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Kimminau KS, Jernigan C, Krebill H, Douglas S, Peltzer J, Hamilton-Reeves J, Chen RC, Jensen R. Roadmap to engagement: Bringing patient partners into cancer research and beyond. J Clin Transl Sci 2023; 7:e178. [PMID: 37654779 PMCID: PMC10465315 DOI: 10.1017/cts.2023.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023] Open
Abstract
The University of Kansas Cancer Center (KU Cancer Center) initiated an engagement program to leverage the lived experience of individuals and families with cancer. KU Cancer Center faculty, staff, and patient partners built an infrastructure to achieve a patient-designed, patient-led, and research-informed engagement program called Patient and Investigator Voices Organizing Together (PIVOT). This special communication offers an engagement roadmap that can be replicated, scaled, and adopted at other cancer centers and academic health systems. PIVOT demonstrates that collaboration among academic leaders, investigators, and people with a lived experience yields a patient-centered, vibrant environment that enriches the research enterprise.
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Affiliation(s)
- Kim S. Kimminau
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
| | - Cheryl Jernigan
- University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Sara Douglas
- Patient Advocacy and Engagement Talaris Therapeutics, Louisville, KY, USA
| | - Jill Peltzer
- University of Kansas School of Nursing, Kansas City, KS, USA
| | - Jill Hamilton-Reeves
- KU Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Ronald C. Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Roy Jensen
- University of Kansas Cancer Center, University of Kansas School of Medicine, Kansas City, KS, USA
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Conlon RPK, Hu H, Saptono A, Hawkins MS, Parmanto B, Levine MD, Buysse DJ. Formative Development of ClockWork for the Postpartum Period: A Theory-Based Intervention to Harness the Circadian Timing System to Address Cardiometabolic Health-Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3669. [PMID: 36834364 PMCID: PMC9961849 DOI: 10.3390/ijerph20043669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Individuals with body mass index (BMI) ≥ 25 kg/m2 before pregnancy have greater difficulty losing the weight gained during pregnancy, and this postpartum weight retention predicts higher risk for cardiometabolic disease. The postpartum period involves substantial disruptions in circadian rhythms, including rhythms related to eating, physical activity, sleep, and light/dark exposure, each of which are linked to obesity and cardiometabolic disease in non-pregnant adult humans and animals. We posit that a multi-component, circadian timing system-based behavioral intervention that uses digital tools-ClockWork-will be feasible and acceptable to postpartum individuals and help promote weight- and cardiometabolic health-related behaviors. We provide data from stakeholder interviews with postpartum individuals (pre-pregnancy BMI ≥ 25; n = 7), which were conducted to obtain feedback on and improve the relevance and utility of digital self-monitoring tools for health behaviors and weight during the postpartum period. Participants perceived the ClockWork intervention and digital monitoring app to be helpful for management of postpartum weight-related health behaviors. They provided specific recommendations for increasing the feasibility intervention goals and improving app features for monitoring behaviors. Personalized, easily accessible interventions are needed to promote gestational weight loss after delivery; addressing circadian behaviors is an essential component of such interventions. Future studies will evaluate the efficacy of the ClockWork intervention and associated digital tools for improving cardiometabolic health-related behaviors linked to the circadian timing system during the postpartum period.
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Affiliation(s)
- Rachel P. Kolko Conlon
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Haomin Hu
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Andi Saptono
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Marquis S. Hawkins
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Bambang Parmanto
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Michele D. Levine
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Daniel J. Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Norton C, Syred J, Kerry S, Artom M, Sweeney L, Hart A, Czuber-Dochan W, Taylor SJC, Mihaylova B, Roukas C, Aziz Q, Miller L, Pollok R, Saxena S, Stagg I, Terry H, Zenasni Z, Dibley L, Moss-Morris R. Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial. Trials 2021; 22:516. [PMID: 34344432 PMCID: PMC8329619 DOI: 10.1186/s13063-021-05466-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 07/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite being in clinical remission, many people with inflammatory bowel disease (IBD) live with fatigue, chronic abdominal pain and bowel urgency or incontinence that limit their quality of life. We aim to test the effectiveness of an online self-management programme (BOOST), developed using cognitive behavioural principles and a theoretically informed logic model, and delivered with facilitator support. PRIMARY RESEARCH QUESTION In people with IBD who report symptoms of fatigue, pain or urgency and express a desire for intervention, does a facilitator-supported tailored (to patient needs) online self-management programme for fatigue, pain and faecal urgency/incontinence improve IBD-related quality of life (measured using the UK-IBDQ) and global rating of symptom relief (0-10 scale) compared with care as usual? METHODS A pragmatic two-arm, parallel group randomised controlled trial (RCT), of a 12-session facilitator-supported online cognitive behavioural self-management programme versus care as usual to manage symptoms of fatigue, pain and faecal urgency/incontinence in IBD. Patients will be recruited through a previous large-scale survey of unselected people with inflammatory bowel disease. The UK Inflammatory Bowel Disease Questionnaire and global rating of symptom relief at 6 months are the co-primary outcomes, with multiple secondary outcomes measured also at 6 and 12 months post randomisation to assess maintenance. The RCT has an embedded pilot study, health economics evaluation and process evaluation. We will randomise 680 patients, 340 in each group. Demographic characteristics and outcome measures will be presented for both study groups at baseline. The UK-IBDQ and global rating of symptom relief at 6 and 12 months post randomisation will be compared between the study groups. DISCUSSION The BOOST online self-management programme for people with IBD-related symptoms of fatigue, pain and urgency has been designed to be easily scalable and implemented. If it is shown to improve patients' quality of life, this trial will enable clinicians and patients to make informed management decisions. This is the first trial, to our knowledge, focused on multiple symptoms prioritised by both people with IBD and health professionals. TRIAL REGISTRATION ISRCTN71618461 . Registered on 9 September 2019.
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Affiliation(s)
| | - Jonathan Syred
- King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
| | - Micol Artom
- NHS Digital, Skipton House, 80 London Road, London, SE1 6LH UK
| | - Louise Sweeney
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ailsa Hart
- IBD Unit, St Mark’s Hospital, Watford Road, Harrow, HA13UJ UK
| | | | - Stephanie J. C. Taylor
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
| | - Borislava Mihaylova
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Chris Roukas
- Institute of Population Health Sciences, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
| | - Qasim Aziz
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, London, E1 2AJ UK
| | - Laura Miller
- Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust and St George’s University of London, London, SW17 0QT UK
| | - Sonia Saxena
- Department of Primary Care and Public Health Imperial College London, London, UK
| | - Imogen Stagg
- London North West University Hospitals, Watford Road, Harrow, HA1 3UJ UK
| | - Helen Terry
- Crohn’s & Colitis UK, 1 Bishops Square (Helios Court), Hatfield Business Park, Hatfield, Hertfordshire, AL10 9NE UK
| | - Zohra Zenasni
- Pragmatic Clinical Trials Unit, Queen Mary University of London, 58 Turner St, Whitechapel, London, E1 2AB UK
| | - Lesley Dibley
- School of Health Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, (Avery Hill Campus), London, SE9 2UG UK
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Obro LF, Heiselberg K, Krogh PG, Handberg C, Ammentorp J, Pihl GT, Osther PJS. Combining mHealth and health-coaching for improving self-management in chronic care. A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:680-688. [PMID: 33143907 DOI: 10.1016/j.pec.2020.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Self-management approaches are widely used to improve chronic care. In this context, health care professionals call for efficient tools to engage patients in managing their illness. Mobile health (mHealth), defined by WHO as medical and public health practice supported by mobile devices, is demonstrated to enhance self-management and health-coaching as an engaging tool in supporting behaviour change. Nevertheless, it is unclear how health-coaching and mHealth can benefit from each other. OBJECTIVE We conducted a scoping review to provide a literature-overview and identify any existing gaps in knowledge of mHealth in combination with health-coaching interventions for improving self-management in patients with chronic diseases. PATIENT INVOLVEMENT No patients were involved in the review process. METHODS The five-stage framework by Arksey and O'Malley was used. The review surveys; PubMed, CINAHL, Embase, Scopus, and PsycInfo. Two independent reviewers performed review selection and characterization. RESULTS The review points at two approaches; (i) coaching used to support mHealth and (ii) mHealth as support for coaching. The findings suggest that patients prefer physical interactions to telecommunication. mHealth was primarily used to facilitate telecommunication and to monitor disease aspects. DISCUSSION We found that mHealth and health-coaching interventions benefit from each other. The review report on a considerable unclarity in the coaching-methods and that the patients were more satisfied with physical interactions than mHealth. We suggest to prioritize human contact and to explore more personalized health technology. PRACTICAL VALUE This scoping review can provide a framework for researchers and care providers to support discussion and introduction of new approaches and technology in self-management for patients with chronic diseases, thereby improving patients' quality of life.
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Affiliation(s)
- Louise Faurholt Obro
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
| | - Kasper Heiselberg
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Department of Engineering, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Charlotte Handberg
- National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark; Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jette Ammentorp
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Palle Jörn Sloth Osther
- Urological Research Center, Lillebaelt Hospital, Vejle, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Hounkpatin HO, Leydon GM, Veighey K, Armstrong K, Santer M, Taal MW, Annells P, May C, Roderick PJ, Fraser SD. Patients' and kidney care team's perspectives of treatment burden and capacity in older people with chronic kidney disease: a qualitative study. BMJ Open 2020; 10:e042548. [PMID: 33310810 PMCID: PMC7735091 DOI: 10.1136/bmjopen-2020-042548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/17/2020] [Accepted: 11/16/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is often a multimorbid condition and progression to more severe disease is commonly associated with increased management requirements, including lifestyle change, more medication and greater clinician involvement. This study explored patients' and kidney care team's perspectives of the nature and extent of this workload (treatment burden) and factors that support capacity (the ability to manage health) for older individuals with CKD. DESIGN Qualitative semistructured interview and focus group study. SETTING AND PARTICIPANTS Adults (aged 60+) with predialysis CKD stages G3-5 (identified in two general practitioner surgeries and two renal clinics) and a multiprofessional secondary kidney care team in the UK. RESULTS 29 individuals and 10 kidney team members were recruited. Treatment burden themes were: (1) understanding CKD, its treatment and consequences, (2) adhering to treatments and management and (3) interacting with others (eg, clinicians) in the management of CKD. Capacity themes were: (1) personal attributes (eg, optimism, pragmatism), (2) support network (family/friends, service providers), (3) financial capacity, environment (eg, geographical distance to unit) and life responsibilities (eg, caring for others). Patients reported poor provision of CKD information and lack of choice in treatment, whereas kidney care team members discussed health literacy issues. Patients reported having to withdraw from social activities and loss of employment due to CKD, which further impacted their capacity. CONCLUSION Improved understanding of and measures to reduce the treatment burden (eg, clear information, simplified medication, joined up care, free parking) associated with CKD in individuals as well as assessment of their capacity and interventions to improve capacity (social care, psychological support) will likely improve patient experience and their engagement with kidney care services.
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Affiliation(s)
- Hilda O Hounkpatin
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Geraldine M Leydon
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Kristin Veighey
- Southampton Academy of Research, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Kirsten Armstrong
- Renal Medicine and Nephrology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Maarten W Taal
- Renal Medicine, Royal Derby Hospital, Derby, UK
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | | | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, London, UK
| | - Paul J Roderick
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
| | - Simon Ds Fraser
- Primary Care, Population Sciences and Medical Education, University of Southampton Faculty of Medicine, Southampton, Southampton, UK
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Biddell CB, Spees LP, Mayer DK, Wheeler SB, Trogdon JG, Rotter J, Birken SA. Developing personalized survivorship care pathways in the United States: Existing resources and remaining challenges. Cancer 2020; 127:997-1004. [PMID: 33259060 DOI: 10.1002/cncr.33355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/27/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Deborah K Mayer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Khan N, Rudoler D, McDiarmid M, Peckham S. A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK. BMC FAMILY PRACTICE 2020; 21:142. [PMID: 32660427 PMCID: PMC7359468 DOI: 10.1186/s12875-020-01208-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 06/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Quality and Outcomes Framework (QOF) is an incentive scheme for general practice, which was introduced across the UK in 2004. The Quality and Outcomes Framework is one of the biggest pay for performance (P4P) scheme in the world, worth £691 million in 2016/17. We now know that P4P is good at driving some kinds of improvement but not others. In some areas, it also generated moral controversy, which in turn created conflicts of interest for providers. We aimed to undertake a meta-synthesis of 18 qualitative studies of the QOF to identify themes on the impact of the QOF on individual practitioners and other staff. METHODS We searched 5 electronic databases, Medline, Embase, Healthstar, CINAHL and Web of Science, for qualitative studies of the QOF from the providers' perspective in primary care, published in UK between 2004 and 2018. Data was analysed using the Schwartz Value Theory as a theoretical framework to analyse the published papers through the conceptual lens of Professionalism. A line of argument synthesis was undertaken to express the synthesis. RESULTS We included 18 qualitative studies that where on the providers' perspective. Four themes were identified; 1) Loss of autonomy, control and ownership; 2) Incentivised conformity; 3) Continuity of care, holism and the caring role of practitioners' in primary care; and 4) Structural and organisational changes. Our synthesis found, the Values that were enhanced by the QOF were power, achievement, conformity, security, and tradition. The findings indicated that P4P schemes should aim to support Values such as benevolence, self-direction, stimulation, hedonism and universalism, which professionals ranked highly and have shown to have positive implications for Professionalism and efficiency of health systems. CONCLUSIONS Understanding how practitioners experience the complexities of P4P is crucial to designing and delivering schemes to enhance and not compromise the values of professionals. Future P4P schemes should aim to permit professionals with competing high priority values to be part of P4P or other quality improvement initiatives and for them to take on an 'influencer role' rather than being 'responsive agents'. Through understanding the underlying Values and not just explicit concerns of professionals, may ensure higher levels of acceptance and enduring success for P4P schemes.
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Affiliation(s)
| | - David Rudoler
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Unit UA3000, Oshawa, ON, L1H 7K4, Canada
| | - Mary McDiarmid
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N 5S9, Canada
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Kent, Canterbury, CT2 7NF, UK
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Allen C, Vassilev I, Kennedy A, Rogers A. The work and relatedness of ties mediated online in supporting long-term condition self-management. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:579-595. [PMID: 31769045 PMCID: PMC7078997 DOI: 10.1111/1467-9566.13042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The 'care transition' is characterised by reduced state involvement in chronic illness management in response to socio-political movements aimed at meeting the challenges presented by an increased prevalence of chronic illness. Amongst these changes has been online communities' rising importance in everyday interactions and attention is being increasingly paid towards the ways online contacts might contribute to self-management. Whilst research has illuminated the relevance of personal networks in long-term condition management, it is relevant to extend this work to consider the place of ties mediated online in this bricolage of support, including better understanding the work drawn from them and the strategies involved in eliciting it. This study examined the work and relatedness of 30 participants, who used online communities. Participants were asked about the role of on and offline ties and ego network mapping was used to frame conversations about the nature of this support. The context of engagement followed three main themes. Participants drew from online communities in response to deficits in offline support, they used online ties to leverage support or action from offline ties and they used online ties to substitute offline support, with less intimate online ties.
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Affiliation(s)
- Chris Allen
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Ivaylo Vassilev
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Anne Rogers
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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Abstract
Purpose
The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.
Design/methodology/approach
The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.
Findings
This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.
Research limitations/implications
The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.
Practical implications
The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.
Originality/value
The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.
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Komaromy M, Madden EF, Zurawski A, Kalishman S, Barker K, O'Sullivan P, Jurado M, Arora S. Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status. PATIENT EDUCATION AND COUNSELING 2018; 101:524-531. [PMID: 28890084 DOI: 10.1016/j.pec.2017.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/06/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs. RESULTS Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors. CONCLUSION These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. PRACTICE IMPLICATIONS For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.
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Affiliation(s)
- Miriam Komaromy
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | | | - Andrea Zurawski
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Summers Kalishman
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Family and Community Medicine, Office of Education at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Kristin Barker
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | | | - Martin Jurado
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sanjeev Arora
- The ECHO Institute at the University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Campling N, Richardson A, Mulvey M, Bennett M, Johnston B, Latter S. Self-management support at the end of life: Patients’, carers’ and professionals’ perspectives on managing medicines. Int J Nurs Stud 2017; 76:45-54. [DOI: 10.1016/j.ijnurstu.2017.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Lesnovska KP, Hollman Frisman G, Hjortswang H, Hjelm K, Börjeson S. Health care as perceived by persons with inflammatory bowel disease - a focus group study. J Clin Nurs 2017; 26:3677-3687. [PMID: 28122403 DOI: 10.1111/jocn.13740] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore the perceptions of health care among persons living with inflammatory bowel disease. BACKGROUND The quality of care plays an important role in the life of persons with a chronic disease. To define what persons with inflammatory bowel disease perceive as high-quality care, greater focus must be placed on the individual's own perspective of living with the condition. DESIGN A qualitative exploratory study was conducted based on focus groups. METHODS Five focus groups were conducted with adult persons living with inflammatory bowel disease, 14 men and 12 women aged 19-76 years. The interviews were performed between January-June 2014. RESULTS The perceptions of health care from the perspective of persons living with inflammatory bowel disease were summarised in two categories: 'professional attitudes of healthcare staff' and 'structure of the healthcare organisation'. Persons with inflammatory bowel disease want to be encountered with respect, experience trust and obtain information at the right time. They also expect shared decision-making, communication and to encounter competent healthcare professionals. Furthermore, the expectations on and perceptions of the structure of the healthcare organisation comprise access to care, accommodation, continuity of care, as well as the pros and cons of specialised care. CONCLUSION The findings show the importance of establishing a respectful and trusting relationship, facilitating healthcare staff and persons with inflammatory bowel disease to work as a team in fulfilling individual care needs - but there is room for improvement in terms of quality of care. RELEVANCE TO CLINICAL PRACTICE A person-centred approach, which places the individual and her/his family at the centre, considering them experts on their own health and enabling them to collaborate with healthcare staff, seems important to reach a high-quality healthcare organisation for patients with Inflammatory bowel disease.
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Affiliation(s)
- Katarina Pihl Lesnovska
- Department of Gastroenterology, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Hollman Frisman
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Anaesthetics, Operations and Specialty Surgery Center, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Katarina Hjelm
- Department of Social and Welfare Studies, Linköping University, Norrkoping, Sweden
| | - Sussanne Börjeson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Umeukeje EM, Merighi JR, Browne T, Wild M, Alsmaan H, Umanath K, Lewis JB, Wallston KA, Cavanaugh KL. Health care providers' support of patients' autonomy, phosphate medication adherence, race and gender in end stage renal disease. J Behav Med 2016; 39:1104-1114. [PMID: 27167227 PMCID: PMC5512866 DOI: 10.1007/s10865-016-9745-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/19/2016] [Indexed: 01/08/2023]
Abstract
This study was designed to assess dialysis subjects' perceived autonomy support association with phosphate binder medication adherence, race and gender. A multi-site cross-sectional study was conducted among 377 dialysis subjects. The Health Care Climate (HCC) Questionnaire assessed subjects' perception of their providers' autonomy support for phosphate binder use, and adherence was assessed by the self-reported Morisky Medication Adherence Scale. Serum phosphorus was obtained from the medical record. Regression models were used to examine independent factors of medication adherence, serum phosphorus, and differences by race and gender. Non-white HCC scores were consistently lower compared with white subjects' scores. No differences were observed by gender. Reported phosphate binder adherence was associated with HCC score, and also with phosphorus control. No significant association was found between HCC score and serum phosphorus. Autonomy support, especially in non-white end stage renal disease subjects, may be an appropriate target for culturally informed strategies to optimize mineral bone health.
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Affiliation(s)
- Ebele M Umeukeje
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
| | - Joseph R Merighi
- School of Social Work, University of Minnesota, Saint Paul, MN, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Marcus Wild
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
| | - Hafez Alsmaan
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
| | - Kausik Umanath
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
| | - Julia B Lewis
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA
| | | | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, 1161 21st Avenue MCN S-3223, Nashville, TN, 37232, USA.
- Vanderbilt Center for Kidney Disease, Nashville, TN, USA.
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Foss C, Knutsen I, Kennedy A, Todorova E, Wensing M, Lionis C, Portillo MC, Serrano-Gil M, Koetsenruijter J, Mujika A, Rogers A. Connectivity, contest and the ties of self-management support for type 2 diabetes: a meta-synthesis of qualitative literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:672-686. [PMID: 26429546 DOI: 10.1111/hsc.12272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
This paper presents a meta-synthesis of the literature on community-based self-management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self-management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU-WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self-management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro- and macro-levels. The synthesis yielded six second-order thematic constructs relating to self-management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients' responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third-order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples' social networks, local communities, economic and ideological conditions in society in a way which support self-management activities. This meta-synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self-management strategies of people with type 2 diabetes in everyday life.
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Affiliation(s)
- Christina Foss
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Ingrid Knutsen
- Department of Nursing Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Kennedy
- NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Hampshire, UK
| | - Elka Todorova
- Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria
| | - Michel Wensing
- Stichting Katholieke Universiteit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | | | | | - Jan Koetsenruijter
- Stichting Katholieke Universiteit, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, Health Sciences, University of Southampton, Hampshire, UK
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Trappes-Lomax T. Self-care for people coping with long-term health conditions in the community: the views of patients and GPs. JOURNAL OF INTEGRATED CARE 2016. [DOI: 10.1108/jica-05-2015-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Long-term health problems put great pressures on health and social care services. Supporting ‘self-care’ has measurable benefits in helping patients cope better, but is difficult to do in practice. This review aims to help improve services by exploring existing evidence about the views of patients and GPs.
Design/methodology/approach
The search terms were identified following detailed discussion with service users. Five databases (PUBMED, CINAHL, TRIP, SCIE and PSYCINFO) were interrogated against pre-set questions and criteria. The data were managed in EndNote v6 and analysed in a series of Word tables.
Findings
37 community-based studies were identified, covering diverse chronic illnesses. Analysis of ‘barriers and enablers’ showed a very complex picture, with health systems often actively inhibiting the responsiveness and flexibility which support self-care. Directly seeking service user and practitioner views could shape more effective services
Research limitations/implications
Further research is needed into: the purpose and outcomes of user involvement, the relationship between integrated care and self-care, how patient motivation and resilience can be encouraged in primary care and the effect of current incentive schemes on self-care support
Due to organisational changes, eligible studies were reviewed by one researcher only and these were mainly qualitative studies lacking generalisability. However, the results spanned a range of settings and health conditions. They are also clearly supported by later primary research findings
Practical implications
Several evidence-based, achievable opportunities to improve self-care support in primary care settings are identified
Originality/value
This service-user study, offers detailed analysis of what helps or hinders self-care in everyday life
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Zia JK, Barney P, Cain KC, Jarrett ME, Heitkemper MM. A Comprehensive Self-Management Irritable Bowel Syndrome Program Produces Sustainable Changes in Behavior After 1 Year. Clin Gastroenterol Hepatol 2016; 14:212-9.e1-2. [PMID: 26453951 PMCID: PMC4718771 DOI: 10.1016/j.cgh.2015.09.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We developed a comprehensive self-management (CSM) program that combines cognitive behavioral therapy with relaxation and dietary strategies; 9 sessions (1 hour each) over 13 weeks were shown to reduce gastrointestinal symptoms and increase quality of life in a randomized trial of patients with irritable bowel syndrome (IBS), compared with usual care. The aims of this study were to describe strategies patients with IBS selected and continued to use, 12 months after the CSM program began. METHODS We performed a cohort study to continue to follow 81 adults with IBS (87% female; mean age, 45 ± 15 years old) who received the CSM program in the previous clinical trial. During the last CSM session, participants selected strategies they intended to continue using to manage their IBS. CSM strategies were categorized into subthemes of diet (composition, trigger foods, meal size or timing, and eating behaviors), relaxation (specific relaxation strategies and lifestyle behaviors), and alternative thoughts (identifying thought distortions, challenging underlying beliefs, and other strategies). Twelve months later, participants were asked how often they used each strategy (not at all or rarely, occasionally, often, very often, or almost always). RESULTS At the last CSM session, 95% of the patients selected the subthemes of specific relaxation strategies, 90% selected diet composition, and 90% identified thought distortions for continued use. At 12 months, 94% of the participants (76 of 81) were still using at least 6 strategies, and adherence was greater than 79% for all subthemes. CONCLUSIONS We developed a CSM program to reduce symptoms and increase quality of life in patients with IBS that produced sustainable behavioral changes in almost all patients (94%) after 1 year of follow-up.
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Affiliation(s)
- Jasmine K. Zia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Pamela Barney
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Kevin C. Cain
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Monica E. Jarrett
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
| | - Margaret M. Heitkemper
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA, USA
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Abstract
BACKGROUND The potentially high costs of care associated with inflammatory bowel disease are recognized. A knowledge-based self-management approach seems to reduce health care costs, improve disease control, and reduce indirect costs. The aim of this study was to determine whether there is a significant association between patient knowledge and health care costs. METHODS Patients diagnosed with inflammatory bowel disease, Crohn's disease (CD), ulcerative colitis, or indeterminate colitis, in 2010 to 2011 were included. Direct costs were investigated for each patient, including costs of blood tests, procedures, medications, hospitalization, and visits. Specific prices were reported according to the hospital billing database for 2010. For medical and surgical hospital admissions, DRG 19 prices were reported. A validated questionnaire (CCKNOW) was used to assess disease-related knowledge. RESULTS Ninety-one patients (38 men), mean age 47 years (range, 33-63 yr) were studied (14 indeterminate colitis, 33 CD, and 44 ulcerative colitis). Median cost for patients is higher in CD (&OV0556;4099.02). The mean overall CCKNOW score was 8.00 (8.50 for indeterminate colitis, 7.50 for CD, and 7.50 for ulcerative colitis). An increase of 5 points on the CCKNOW corresponds to a cost decrease of &OV0556;1099.53 in the first year of disease. CONCLUSIONS Higher levels of knowledge were shown to be associated with significantly lower health care costs. The data suggest that better information could lead to better choices and improved outcomes; thus, patient information and education is a key priority for managing patients with inflammatory bowel disease, perhaps planning structured and formal patient education programs in the future.
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Panagioti M, Richardson G, Murray E, Rogers A, Kennedy A, Newman S, Small N, Bower P. Reducing Care Utilisation through Self-management Interventions (RECURSIVE): a systematic review and meta-analysis. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02540] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BackgroundA critical part of future service delivery will involve improving the degree to which people become engaged in ‘self-management’. Providing better support for self-management has the potential to make a significant contribution to NHS efficiency, as well as providing benefits in patient health and quality of care.ObjectiveTo determine which models of self-management support are associated with significant reductions in health services utilisation (including hospital use) without compromising outcomes, among patients with long-term conditions.Data sourcesCochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, EconLit (the American Economic Association’s electronic bibliography), EMBASE, Health Economics Evaluations Database, MEDLINE (the US National Library of Medicine’s database), MEDLINE In-Process & Other Non-Indexed Citations, NHS Economic Evaluation Database (NHS EED) and PsycINFO (the behavioural science and mental health database), as well as the reference lists of published reviews of self-management support.MethodsWe included patients with long-term conditions in all health-care settings and self-management support interventions with varying levels of additional professional support and input from multidisciplinary teams. Main outcome measures were quantitative measures of service utilisation (including hospital use) and quality of life (QoL). We presented the results for each condition group using a permutation plot, plotting the effect of interventions on utilisation and outcomes simultaneously and placing them in quadrants of the cost-effectiveness plane depending on the pattern of outcomes. We also conducted conventional meta-analyses of outcomes.ResultsWe found 184 studies that met the inclusion criteria and provided data for analysis. The most common categories of long-term conditions included in the studies were cardiovascular (29%), respiratory (24%) and mental health (16%). Of the interventions, 5% were categorised as ‘pure self-management’ (without additional professional support), 20% as ‘supported self-management’ (< 2 hours’ support), 47% as ‘intensive self-management’ (> 2 hours’ support) and 28% as ‘case management’ (> 2 hours’ support including input from a multidisciplinary team). We analysed data across categories of long-term conditions and also analysed comparing self-management support (pure, supported, intense) with case management. Only a minority of self-management support studies reported reductions in health-care utilisation in association with decrements in health. Self-management support was associated with small but significant improvements in QoL. Evidence for significant reductions in utilisation following self-management support interventions were strongest for interventions in respiratory and cardiovascular disorders. Caution should be exercised in the interpretation of the results, as we found evidence that studies at higher risk of bias were more likely to report benefits on some outcomes. Data on hospital use outcomes were also consistent with the possibility of small-study bias.LimitationsSelf-management support is a complex area in which to undertake literature searches. Our analyses were limited by poor reporting of outcomes in the included studies, especially concerning health-care utilisation and costs.ConclusionsVery few self-management support interventions achieve reductions in utilisation while compromising patient outcomes. Evidence for significant reductions in utilisation were strongest for respiratory disorders and cardiac disorders. Research priorities relate to better reporting of the content of self-management support, exploration of the impact of multimorbidity and assessment of factors influencing the wider implementation of self-management support.Study registrationThis study is registered as PROSPERO CRD42012002694.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
| | - Anne Kennedy
- Health Sciences, University of Southampton, Southampton, UK
| | - Stanton Newman
- School of Health Sciences, City University London, London, UK
| | - Nicola Small
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Kennedy A, Rogers A, Chew-Graham C, Blakeman T, Bowen R, Gardner C, Lee V, Morris R, Protheroe J. Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients. Implement Sci 2014; 9:129. [PMID: 25331942 PMCID: PMC4210530 DOI: 10.1186/s13012-014-0129-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 09/18/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework. METHODS A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context. RESULTS Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS. CONCLUSION The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a legitimate activity or a professional priority. There was failure to, in principle, engage with and identify patients' support needs. Policy presumptions concerning SMS appear to be misplaced. Implementation of SMS within the health service does not currently account for patient circumstances. Primary care priorities and support for SMS could be enhanced if they link to patients' broader systems of implementation networks and resources.
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Affiliation(s)
- Anne Kennedy
- NIHR CLAHRC Wessex, University of Southampton, Southampton SO17 1BJ, UK.
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20
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The Effectiveness of a Structured Educational Intervention on Disease-Related Misconception and Quality of Life in Patients With Irritable Bowel Syndrome. Gastroenterol Nurs 2014; 37:289-98. [DOI: 10.1097/sga.0000000000000057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Norris M, Jones F, Kilbride C, Victor C. Exploring the experience of facilitating self-management with minority ethnic stroke survivors: a qualitative study of therapists' perceptions. Disabil Rehabil 2014; 36:2252-61. [PMID: 24670190 PMCID: PMC4364271 DOI: 10.3109/09638288.2014.904936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/13/2022]
Abstract
PURPOSE The utility of self-management with people from minority ethnic backgrounds has been questioned, resulting in the development of culturally specific tools. Yet, the use of stroke specific self-management programmes is underexplored in these high risk groups. This article presents the experience of stroke therapists in using a stroke specific self-management programme with stroke survivors from minority ethnic backgrounds. METHODS 26 stroke therapists with experience of using the self-management programme with stroke survivors from minority ethnic backgrounds participated in semi-structured interviews. These were audio recorded, transcribed verbatim and analysed thematically. RESULTS Three themes were identified. One questioned perceived differences in stroke survivors interaction with self-management based on ethnicity. The other themes contrasted with this view demonstrating two areas in which ethnic and cultural attributes were deemed to influence the self-management process both positively and negatively. Aspects of knowledge of health, illness and recovery, religion, family and the professionals themselves are highlighted. CONCLUSIONS This study indicates that ethnicity should not be considered a limitation to the use of an individualized stroke specific self-management programme. However, it highlights potential facilitators and barriers, many of which relate to the capacity of the professional to effectively navigate cultural and ethnic differences.
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Affiliation(s)
- Meriel Norris
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, London, UK
| | - Fiona Jones
- Faculty of Health and Social Care Science, St George's University of London & Kingston University, London, UK
| | - Cherry Kilbride
- Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Brunel University, London, UK
| | - Christina Victor
- Brunel Institute of Ageing Studies, School of Health Sciences and Social Care, Brunel University, London, UK
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Kennedy A, Rogers A, Blickem C, Daker-White G, Bowen R. Developing cartoons for long-term condition self-management information. BMC Health Serv Res 2014; 14:60. [PMID: 24507692 PMCID: PMC3945740 DOI: 10.1186/1472-6963-14-60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/05/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD). METHODS Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods. RESULTS In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret. CONCLUSION Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management.
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Affiliation(s)
- Anne Kennedy
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Christian Blickem
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Gavin Daker-White
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Robert Bowen
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
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Lowe W, Ballinger C, Protheroe J, Lueddeke J, Nutbeam D, Armstrong R, Falzon L, Edwards C, Russell C, McCaffery K, Adams J. Effectiveness of musculoskeletal education interventions in people with low literacy levels: a systematic review. Arthritis Care Res (Hoboken) 2014; 65:1976-85. [PMID: 23925869 PMCID: PMC4298758 DOI: 10.1002/acr.22085] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/03/2013] [Indexed: 12/26/2022]
Abstract
Objective To conduct a systematic review to assess the effectiveness of patient education interventions delivered or directed by health professionals for people with musculoskeletal conditions who also have lower levels of literacy. Methods Electronic databases were searched from 1946 to May 2012. Randomized controlled trials with primary interventions designed specifically for individuals with musculoskeletal conditions and lower levels of literacy were eligible for inclusion. The quality of the study was determined by assessing method of randomization, allocation concealment, creation and maintenance of comparable groups, blinding of patients and providers, control of confounding, and the validity and reliability of outcome measures. Results Of the 2,440 studies located using the search strategy, 6 studies met the inclusion criteria. Three public health community studies and 3 rheumatology clinic-based studies delivered educational programs to people with musculoskeletal conditions who also had lower levels of literacy. Three moderate quality studies suggest that musculoskeletal educational interventions had a small short-term effect on knowledge and 2 moderate quality studies suggest musculoskeletal interventions had a small effect on self-efficacy (although results on self-efficacy were conflicting in 1 of these studies). Only 1 moderate quality study showed a small effect on anxiety and 1 on self-perceived health and well-being in people with lower literacy. Conclusion High quality evidence is lacking on the effectiveness of musculoskeletal education interventions for people with lower literacy levels. Research programs that test the effectiveness of patient education interventions for arthritis must recruit and engage people with lower levels of literacy.
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Affiliation(s)
- Wendy Lowe
- University of Southamptom, Southampton, UK
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Huang VW, Reich KM, Fedorak RN. Distance management of inflammatory bowel disease: Systematic review and meta-analysis. World J Gastroenterol 2014; 20:829-842. [PMID: 24574756 PMCID: PMC3921492 DOI: 10.3748/wjg.v20.i3.829] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/15/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease (IBD) patients.
METHODS: A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients. Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program, electronic interface, or self-directs open access to clinic follow up. The search strategy included electronic databases (Medline, PubMed, CINAHL, The Cochrane Central Register of Controlled Trials, EMBASE, KTPlus, Web of Science, and SCOPUS), conference proceedings, and internet search for web publications. The primary outcome was the mean difference in quality of life, and the secondary outcomes included mean difference in relapse rate, clinic visit rate, and hospital admission rate. Study selection, data extraction, and risk of bias assessment were completed by two independent reviewers.
RESULTS: The search strategy identified a total of 4061 articles, but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis. Three trials involved telemanagement, and three trials involved directed patient self-management and open access clinics. The total sample size was 1463 patients. There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28 (95%CI: -3.25-17.81) points higher than standard clinic follow-up. There was a significant decrease in the clinic visit rate among distance management patients mean difference -1.08 (95%CI: -1.60--0.55), but no significant change in relapse rate or hospital admission rate.
CONCLUSION: Distance management of IBD significantly decreases clinic visit utilization, but does not significantly affect relapse rates or hospital admission rates.
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O'Connor M, Bager P, Duncan J, Gaarenstroom J, Younge L, Détré P, Bredin F, Dibley L, Dignass A, Gallego Barrero M, Greveson K, Hamzawi M, Ipenburg N, Keegan D, Martinato M, Murciano Gonzalo F, Pino Donnay S, Price T, Ramirez Morros A, Verwey M, White L, van de Woude CJ. N-ECCO Consensus statements on the European nursing roles in caring for patients with Crohn's disease or ulcerative colitis. J Crohns Colitis 2013; 7:744-64. [PMID: 23831217 DOI: 10.1016/j.crohns.2013.06.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/05/2013] [Indexed: 02/08/2023]
Affiliation(s)
- M O'Connor
- IBD Unit, St. Mark's Hospital, Harrow, London, UK. marian.o'
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Mikocka-Walus AA, Gordon AL, Stewart BJ, Andrews JM. ‘Just to get it off my chest’: Patients' views on psychotherapy in inflammatory bowel disease. COUNSELLING & PSYCHOTHERAPY RESEARCH 2013. [DOI: 10.1080/14733145.2012.730540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Martin F, Turner A, Wallace LM, Bradbury N. Conceptualisation of self-management intervention for people with early stage dementia. Eur J Ageing 2013; 10:75-87. [PMID: 28804285 PMCID: PMC5549115 DOI: 10.1007/s10433-012-0253-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Dementia is a major challenge for health and social care services. People living with dementia in the earlier stages experience a "care-gap". Although they may address this gap in care, self-management interventions have not been provided to people with dementia. It is unclear how to conceptualise self-management for this group and few published papers address intervention design. Initial focusing work used a logic mapping approach, interviews with key stakeholders, including people with dementia and their family members. An initial set of self-management targets were identified for potential intervention. Self-management for people living with dementia was conceptualised as covering five targets: (1) relationship with family, (2) maintaining an active lifestyle, (3) psychological wellbeing, (4) techniques to cope with memory changes, and (5) information about dementia. These targets were used to focus literature reviewing to explore an evidence base for the conceptualisation. We discuss the utility of the Corbin and Strauss (Unending work and care: managing chronic illness at home. Jossey-Bass, Oxford, 1988) model of self-management, specifically that self-management for people living with dementia should be conceptualised as emphasising the importance of "everyday life work" (targets 1 and 2) and "biographical work" (target 3), with inclusion of but less emphasis on specific "illness work" (targets 4, 5). We argue that self-management is possible for people with dementia, with a strengths focus and emphasis on quality of life, which can be achieved despite cognitive impairments. Further development and testing of such interventions is required to provide much needed support for people in early stages of dementia.
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Affiliation(s)
- Faith Martin
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Andrew Turner
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Louise M. Wallace
- Applied Research Centre in Health and Lifestyle Interventions Whitefriars Building, Coventry University, Coventry, CV1 5FB UK
| | - Nicola Bradbury
- Mental Health Services Older People Division, Birmingham & Solihull Mental Health NHS Foundation Trust, Juniper Centre, Moseley Hall Hospital, Alcester Road, Moseley, Birmingham, B13 8AQ UK
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MacKichan F, Paterson C, Britten N. GP support for self-care: the views of people experiencing long-term back pain. Fam Pract 2013; 30:212-8. [PMID: 23042439 DOI: 10.1093/fampra/cms062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Promotion of self-care for persistent back pain and other long-term conditions has become a central component in health care policy in the UK, and general practitioners face increasing demands to support patients' self-care efforts. Gaining insight into patients' views may facilitate support. OBJECTIVE To describe patients' experience of self-care for long-term back pain and their views on provision of support for self-care. METHODS Adults experiencing persistent back pain were purposively sampled from a community-based survey. In-depth qualitative interviews were audiotaped, transcribed and analysed using the constant comparative method to inductively derive a thematic account of the data. RESULTS Most of the 23 interviewees felt a responsibility to self-care. Individual capacity for self-care, however, was variable and could be inhibited by factors such as caring roles or lack of diagnosis and information. GP support for self-care was largely considered to be desirable, although the feasibility of greater provision of support was questioned. Some interviewees expressed a strong preference for alternative models of care and support. CONCLUSION Self-care for back pain is contextualized by the individual's capacity to self-care and preferences for support. Doubt over the ability of GPs to provide support for self-care may mean that those who have specific needs are reticent to seek help. The role of self-care in the management of back pain should be discussed openly at the consultation level, and GPs may be well placed to signpost patients and provide guidance on the safety of specific self-care activities.
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Affiliation(s)
- Fiona MacKichan
- School of Social and Community Medicine, University of Bristol, 39, Whatley Road, Bristol, BS8 2PS, UK.
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Blickem C, Blakeman T, Kennedy A, Bower P, Reeves D, Gardner C, Lee V, Chew-Graham C, Richardson G, Brooks H, Dawson S, Mossabir R, Jariwala P, Swallow A, Kontopantelis E, Gaffney H, Small N, Spackman E, Rogers A. The clinical and cost-effectiveness of the BRinging Information and Guided Help Together (BRIGHT) intervention for the self-management support of people with stage 3 chronic kidney disease in primary care: study protocol for a randomized controlled trial. Trials 2013; 14:28. [PMID: 23356861 PMCID: PMC3599273 DOI: 10.1186/1745-6215-14-28] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/11/2013] [Indexed: 12/31/2022] Open
Abstract
Background Improving the quality of care for people with vascular disease is a key priority. Chronic kidney disease (CKD) has recently been included as a target condition for general practices to add to registers of chronic conditions as part of the Quality and Outcome Framework. This paper outlines the implementation and evaluation of a self-management intervention involving an information guidebook, tailored access to local resources and telephone support for people with stage 3 chronic kidney disease. Methods/Design The study involves a multi-site, longitudinal patient-level randomized controlled trial. The study will evaluate the clinical use and cost-effectiveness of a complex self-management intervention for people with stage 3 chronic kidney disease in terms of self-management capacity, health-related quality of life and blood pressure control compared to care as usual. We describe the methods of the patient-level randomized controlled trial. Discussion The management of chronic kidney disease is a developing area of research. The BRinging Information and Guided Help Together (BRIGHT) trial aims to provide evidence that a complementary package of support for people with vascular disease that targets both clinical and social need broadens the opportunities of self-management support by addressing problems related to social disadvantage. Trial registration Trial registration reference: ISRCTN45433299
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Affiliation(s)
- Christian Blickem
- Centre for Primary Care, Institute of Population Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Mair M, Kierans C. Patients' uses of information as researchable domains of social practice. Health Informatics J 2012; 18:271-83. [PMID: 23257057 DOI: 10.1177/1460458212445400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this article we argue that research into information for patients has to extend beyond an evaluation of particular information resources to studies of how those resources are engaged with, made sense of and used in practice. We draw on empirical data collected in the course of a study of a patient information resource designed for breast cancer patients in Liverpool and Newcastle in order to demonstrate the limitations of a restricted focus on information resources alone - namely, that it does not take into account the specific ways in which information is incorporated within what patients do as the grounds of 'further inference and action'. Our interest is less in discussing the strengths and weaknesses of this particular resource than in explicating some neglected aspects of the commonplace ways in which patients 'work' with information. We conclude by sketching some broad features of those 'reading' and 'linking' practices, the study of which, we believe, would help us as researchers to explicate the 'problem of information' as it is actually encountered and resolved by patients in realworld settings for their own practical purposes. Taking our lead from ethnomethodological studies and related research in various fields, we argue patients' uses of information are social practices that can and should be treated as researchable phenomena.
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Affiliation(s)
- Michael Mair
- Sociology, Social Policy and Criminology, University of Liverpool, UK.
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31
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Manor Y, Mootanah R, Freud D, Giladi N, Cohen JT. Video-assisted swallowing therapy for patients with Parkinson's disease. Parkinsonism Relat Disord 2012; 19:207-11. [PMID: 23131836 DOI: 10.1016/j.parkreldis.2012.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/07/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conventional swallowing therapy for patients with Parkinson's disease (PD) and swallowing difficulties has poor carryover to everyday life. Herein, we test the effectiveness of visual information while treating swallowing disturbances in patients with PD. METHODS Forty two non-demented PD patients with swallowing disturbances were randomly divided into two groups. An experimental group received video-assisted swallowing therapy (VAST) and a control group (n = 21) was given conventional therapy. Both groups were given 6 interventional sessions by the same speech and swallowing therapist. Patients in the VAST group were exposed to video of the swallowing process in general as well as of their own, as part of all therapy sessions. Swallowing function was assessed before and post-intervention by fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life, quality of care and the degree of pleasure from eating were also assessed by questioners pre and post-intervention. RESULTS There was a significant improvement in swallowing functions following both interventions. The FEESs demonstrated a significantly greater reduction in food residues in the pharynx in the VAST group compared to the conventional treatment group. There were significant group improvement in some parameters of the quality of life, quality of care and pleasure of eating scales. CONCLUSION In cognitively intact patients with PD with swallowing disturbances VAST was associated with improved swallowing related QOL and less food residues in the pharynx.
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Affiliation(s)
- Yael Manor
- Movement Disorders Unit, Dept of Neurology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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The evaluation of chronic disease self-management support across settings: the international experience of the health education impact questionnaire quality monitoring system. Nurs Clin North Am 2011; 46:255-70, v. [PMID: 21791261 DOI: 10.1016/j.cnur.2011.05.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Chronic disease self-management is a growing field yet few systematic measures of its impact exist. The Health Education Impact Questionnaire (heiQ)-rigorously developed in partnership with key stakeholders-is a panel of eight highly relevant questionnaires that has been tested and applied in many settings. Wide uptake across diseases has occurred because it resonates with patient concerns, helps researchers and practitioners develop quality services, and assists policy-makers to appreciate the value of self-management support interventions. The heiQ continues to be adapted for new uses and applications creating a web of knowledge of the value and impact of health education programs.
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Blickem C, Bower P, Protheroe J, Kennedy A, Vassilev I, Sanders C, Kirk S, Chew-Graham C, Rogers A. The role of information in supporting self-care in vascular conditions: a conceptual and empirical review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:449-459. [PMID: 21158998 DOI: 10.1111/j.1365-2524.2010.00975.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Self-care has the potential to make a significant contribution to vascular conditions, but engagement with self-care support has been limited. Lack of relevant information is highlighted by patients and policy-makers as an important barrier to effective self-care, and information provides a potentially efficient platform for changing behaviour. However, work within the social sciences has generally seen information as a necessary but insufficient driver of health behaviours. Furthermore, some groups (such as the socially disadvantaged) are expected to be less amenable to information interventions. We conducted an integrated conceptual and empirical review on information-based interventions for people with vascular disease (diabetes, heart disease and kidney disease). We reviewed conceptual and empirical work concerning the role and impact of information in self-care support to generate an explanatory framework to determine why information was effective or ineffective in encouraging self-care in patients with vascular conditions. This involved mapping relevant theories and models linking information and self-care. We also explored published systematic reviews of educational interventions in diabetes, coronary heart disease and chronic kidney disease to examine the role of information and evidence concerning its effectiveness and impact in different patient populations. The conceptual review identified variation among information interventions in terms of type, function, and their relationship to behaviour change techniques and psychological mediators of behaviour change. Key moderators of the effect of information included types of disorder, and patient capacity and resources. A wealth of educational interventions exists for diabetes and heart conditions, but the precise components of these interventions that are effective are difficult to identify. There is little evidence concerning optimal ways of tailoring interventions for socially disadvantaged groups other than ethnic minorities. A focus on printed information may not provide access to effective methods of information delivery (e.g. tailored information, use of narratives and user generated content). Developing a framework for the effective use of information needs to take account the full range of the factors identified.
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Affiliation(s)
- Christian Blickem
- NIHR Collaboration for Leadership in Applied Health Research (CLARHC) for Greater Manchester, Health Sciences Research Group, The University of Manchester, Manchester, UK.
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MacKichan F, Paterson C, Henley WE, Britten N. Self-care in people with long term health problems: a community based survey. BMC FAMILY PRACTICE 2011; 12:53. [PMID: 21689455 PMCID: PMC3143929 DOI: 10.1186/1471-2296-12-53] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/20/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND Self-care is a key component of current policies to manage long term conditions. Although most people with long-term health problems care for themselves within lay networks, consultation rates for long-term undifferentiated illness remain high. Promotion of self-care in these individuals requires an understanding of their own self-care practices and needs to be understood in the context of health care pluralism. The aim was to investigate the extent and nature of self-care practices in patients experiencing long term health problems, sources of information used for self-care, and use of other forms of health care (conventional health care and complementary and alternative medicine). METHODS The study involved a cross-sectional community-based survey set in three general practices in South West England: two in urban areas, one in a rural area. Data were collected using a postal questionnaire sent to a random sample of 3,060 registered adult patients. Respondents were asked to indicate which of six long term health problems they were experiencing, and to complete the questionnaire in reference to a single (most bothersome) problem only. RESULTS Of the 1,347 (45% unadjusted response rate) who responded, 583 reported having one or more of the six long term health problems and 572 completed the survey questionnaire. Use of self-care was notably more prevalent than other forms of health care. Nearly all respondents reported using self-care (mean of four self-care practices each). Predictors of high self-care reported in regression analysis included the reported number of health problems, bothersomeness of the health problem and having received a diagnosis. Although GPs were the most frequently used and trusted source of information, their advice was not associated with greater use of self-care. CONCLUSIONS This study reveals both the high level and wide range of self-care practices undertaken by this population. It also highlights the importance of GPs as a source of trusted information and advice. Our findings suggest that in order to increase self-care without increasing consultation rates, GPs and other health care providers may need more resources to help them to endorse appropriate self-care practices and signpost patients to trusted sources of self-care support.
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Affiliation(s)
- Fiona MacKichan
- Institite of Health Services Research, Peninsula Medical School, University of Exeter, Exeter EX2 4SG, UK
| | - Charlotte Paterson
- Institite of Health Services Research, Peninsula Medical School, University of Exeter, Exeter EX2 4SG, UK
| | - William E Henley
- Institite of Health Services Research, Peninsula Medical School, University of Exeter, Exeter EX2 4SG, UK
| | - Nicky Britten
- Institite of Health Services Research, Peninsula Medical School, University of Exeter, Exeter EX2 4SG, UK
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Rogers A, Vassilev I, Sanders C, Kirk S, Chew-Graham C, Kennedy A, Protheroe J, Bower P, Blickem C, Reeves D, Kapadia D, Brooks H, Fullwood C, Richardson G. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support. Implement Sci 2011; 6:56. [PMID: 21619695 PMCID: PMC3120720 DOI: 10.1186/1748-5908-6-56] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/29/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. METHODS Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT), and the whole systems informing self-management engagement (WISE) approach to self-care support. DISCUSSION The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.
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Affiliation(s)
- Anne Rogers
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Ivaylo Vassilev
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Caroline Sanders
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Susan Kirk
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Anne Kennedy
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Joanne Protheroe
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Peter Bower
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Christian Blickem
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - David Reeves
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Dharmi Kapadia
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Helen Brooks
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
| | - Catherine Fullwood
- Health Sciences Research Group, and Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester, School for Community Based Medicine, University of Manchester, Manchester, UK
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Jowsey T, Gillespie J, Aspin C. Effective communication is crucial to self-management: the experiences of immigrants to Australia living with diabetes. Chronic Illn 2011; 7:6-19. [PMID: 21078683 DOI: 10.1177/1742395310387835] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Ageing immigrant populations now pose problems for the management of chronic illness in Australia. This article asks questions about the experiences of immigrants in Australia with type II diabetes mellitus (DM). What impact, if any, have health policies had on the lives of immigrants? How do their experiences of living with DM compare with those of people with DM who were born in Australia? METHODS Semi-structured interviews were conducted with 32 participants who had DM (n = 25) or cared for someone with DM (n = 7). Fifteen participants had migrated to Australia and English was not their first language. Participants were asked to describe their experience of managing diabetes. RESULTS Immigrants to Australia confront linguistic and cultural barriers that create an extra layer of problems not experienced by Australian-born people. Older people who were born overseas face obstacles to effective engagement with the health system that weaken their ability to take an active part in the management of their conditions. CONCLUSIONS Chronic disease policy is failing immigrants to Australia. Health professionals and services must recognize the central role that cultural diversity plays in self-management and the impact that this can have on health outcomes for immigrants with chronic illness.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute and Menzies Centre for Health Policy, Australian National University, Ian Potter House, Australian National University, ACTON 0200 ACT, Australia.
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Vassilev I, Rogers A, Sanders C, Kennedy A, Blickem C, Protheroe J, Bower P, Kirk S, Chew-Graham C, Morris R. Social networks, social capital and chronic illness self-management: a realist review. Chronic Illn 2011; 7:60-86. [PMID: 20921033 DOI: 10.1177/1742395310383338] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Existing literature on the design of interventions and health policy about self-management have tended to focus on individual-centred definitions of self-care and there is growing recognition of the need to extend consideration beyond individual factors, which determine self-care, to examine wider influences such as the health service, the family and the wider social context. AIMS To explore the theoretical and empirical links between social networks, social capital and the self-care practices associated with chronic illness work and management in the context of people's everyday lives. METHOD A realist review method was used to search and appraise relevant quantitative and qualitative literature. FINDINGS The review findings indicate that social networks play an important part in the management of long-term conditions. We found that social networks tend to be defined narrowly and are primarily used as a way of acknowledging the significance of context. There is insufficient discussion in the literature of the specific types of networks that support or undermine self-care as well as an understanding of the processes involved. This necessitates shifting the emphasis of self-care towards community and network-centred approaches, which may also prove more appropriate for engaging people in socially and economically deprived contexts.
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Affiliation(s)
- Ivaylo Vassilev
- Health Sciences Research Group-Primary Care, School of Community Based Medicine, University of Manchester, UK.
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Vevea NN, Miller AN. Patient Narratives: Exploring the Fit of Uncertainty-Management Models of Health Care. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15358593.2010.501907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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