinical, and community leaders built a deidentified dataset containing electronic health records from millions of New Yorkers. Guided by a patient-clinician advisory board, we developed a question guide to explore patient and clinician experiences and ideas about research using large datasets. Trained facilitators led discussions during preexisting patient, community, and clinician group meetings. The research team coded meeting notes and identified themes. RESULTS Fully 272 individuals participated in 19 listening sessions (139 patients/advocates, 133 clinicians) at 6 medical centers with diverse NYC communities: 76% were female and 63% were nonwhite. Clinicians and patients agreed on all major themes including the central role of clinicians in introducing patients to research and the need for public campaigns to inform stakeholders about Big Data. Stakeholders were interested in using granular data to compare the care and clinical outcomes of their neighborhoods with others across NYC, but were also concerned that data could not truly be deidentified. CONCLUSIONS Clinicians and patients agree on potential benefits of stakeholder-engaged Big Data research and provided suggestions for further research and building stakeholder research capacity. This evaluation demonstrated the potential of brief meetings with existing patient and clinical groups to explore barriers and facilitators to patient and clinician engagement.
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Jónsdóttir H, Ingadóttir TS. Reluctance of patients with chronic obstructive pulmonary disease in its early stages and their families to participate in a partnership-based self-management trial: A search for explanation. Chron Respir Dis 2018; 15:315-322. [PMID: 29207891 PMCID: PMC6100171 DOI: 10.1177/1479972317743758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 10/18/2017] [Indexed: 11/16/2022] Open
Abstract
Recruitment, the process of accessing, screening, selecting and retaining participants for research remains a challenge. In a randomized controlled trial, partnership-based self-management intervention for patients who have chronic obstructive pulmonary disease (COPD) in its initial stages, and their families, a theoretical framework developed for patients with an advanced COPD and their families was modified and implemented in a primary care context. In contrast to recruitment to the original study where 4% decline participation, in this study 25% of the potential patients declined participation. Although participants were encouraged to bring a family member, only 25% of them did so. The main reason for not being accompanied by a family member was that patients did not want anybody accompany them. Those who had quit smoking were more often accompanied by a family member compared to those who smoked. Reviewing the literature, the most compelling explanations for non-participation are shame and self-blame due to smoking, and that potential participants may not have envisioned any benefits from participating since they might not have realized that they had COPD. An alternative recruitment process needs to embrace the situation that potential participants find themselves in and which takes account of the issues at stake.
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Affiliation(s)
- Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Thorbjörg Sóley Ingadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
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Baker E, Fatoye F. Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review. Int J Nurs Stud 2017; 71:125-138. [DOI: 10.1016/j.ijnurstu.2017.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 03/08/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
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Barnett W, Brittain K, Sorsdahl K, Zar HJ, Stein DJ. Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants. Philos Ethics Humanit Med 2016; 11:3. [PMID: 27435596 PMCID: PMC4952056 DOI: 10.1186/s13010-016-0036-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/23/2016] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. METHODS Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. RESULTS Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child's health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. CONCLUSIONS Satisfaction scores were high and associated with increased visit attendance. Participants' perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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Affiliation(s)
- Whitney Barnett
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Kirsty Brittain
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- />Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Heather J. Zar
- />Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, and Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- />Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- />Medical Research Council Unit on Anxiety & Stress Disorders, Cape Town, South Africa
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9
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Garg N, Round TP, Daker-White G, Bower P, Griffiths CJ. Attitudes to participating in a birth cohort study, views from a multiethnic population: a qualitative study using focus groups. Health Expect 2016; 20:146-158. [PMID: 27312575 PMCID: PMC5217869 DOI: 10.1111/hex.12445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/30/2022] Open
Abstract
Background Recruitment to birth cohort studies is a challenge. Few studies have addressed the attitudes of women about taking part in birth cohort studies particularly those from ethnic minority groups. Objective To seek the views of people from diverse ethnic backgrounds about participation in a proposed birth cohort examining the impact of infections. Design and setting Eight focus groups of pregnant women and mothers of young children took place in GP surgeries and community centres in an ethnically diverse area of east London. Purposeful sampling and language support ensured representation of people from ethnic minority groups. Audio recordings were taken and transcripts were analysed using the Framework approach. Main outcome measures The views of participants about taking part in the proposed birth cohort study, in particular concerning incentives to taking part, disincentives and attitudes to consenting children. Results There was more convergence of opinion than divergence across groups. Altruism, perceived health gains of participating and financial rewards were motivating factors for most women. Worries about causing harm to their child, inconvenience, time pressure and blood sample taking as well as a perceived lack of health gains were disincentives to most. Mistrust of researchers did not appear to be a significant barrier. The study indicates that ethnicity and other demographic factors influence attitudes to participation. Conclusions To recruit better, birth cohort studies should incorporate financial and health gains as rewards for participation, promote the altruistic goals of research, give assurances regarding the safety of the participating children and sensitive data, avoid discomfort and maximize convenience. Ethnicity influences attitudes to participation in many ways, and researchers should explore these factors in their target population.
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Affiliation(s)
- Neeru Garg
- NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Thomas P Round
- Department of Primary Care and Public Health Research, King's College London, London, UK
| | - Gavin Daker-White
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Chris J Griffiths
- Centre for Health Sciences, Queen Mary University of London, London, UK
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Soule MC, Beale EE, Suarez L, Beach SR, Mastromauro CA, Celano CM, Moore SV, Huffman JC. Understanding motivations to participate in an observational research study: Why do patients enroll? SOCIAL WORK IN HEALTH CARE 2016; 55:231-246. [PMID: 26933943 PMCID: PMC4870048 DOI: 10.1080/00981389.2015.1114064] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects.
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Affiliation(s)
- Michael C. Soule
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Eleanor E. Beale
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Laura Suarez
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Carol A. Mastromauro
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
| | - Shannon V Moore
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
| | - Jeff C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 55 Fruit St, Boston, MA, 02114, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, 25 Shattuck Street, Boston, MA 02115, United States of America
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Guillemin M, Gillam L, Barnard E, Stewart P, Walker H, Rosenthal D. "We're checking them out": Indigenous and non-Indigenous research participants' accounts of deciding to be involved in research. Int J Equity Health 2016; 15:8. [PMID: 26772174 PMCID: PMC4715344 DOI: 10.1186/s12939-016-0301-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is important for researchers to understand the motivations and decision-making processes of participants who take part in their research. This enables robust informed consent and promotes research that meets the needs and expectations of the community. It is particularly vital when working with Indigenous communities, where there is a history of exploitative research practices. In this paper, we examine the accounts of Australian Indigenous and non-Indigenous research participants in terms of how and why they agree to take part in research. METHODS A qualitative research approach was employed to undertake individual interviews with 36 research participants in Victoria, Australia. Eight participants identified as Indigenous and 28 were non-Indigenous. Thematic analysis was used to interpret the data. RESULTS There were stark differences between Indigenous and non-Indigenous research participants in terms of why and how they decided to participate in research. For Indigenous participants, taking part in research was primarily to benefit their communities rather than for personal interests. Indigenous participants often started from a position of caution, and showed a considered and deliberate process of decision making. In weighing up their decision to participate, some Indigenous participants clearly articulated what was valued in conducting research with Indigenous communities, for example, honesty, reciprocity, and respect; these values were explicitly used to assist their decision whether or not to participate. This was in contrast to non-Indigenous participants who took researchers' claims on face value, and for whom deciding to participate in research was relatively straightforward. The motivations to participate of non-Indigenous participants were due to personal interests, a desire to help others, or trust in the medical practitioner who recruited them for the research project. CONCLUSION Understanding research participants' motivations about taking part in research is important. This is particularly relevant for Indigenous communities where there is a reported history of research abuse leading to mistrust. This understanding can lead to research practice that is more respectful and responsive to the needs of Indigenous communities and abides by the values of Indigenous communities. Moreover it can lead to more ethical and respectful research practice for all.
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Affiliation(s)
- Marilys Guillemin
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Lynn Gillam
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Emma Barnard
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Paul Stewart
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Hannah Walker
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
| | - Doreen Rosenthal
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 207 Bouverie Street, VIC, 3010, Melbourne, Australia.
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MacNab M, Lee SH, McCloughan L, Hanley J, McKinstry B, Pinnock H. Oximetry-supported self-management for chronic obstructive pulmonary disease: mixed method feasibility pilot project. BMC Health Serv Res 2015; 15:485. [PMID: 26503028 PMCID: PMC4624181 DOI: 10.1186/s12913-015-1135-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 10/09/2015] [Indexed: 12/22/2022] Open
Abstract
Background Pulse oximetry could potentially contribute to self-monitoring. NHS Lothian’s ‘Light Touch’ service provided COPD patients with a self-management plan based on symptoms and oximetry. The service was overseen (though not actively monitored) by respiratory-trained community teams who were contactable by a telephone helpline. We aimed to assess the feasibility, perceived utility and impact of the ‘Light Touch’ service. Methods A before-and-after assessment of St George’s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS) and use of healthcare resources during the 6-month feasibility study compared to the previous corresponding 6-months. Paired semi-structured interviews with patients at baseline and 6-months, interviews with managers and a focus group of professionals explored perceptions of the service and self-management. Transcripts were coded, and analysed thematically. Results We recruited 51 participants (mean age 69.7 years (SD 8.4); 21 (46 %) male). 46 participants completed quantitative follow up (2 died, 2 were unwell, 1 refused). SGRQ: 21 (46 %) participants improved by 4 or more (the minimum important difference); 12 (26 %) deteriorated by 4 or more. HADS: more participants had normal scores for anxiety (65 %) and depression (80 %) at 6-months than at baseline (51 and 64 %). More emergency therapy was prescribed during the study period compared to the previous year. Only 18 participants (39 %) contacted the Light Touch Helpline during the 6-month study. Twenty patients provided a total of 36 interviews, 8 clinicians contributed to a focus group and 6 managers were interviewed. Patients considered that the oximetry readings heightened awareness of their condition and gave them confidence to make self-management decisions. Healthcare professionals valued oximetry as a tool for teaching people self-management skills, but were concerned that patients rarely contacted the teams for help or advice during the study. Conclusions ‘Light Touch’ shows promise as a low-cost strategy for empowering patients’ self-management skills and reducing reliance on clinical supervision. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1135-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michele MacNab
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Siew Hwa Lee
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland.
| | - Lucy McCloughan
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Janet Hanley
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK.
| | - Brian McKinstry
- e-Health Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
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Guillemin M, Barnard E, Walker H, Bennell K, Hinman R, Gillam L. Participants' Understanding of Informed Consent in a Randomized Controlled Trial for Chronic Knee Pain. J Empir Res Hum Res Ethics 2015; 10:435-43. [PMID: 26483427 DOI: 10.1177/1556264615610209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored participants' experiences of randomized controlled trial (RCT) participation to examine their understanding of the trial design and whether their consent was indeed informed. A nested qualitative interview study was conducted with 38 participants from a sample of 282 who participated in a complex RCT evaluating the effectiveness of laser compared with needle acupuncture for chronic knee pain. Overall participants had a good understanding of the RCT, and concepts such as randomization and placebo. Their experiences of being in the trial were largely positive, even if they did not experience any knee pain improvement. Their responses to unblinding at the end of the study were accepting. Participants had a good functional understanding of the RCT, sufficient for valid informed consent.
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Affiliation(s)
| | | | | | - Kim Bennell
- University of Melbourne, Parkville, Australia
| | - Rana Hinman
- University of Melbourne, Parkville, Australia
| | - Lynn Gillam
- University of Melbourne, Parkville, Australia
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14
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Slegers C, Zion D, Glass D, Kelsall H, Fritschi L, Brown N, Loff B. Why do people participate in epidemiological research? JOURNAL OF BIOETHICAL INQUIRY 2015; 12:227-37. [PMID: 25672617 DOI: 10.1007/s11673-015-9611-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/23/2014] [Indexed: 05/02/2023]
Abstract
Many assumptions are made about public willingness to participate in epidemiological research, yet few empirical studies have been conducted to ascertain whether such assumptions are correct. Our qualitative study of the public and of expert stakeholders leads us to suggest that people are generally prepared to participate in epidemiological research, particularly if it is conducted by a trusted public institution such as a government health department, charity, or university. However, there is widespread community distrust of research conducted or sponsored by pharmaceutical companies. Individuals are prompted to take part if the study concerns an illness they or a family member or friend have personally experienced or if they believe the research will confer a widespread public benefit. Preferences vary about the mode of contact for the research to be conducted. Willingness to participate in telephone surveys has decreased in recent years, and this may be a consequence of an increase in calls to homes by telemarketers and market researchers. Participants also stressed the importance of knowing where their names and contact details were sourced and suggested that this information be available to prospective study participants as a matter of course in the first approach or letter. We provide valuable information to epidemiologists in designing studies.
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Affiliation(s)
- Claudia Slegers
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, Commercial Road, Melbourne, Victoria, 3004, Australia,
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15
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Irani E, Richmond TS. Reasons for and reservations about research participation in acutely injured adults. J Nurs Scholarsh 2015; 47:161-9. [PMID: 25599886 DOI: 10.1111/jnu.12120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study. DESIGN AND METHODS This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis. FINDINGS The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements. CONCLUSIONS Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences. CLINICAL RELEVANCE Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.
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Affiliation(s)
- Elliane Irani
- Xi, Doctoral Student, University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
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16
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Zwerink M, Brusse‐Keizer M, van der Valk PDLPM, Zielhuis GA, Monninkhof EM, van der Palen J, Frith PA, Effing T. Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 2014:CD002990. [PMID: 24665053 PMCID: PMC7004246 DOI: 10.1002/14651858.cd002990.pub3] [Citation(s) in RCA: 269] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Self management interventions help patients with chronic obstructive pulmonary disease (COPD) acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease. Since the first update of this review in 2007, several studies have been published. The results of the second update are reported here. OBJECTIVES 1. To evaluate whether self management interventions in COPD lead to improved health outcomes.2. To evaluate whether self management interventions in COPD lead to reduced healthcare utilisation. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials (current to August 2011). SELECTION CRITERIA Controlled trials (randomised and non-randomised) published after 1994, assessing the efficacy of self management interventions for individuals with COPD, were included. Interventions with fewer than two contact moments between study participants and healthcare providers were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Investigators were contacted to ask for additional information. When appropriate, study results were pooled using a random-effects model. The primary outcomes of the review were health-related quality of life (HRQoL) and number of hospital admissions. MAIN RESULTS Twenty-nine studies were included. Twenty-three studies on 3189 participants compared self management versus usual care; six studies on 499 participants compared different components of self management on a head-to-head basis. Although we included non-randomised controlled clinical trials as well as RCTs in this review, we restricted the primary analysis to RCTs only and reported these trials in the abstract.In the 23 studies with a usual care control group, follow-up time ranged from two to 24 months. The content of the interventions was diverse. A statistically relevant effect of self management on HRQoL was found (St George's Respiratory Questionnaire (SGRQ) total score, mean difference (MD) -3.51, 95% confidence interval (CI) -5.37 to -1.65, 10 studies, 1413 participants, moderate-quality evidence). Self management also led to a lower probability of respiratory-related hospitalisation (odds ratio (OR) 0.57, 95% CI 0.43 to 0.75, nine studies, 1749 participants, moderate-quality evidence). Over one year of follow-up, eight (95% CI 5 to 14) participants with a high baseline risk of respiratory-related hospital admission needed to be treated to prevent one participant with at least one hospital admission, and 20 (95% CI 15 to 35) participants with a low baseline risk of hospitalisation needed to be treated to prevent one participant with at least one respiratory-related hospital admission.No statistically significant effect of self management on all-cause hospitalisation (OR 0.77, 95% CI 0.45 to 1.30, 6 studies, 1365 participants, low-quality evidence) or mortality (OR 0.79, 95% CI 0.58 to 1.07, 8 studies, 2134 participants, very low-quality evidence) was detected. Also, dyspnoea measured by the (modified) Medical Research Council Scale ((m)MRC) was reduced in individuals who participated in self management (MD -0.83, 95% CI -1.36 to -0.30, 3 studies, 119 participants, low-quality evidence). The difference in exercise capacity as measured by the six-minute walking test was not statistically significant (MD 33.69 m, 95% CI -9.12 to 76.50, 6 studies, 570 participants, very low-quality evidence). Subgroup analyses depending on the use of an exercise programme as part of the intervention revealed no statistically significant differences between studies with and without exercise programmes in our primary outcomes of HRQoL and respiratory-related hospital admissions.We were unable to pool head-to-head trials because of heterogeneity among interventions and controls; thus results are presented narratively within the review. AUTHORS' CONCLUSIONS Self management interventions in patients with COPD are associated with improved health-related quality of life as measured by the SGRQ, a reduction in respiratory-related hospital admissions, and improvement in dyspnoea as measured by the (m)MRC. No statistically significant differences were found in other outcome parameters. However, heterogeneity among interventions, study populations, follow-up time and outcome measures makes it difficult to formulate clear recommendations regarding the most effective form and content of self management in COPD.
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Affiliation(s)
- Marlies Zwerink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineHaaksbergerstraat 55EnschedeNetherlands7513 ER
| | - Marjolein Brusse‐Keizer
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineHaaksbergerstraat 55EnschedeNetherlands7513 ER
| | - Paul DLPM van der Valk
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineHaaksbergerstraat 55EnschedeNetherlands7513 ER
| | - Gerhard A Zielhuis
- Radboud University Medical CenterDepartment for Health EvidencePO Box 9101NijmegenNetherlands6500 HB
| | - Evelyn M Monninkhof
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands3508 GA
| | - Job van der Palen
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineHaaksbergerstraat 55EnschedeNetherlands7513 ER
- University of TwenteDepartment of Research Methodology, Measurement and Data AnalysisEnschedeNetherlands
| | - Peter A Frith
- Repatriation General HospitalRespiratory Clinical Research UnitDaw ParkSouth AustraliaAustralia
- Flinders UniversitySchool of MedicineAdelaideSouth AustraliaAustralia
| | - Tanja Effing
- Repatriation General HospitalRespiratory Clinical Research UnitDaw ParkSouth AustraliaAustralia
- Flinders UniversitySchool of MedicineAdelaideSouth AustraliaAustralia
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17
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Abstract
Internet psychological interventions are efficacious and may reduce traditional access barriers. No studies have evaluated whether any sampling bias exists in these trials that may limit the translation of the results of these trials into real-world application. We identified 7999 potentially eligible trial participants from a community-based health cohort study and invited them to participate in a randomized controlled trial of an online cognitive behavioural therapy programme for people with depression. We compared those who consented to being assessed for trial inclusion with nonconsenters on demographic, clinical and behavioural indicators captured in the health study. Any potentially biasing factors were then assessed for their association with depression outcome among trial participants to evaluate the existence of sampling bias. Of the 35 health survey variables explored, only 4 were independently associated with higher likelihood of consenting-female sex (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.05-1.19), speaking English at home (OR 1.48, 95% CI 1.15-1.90) higher education (OR 1.67, 95% CI 1.46-1.92) and a prior diagnosis of depression (OR 1.37, 95% CI 1.22-1.55). The multivariate model accounted for limited variance (C-statistic 0.6) in explaining participation. These four factors were not significantly associated with either the primary trial outcome measure or any differential impact by intervention arm. This demonstrates that, among eligible trial participants, few factors were associated with the consent to participate. There was no indication that such self-selection biased the trial results or would limit the generalizability and translation into a public or clinical setting.
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Pollock K. Procedure versus process: ethical paradigms and the conduct of qualitative research. BMC Med Ethics 2012; 13:25. [PMID: 23016663 PMCID: PMC3519630 DOI: 10.1186/1472-6939-13-25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research is fundamental to improving the quality of health care. The need for regulation of research is clear. However, the bureaucratic complexity of research governance has raised concerns that the regulatory mechanisms intended to protect participants now threaten to undermine or stifle the research enterprise, especially as this relates to sensitive topics and hard to reach groups. DISCUSSION Much criticism of research governance has focused on long delays in obtaining ethical approvals, restrictions imposed on study conduct, and the inappropriateness of evaluating qualitative studies within the methodological and risk assessment frameworks applied to biomedical and clinical research. Less attention has been given to the different epistemologies underlying biomedical and qualitative investigation. The bioethical framework underpinning current regulatory structures is fundamentally at odds with the practice of emergent, negotiated micro-ethics required in qualitative research. The complex and shifting nature of real world settings delivers unanticipated ethical issues and (occasionally) genuine dilemmas which go beyond easy or formulaic 'procedural' resolution. This is not to say that qualitative studies are 'unethical' but that their ethical nature can only be safeguarded through the practice of 'micro-ethics' based on the judgement and integrity of researchers in the field. SUMMARY This paper considers the implications of contrasting ethical paradigms for the conduct of qualitative research and the value of 'empirical ethics' as a means of liberating qualitative (and other) research from an outmoded and unduly restrictive research governance framework based on abstract prinicipalism, divorced from real world contexts and values.
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Affiliation(s)
- Kristian Pollock
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2HA, UK.
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Walters EH, Walters J, Wills KE, Robinson A, Wood-Baker R. Clinical diaries in COPD: compliance and utility in predicting acute exacerbations. Int J Chron Obstruct Pulmon Dis 2012; 7:427-35. [PMID: 22848156 PMCID: PMC3402058 DOI: 10.2147/copd.s32222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Daily diaries are often used to collect data on disease activity, but are burdensome and compliance may be poor. Their use in chronic obstructive pulmonary disease (COPD) and impact on the prevention and treatment of exacerbations is poorly researched. Methods We investigated diary-keeping in COPD and ascertained items that best predicted emergency attendances for exacerbations. Participants in the active limb of a clinical trial in COPD kept daily diaries rating breathlessness, cough, sputum, physical activity, and use of reliever medication. Results Data on 55 participants, 67% of whom were female, showed that overall compliance with diary-keeping was 62%. Participants educated to primary school level only had lower compliance (P = 0.05). Twenty patients had at least one emergency attendance, in whom the relative risk of an acute exacerbation for an increase in item score rose from six days prior to hospitalization, most sharply in the last two days. Even for optimal combinations of items, the positive predictive value was poor, the best combination being cough, activity level, and inhaler use. Conclusion Good compliance can be achieved using daily diaries in COPD, although this is worse in those with a poor educational level. Diary-keeping is not accurate in predicting acute exacerbations, but could be substantially simplified without loss of efficiency.
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Affiliation(s)
- E Haydn Walters
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
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20
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Abstract
The aim of this article is to understand the reasons for attending a chronic obstructive pulmonary disease (COPD)-specific self-management (SM) programme and how attendance at such programmes might be improved. A total of 20 qualitative semistructured interviews were carried out with patients and with lay programme tutors involved in the Better Living with Long term Airways disease (BELLA) pilot trial. Thematic framework data analysis was used. Common reasons for participant attendance arising from patients and tutors include (1) desire to learn about SM, (2) social benefits of meeting others with COPD and (3) altruism. Patients' reasons for poor attendance include (1) being too ill or not feeling ill enough and (2) practical, physical and emotional barriers. Tutor’s explanations for patients’ poor attendance were (1) failure to accept their condition, (2) fear of making a change, (3) lack of adequate support, (4) guilt about smoking and (5) the ‘scripted’ nature of the course. Suggestions for improving programme participation included (1) having choice of several start dates, (2) minimal delay inviting participant onto courses, (3) planning for ‘special needs’. Participation may be better amongst those who have accepted their condition or who are motivated towards improving their condition or to help others. Providing solutions for practical barriers may improve participation. However, alternatives to group-based interventions need to be developed for people with functional and emotional barriers to attendance.
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Keshet Y, Arnon Z, Ben-Arye E, Attias S, Sroka G, Matter I, Schiff E. The perceived impact of integrative medicine in a surgical department. Eur J Integr Med 2012. [DOI: 10.1016/j.eujim.2011.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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