Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review

OBJECTIVE

To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs.

METHODS

A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team.

RESULTS

Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics.

CONCLUSIONS

Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs.

PRACTICE IMPLICATIONS

Including community members and service users in design and implementation may enhance CDSM program access.

Attending with family members, completion rate and benefits accrued from chronic disease self-management program

OBJECTIVES

Chronic Disease Self-Management Program (CDSMP) has been demonstrated effective in addressing the self-management of chronic conditions among older adults. With a higher attrition rate, this study investigated whether attending with family members influenced completion of and benefits accrued from the CDSMP.

METHODS

The baseline data were collected from CDSMP participants in New York State (n = 4184), and the follow-up data were collected from completers (attended 4+ sessions) (n = 293). Multi-level logistic regression was employed to predict the association between family accompany and program completion. Paired sample t-test was used to compare the differences in benefits from CDSMP after six months.

RESULTS

Attending with family members was associated with a higher likelihood of completing the CDSMP (OR = 1.626, p < .05). All completers reported small but significant improvements in self-rated health at six months (p < .001), and the changes were greater for those with family members. Males, caregivers, those aged 65 to 84 years old, with college or above education, were more accompanied by family members. Workshops in senior centers, libraries, or educational institutions attracted more family companions.

DISCUSSION

Engaging family members may increase CDSMP participants' motivation to complete the program. CDSMP providers should encourage participants to attend with their family members.

Effectiveness of a Self-Management Program to Improve Cognition and Quality of Life in Epilepsy: A Pragmatic, Randomized, Multicenter Trial

OBJECTIVE

To determine the effectiveness of HOBSCOTCH (Home-based self-management and cognitive training changes lives) in a real-world setting, and to assess feasibility of a virtual intervention, we conducted a multi-site, pragmatic replication trial at four New England epilepsy centers.

METHODS

HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QOL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in four states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3-months, and 6-months; intervention groups received long-term follow-up at 9- and 12-months.

RESULTS

A total of 108 participants were recruited, of which 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QOL score compared to controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or healthcare utilization at any timepoints, and the treatment effect for QOL diminished by 6-months. The virtual intervention demonstrated feasibility, but did not significantly improve outcomes compared to controls. Within-group analysis found improvements in QOL for both H-V and H-IP.

CONCLUSIONS

This study replicated the effectiveness of the HOBSCOTCH program in improving QOL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.The study was registered and listed on ClinicalTrials.gov (NCT02394509).

Patient characteristics associated with retention in an asthma self-management trial for older adults

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.

Telephone Follow-up Design and Practice for Advanced Cancer Pain Patients

To describe the design of a telephone follow-up protocol and to evaluate the feasibility of this protocol for advanced cancer pain patients. A series of nine telephone follow-up calls was implemented with 40 advanced cancer pain patients within 3 months after their discharge from the Department of Chemotherapy. Cancer pain information and the pain-related knowledge of the patients were collected by nurses using pain follow-up information sheets and the Patient Pain Questionnaire (PPQ); pain self-efficacy and the quality of life were reported by patients using the Chronic Pain Self-Efficacy Scale (CPSS) Chinese version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) Chinese version. The average score assessed by advanced cancer pain patients of the need for pain care from nurses was 24.28 (SD = 4.90). Twenty-one and eight patients completed all nine telephone follow-up calls and seven self-reported questionnaires, respectively. The pain intensity of patients at the time of follow-up was mild, but there had been breakthrough pain in the previous week. All patients were satisfied with the nurses' pain follow-up practices. There was a highly positive correlation between the time of follow-up and the patients' pain-related knowledge scores (r = 0.963**, p < 0.01). Patients' pain self-efficacy scores and quality of life scores varied across different dimensions. The baseline pain self-efficacy subscales were associated with all dimensions of quality of life (p < 0.05 or p < 0.01). Telephone follow-up can be an effective method of transitional care. For advanced cancer pain patients, it is still necessary to further explore the cost effectiveness of this method, including the appropriate follow-up duration, endpoints, and outcome measures based on government requirements and policies.

Pre-post effectiveness evaluation of Chronic Disease Self-Management Program (CDSMP) participation on health, well-being and health service utilization

Objectives

The Chronic Disease Self-Management Program (CDSMP) is a standardized self-management intervention for patients with various chronic diseases. CDSMP provides self-management skills to enhance patient health, well-being, and coping skills. The present study evaluates the effectiveness of CDSMP delivered in routine clinical services on health, health behaviors and healthcare utilization in patients with various chronic illnesses.

Methods

A pragmatic single group pre-post design evaluated the effectiveness of the CDSMP in an Irish cohort using self-report data collected by service providers in hospital, community health and patient organizations. Data on health, health behavior and healthcare utilization were collected at baseline ( n = 263), immediately post-program ( n = 102), and six months ( n = 81) after enrollment.

Results

CDSMP participants reported statistically significant increases in activity levels, self-efficacy, energy and quality of life, and a significant decrease in depression scores at six months follow-up. There was a significant decrease in self-reported visits to the GP and in total nights spent in hospital.

Discussion

This national pre–post study provides preliminary evidence for the potential effectiveness of CDSMP delivered during routine care in improving important health outcomes and reducing health care utilization among a heterogeneous sample of chronic disease patients.

Implementation and Outcomes of Lay Health Worker-Led Self-Management Interventions for Long-Term Conditions and Prevention: A Systematic Review

The aim of this study was to systematically review lay health worker (LHW)-led self-management interventions for adults with long-term conditions to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO, and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes (n = 29), cardiovascular diseases (n = 8), and those at risk of cardiovascular diseases (n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of 1 day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and noneffective interventions. The review found that LHW-led interventions have potential in promoting self-management in long-term condition. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.

Flow and Grit by Design: Exploring Gamification in Facilitating Adherence to Swallowing Therapy

PURPOSE

Delivery of swallowing therapy is faced with challenges regarding access to in-clinic services and adherence to prescribed home programs. Mobile health (mHealth) technologies are being developed at a rapid pace to address these difficulties. Whereas some benefits to using these modern tools for therapy are obvious (e.g., electronic reminders), other advantages are not as well understood. One example is the potential for mHealth devices and apps to enhance adherence to treatment regimens.

METHOD

This article introduces a number of psychological concepts that relate to adherence and that can be leveraged by mHealth. Elements that contribute to flow (optimal experience) during an activity and those that reinforce grit (perseverance to achieve a long-term goal) can be used to engage patients in their own rehabilitation.

RESULTS

The experience of flow can be targeted by presenting the rehabilitation exercise as an optimally challenging game, one that offers a match between challenge and ability. Grit can be supported by reinforcing routine and by varying the therapy experience using different games.

CONCLUSIONS

A combination of hardware and software design approaches have the potential to transform uninteresting and repetitive activities, such as those that make up swallowing therapy regimens, into engaging ones. The field of gamification, however, is still developing, and gamified mHealth apps will need to withstand scientific testing of their claims and demonstrate effectiveness in all phases of outcome research.

A latent profile analysis on patient empowerment programme in a Hong Kong primary care setting

OBJECTIVE

This study identified the profiles of subgroups of type 2 diabetic (T2DM) patients of the Patient Empowerment Programme (PEP) by different levels of benefits gained in diabetic self-management behaviors, self-efficacy, and health literacy.

METHODS

This study adopted a non-experimental repeated-measures design on T2DM patients who joined PEP, using structured questionnaires. Latent profile analysis (LPA) was used to identify patterns of participants' change on the outcome measures.

RESULTS

Findings of LPA revealed that participants who were older, unemployed, weaker in diabetic self-management, and having a higher self-perception in personal disease risk were more likely to join the empowerment sessions and gained more benefits from the program. Participants with lower impairment in energy function and lower autonomy in personal health care showed more improvement in the outcomes.

CONCLUSION

The study identified significant factors associated with patients' participation on and benefits gained from a service delivery model integrating health education and patient empowerment in a primary care setting.

PRACTICE IMPLICATION

Findings from this study shed light on strategies to improve the PEP design in order to meet the needs of individuals with different health-related profiles.

Evaluating holistic needs assessment in outpatient cancer care--a randomised controlled trial: the study protocol

INTRODUCTION

People living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured discussion of patients' needs within a clinical consultation. However, there is little evidence on how HNA impacts on the dynamics of the clinical consultation. This study aims to establish (1) how HNA affects the type of conversation that goes on during a clinical consultation and (2) how these putative changes impact on shared decision-making and self-efficacy.

METHODS AND ANALYSIS

The study is hosted by 10 outpatient oncology clinics in the West of Scotland and South West England. Participants are patients with a diagnosis of head and neck, breast, urological, gynaecological and colorectal cancer who have received treatment for their cancer. Patients are randomised to an intervention or control group. The control group entails standard care--routine consultation between the patient and clinician. In the intervention group, the patient completes a holistic needs assessment prior to consultation. The completed assessment is then given to the clinician where it informs a discussion based on the patient's needs and concerns as identified by them. The primary outcome measure is patient participation, as determined by dialogue ratio (DR) and preponderance of initiative (PI) within the consultation. The secondary outcome measures are shared decision-making and self-efficacy. It is hypothesised that HNA will be associated with greater patient participation within the consultation, and that shared decision-making and feelings of self-efficacy will increase as a function of the intervention.

ETHICS AND DISSEMINATION

This study has been given a favourable opinion by the West of Scotland Research Ethics Committee and NHS Research & Development. Study findings will be disseminated through peer-reviewed publications and conference attendance.

TRAIL REGISTRATION NUMBER

Clinical Trials.gov NCT02274701.