Self-management education: history, definition, outcomes, and mechanisms

Development and psychometric testing of a self-management scale for cancer survivors with radiotherapy/chemotherapy-induced oral mucositis in China

Objective

This study aims to develop and validate a self-management scale for radiotherapy/chemotherapy-induced oral mucositis (SMS-RIOM/CIOM) in cancer survivors, addressing the need for a comprehensive tool to assess self-management capabilities.

Methods

This study employed a two-phase process: (1) initial scale development through literature review, semi-structured interviews, and expert consultations, and (2) psychometric testing with 420 cancer survivors from five wards of Zibo Hospital. The psychometric evaluation included item analysis, content validity testing, reliability assessments, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

The finalized SMS-RIOM/CIOM consists of 15 items across four dimensions: medication management, oral pain management, disease monitoring, and daily life management. EFA explained 77.322% of the total variance, while CFA demonstrated an excellent model fit (χ²/df=1.909, RMSEA=0.064, RMR=0.052, GFI=0.911, CFI=0.964, NFI=0.928, TLI=0.955, IFI=0.964). Reliability metrics were robust, including Cronbach's alpha of 0.902, split-half reliability of 0.849, test-retest reliability of 0.862, and a scale content validity index of 0.910.

Conclusions

The SMS-RIOM/CIOM is a reliable and valid tool for assessing self-management in cancer survivors with RIOM/CIOM. It provides valuable insights for clinical practice, enabling targeted interventions to improve self-management and enhance the quality of life for cancer survivors. Further research is recommended to validate its application across diverse populations and healthcare settings.

Implementing Patient-Centred Goal-Setting in Practice: Perspectives of Primary Care Nurses

BACKGROUND

As a component of goal-oriented care, goal-setting is an important strategy to improve self-management and reduce the economic and personal burden of chronic illness. Primary care nurses, as integral members of the healthcare team, play a pivotal role in providing self-management support to patients with multiple chronic illnesses. Yet, little is known about their perspectives on partnering with patients to set meaningful goals within self-management support programmes.

AIM

To explore perspectives of primary care nurses about their practice of goal-setting with patients to improve self-management.

METHODS

For this qualitative exploratory study, we conducted semi-structured interviews with 28 primary care nurses who provided self-management support to patients with multiple chronic illnesses. Data were analysed using inductive thematic analysis. This research was approved by the Mayo Clinic Institutional Review Board.

RESULTS

Key themes from interviews focused on: (1) goal-setting practices; (2) challenges encountered in goal-setting; and (3) the perceived value-add of using a patient-centred goal-setting approach. Nurses described practices that empower patients to take charge of goal-setting, emphasising that the opportunity to create personal goals enhances motivation and enables the development of realistic action plans. Key challenges faced were patients' lack of familiarity with personal goal-setting, competing life stressors and patients' reluctance to change.

CONCLUSION

Our findings contribute valuable insights about how primary care nurses approach goal-setting within a self-management support program. Notably, unlike previous studies where clinicians reported that time-limited appointments and institutional expectations hindered patient-centred goal-setting, our participants practicing in an institutionally supported goal-oriented patient-centred model of care did not report time constraints or pressures to prioritise clinical goals over patient goals. Instead, they described patient-centred goal-setting practices that are associated with positive patient and clinical outcomes. To potentially corroborate and expand upon our findings and inform practice and training, future research should include qualitative and survey studies to explore primary care RNs perspectives about goal-setting and observational research to evaluate nurse-patient goal-setting interactions.

Facilitators and barriers to medication self-management for patients with multiple long-term conditions transitioning from hospital to home

Background

Being a patient with multiple long-term conditions (MLTCs) often entails a need for complex medication treatment, which poses a challenge to medication self-management. Medication self-management during transition of care is often hindered by challenges such as inadequate communication, which increases the risk of medication errors and adverse outcomes.

Aim

Identify facilitators and barriers to medication self-management for patients with MLTCs transitioning from hospital to home.

Methods

Semi-structured interviews were conducted in patient's homes 1-2 weeks after hospital discharge. Interviews were transcribed and analysed by qualitative deductive content analysis using the Taxonomy of Every Day Self-management Strategies (TEDSS) framework. The data collection continued until enough information power and meaning saturation was reached.

Results

Twenty-one patients and three next of kin participated. Numerous facilitators and barriers to medication self-management were identified within all seven TEDSS domains, which varied extensively between individuals. Resource and process strategies were the most frequently discussed domains, while health behaviour and social interaction strategies were less frequently discussed. Key facilitators identified were access to resources that support medication self-management and knowing the medication's purpose. Key barriers included patients perceiving medications as burdensome or not recognising the importance of their medications.

Conclusions

This study highlights the complex and wide spectre of facilitators and barriers to medication self-management for patients with MLTCs transitioning from hospital to home. In clinical practice, patients' medication self-management could be supported through a holistic approach adapted to the individual patient's daily life, including improved care coordination and patient empowerment.

Daily routines, short-term priorities, and nurses' role hamper self-management support in a hospital setting: A mixed methods study

Background

Self-management support is widely considered a critical aspect of nursing. Still, many studies indicate that nurses frequently experience difficulties in daily practice.

Objective

To gain a deeper understanding of the factors perceived by nurses to impede or promote their support of patients' self-management within the dynamic environment of the in-patient hospital setting.

Design

Mixed methods design.

Participants

Nurses (n = 269) working in a teaching hospital in the Netherlands completed a questionnaire. Subsequently, 38 nurses participated in interviews.

Methods

The SEPSS-36 questionnaire assessed nurses' self-efficacy and performance in self-management support. Semi-structured interviews were conducted to address salient results from the questionnaire, focusing on factors influencing self-management support, goal setting, follow-up care, and the nurse's role in a hospital setting.

Results

the response rate for the questionnaire study was 62 %. A paired t-test revealed a significant mean difference of 6.30 95 % CI [5.91-6.69] p ≤ 0.001 between nurses' perceived self-efficacy (mean = 18.34/24) and their actual performance (mean = 12.03/24) in self-management support. The interviews revealed that nurses typically focus on medical procedures and maintaining patients' functional status. Spending time with patients to offer emotional support was viewed as 'something extra' rather than a core part of their job. High patient turnover hindered nurses from having meaningful conversations with patients.

Conclusions

Short-term priorities such as 'getting the work done' dominate nurses' daily tasks in hospital wards, leading them to overlook often the benefits of supporting patient self-management. This narrow view of their responsibilities can hinder patient care, whereas adopting a broader perspective on the patient journey could be very beneficial.

Correlation Between Self-Management Behavior and Self-Efficacy in Patients With Lower Extremity Arterial Disease

Lower extremity arterial disease (LEAD) is a common condition that significantly impacts patients' quality of life and increases the risk of disability. Effective self-management is critical for patients with LEAD to improve health outcomes and prevent disease progression. This study aims to explore and analyze the internal correlation between self-management behavior and self-efficacy of patients with lower extremity artery disease. A convenience sampling method was used to select 146 patients with LEAD who visited the vascular surgery department in a hospital in Shanxi Province from January 2022 to December 2022. The Chronic Disease Self-Management Behavior Scale and the Chronic Disease Self-Efficacy Scale were used to assess patients' self-management behaviors and self-efficacy levels. Pearson correlation analysis was employed to explore the relationship between the two. The total self-management behavior score of 143 patients with LEAD was 17.64 ± 3.24. The total self-efficacy score was 33.24 ± 4.11. The total score of self-management behavior was positively correlated with the total score of self-efficacy. The self-management abilities of patients with LEAD are generally low. Healthcare providers should focus on enhancing self-management behaviors, boosting patients' confidence in managing their condition, correcting misconceptions, and providing targeted interventions.

Self-management Behaviors and Associated Factors in Adult Cancer Survivors: An Integrative Review

BACKGROUND

Despite numerous systematic reviews on self-management interventions for cancer survivors, little is known about survivors' daily self-management practices and the influencing factors.

OBJECTIVE

To identify self-management behaviors and related factors among cancer survivors.

METHODS

Six databases were searched for primary quantitative, qualitative, and mixed-methods studies on self-management behaviors in cancer survivors that were published in English-language, peer-reviewed journals between 2012 and July 2022. The methodological quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. The data extracted using a predetermined form were analyzed using qualitative content analysis.

RESULTS

A total of 22 articles were included in the review; the majority were qualitative research, and half had moderate to high quality of evidence. Nine domains of self-management behaviors were identified, namely, physical activity/exercise, diet, emotional management, complementary and alternative medicine, symptom management, religiosity/spirituality, attending regular follow-ups, adjustment of other lifestyles, and medication management. Four categories of factors were associated with self-management behaviors in cancer survivors: (1) personal factors (demographic and psychological), (2) health status, (3) family factors, and (4) healthcare system. However, the relationships between self-management behaviors and these factors were mainly identified from qualitative studies or addressed in single studies.

CONCLUSIONS

Self-management behaviors in cancer survivors are multifaceted. There is an urgent need for quantitative exploration of factors associated with self-management in cancer survivors.

IMPLICATIONS FOR PRACTICE

This review provides nurses with a comprehensive basis for designing self-management support interventions for cancer survivors.

Rural Culture and Diabetes Self-Management Beliefs, Behaviors, and Health Outcomes

BACKGROUND

Rural populations in the United States face a diabetes mortality penalty. Self-management is a core component of treatment for Type 2 diabetes, but there is low uptake of self-management education and support interventions in rural areas. Rural structural barriers to diabetes self-management have been described, yet the role of rural culture has not been extensively explored.

OBJECTIVE

The purpose was to examine the relationships among rural culture, diabetes beliefs, self-management behaviors, and health outcomes.

METHODS

A stratified random sample of 500 adults with Type 2 diabetes were recruited from a rural integrated healthcare system and invited to participate in this nonexperimental cross-sectional study. Participants completed a survey that included validated measures of rural identity, self-reliance, perceived diabetes threat, and diabetes self-management behaviors. The most recent A1c was collected from the medical record. Descriptive, bivariate, multivariate, and moderation analyses were conducted.

RESULTS

One hundred twenty-eight participants returned completed surveys. Having an A1c <8% was associated with better diabetes self-management behaviors, lower perceived threat, being female, and older age. Better diabetes self-management behaviors were associated with lower self-reliance, lower perceived threat, and older age. The combined moderation effect of both self-reliance and rural identity on the relationship between perceived threat and self-management behaviors was significant.

DISCUSSION

Findings highlight the complex relationship between diabetes beliefs and behavior in rural populations and demonstrate that components of the rural culture have both direct and moderating effects on diabetes beliefs and self-management behaviors. These findings have important ramifications for nurses practicing in rural settings.

Co-design and prototype development of MedManageSCI: a medication self-management toolkit for adults with spinal cord injury/dysfunction

BACKGROUND

Medications are among the most common health interventions, with certain populations, such as individuals with spinal cord injury/dysfunction (SCI/D), commonly prescribed multiple medications. Consequently, adults with SCI/D often engage in activities related to medication self-management, but there are few comprehensive resources for this population. The objective of this study was to co-design the prototype of a toolkit to support medication self-management among adults with SCI/D.

METHODS

We conducted a participatory multi-methods study, using the Good Things Foundation Pathfinder Model as a guide for the co-design process. Participants included adults with SCI/D, caregivers, and healthcare providers. Following the model's three stages, we: (1) understood and defined the problem by conducting a scoping review, concept mapping study, and working group sessions; (2) created a prototype of the toolkit through working group sessions and website development meetings; and (3) tested the prototype through working group sessions.

RESULTS

The working group consisted of 19 individuals, including 9 adults with SCI/D, 1 caregiver, and 9 healthcare providers. In Stage 1, we identified the need for a comprehensive medication self-management resource through a scoping review, brainstormed content and delivery methods, and thematized and prioritized the content into eight categories through a concept mapping study. The concept mapping study included 44 participants, including 21 adults with SCI/D, 11 caregivers, and 12 healthcare providers. In Stage 2, feedback on the content mapped onto five categories: first impressions, message and purpose, visual elements, layout and flow, and graphics. The name, MedManageSCI, was selected by the working group. Through an iterative process with the website development company, an online version of the toolkit prototype was created ( www.medmanagesci.ca ). In Stage 3, participants provided recommendations to improve the website's functionality and navigation.

CONCLUSIONS

The co-design of the MedManageSCI prototype is a significant step toward addressing the medication self-management needs of adults with SCI/D. The implications of this work extend beyond SCI/D, highlighting the importance of tailored digital health resources for populations with complex healthcare needs. Future work is needed to refine the content, assess the feasibility, acceptability, and appropriateness of the toolkit, and examine outcomes related to medication self-management.

Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study

BACKGROUND

Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care.

OBJECTIVE

This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain.

METHODS

Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions.

RESULTS

In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative.

CONCLUSIONS

This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2019-033092.

Exploring patients' experiences of self-management in rehabilitation following total knee arthroplasty: A qualitative study

Self-management during the rehabilitation of patients following total knee arthroplasty presents several challenges, with approximately 20% of patients failing to meet their recovery expectations due to inadequate self-management during the postoperative rehabilitation process. This study aimed to explore the experiences of patients with self-management during rehabilitation after total knee arthroplasty. Twenty-four participants who had undergone total knee arthroplasty in China participated in semi-structured interviews. Content analysis was used to analyze the interview data, revealing four themes: distress from postoperative complications, knowledge and guidance needs during the rehabilitation process, negative beliefs and attitudes, and fears and worries. The results indicated that participants' self-management during rehabilitation after surgery was hindered by postoperative complications. Additionally, the participants exhibited negative attitudes and experienced psychological issues related to self-management during rehabilitation. We recommend that future rehabilitation efforts for patients following total knee arthroplasty should emphasize enhanced guidance and supervision, while also addressing their psychological challenges.

Adolescents' perceptions of being physically active in the presence of lowback pain - an interview study

OBJECTIVE

The aim of this study was to explore the knowledge adolescents with low back pain (LBP) need and already claim to have about being in motion despite pain, and how they search to increase this knowledge.

METHODS

Face-to-face semi-structured, in-depth interviews based on an interview guide were conducted with 15 adolescents with LBP recruited from a senior secondary school in Gothenburg, Sweden and analyzed using qualitative content analysis.

RESULTS

An overarching theme "Stuck in ambivalence" emerged, comprising three categories: "Existing knowledge is insufficient," "Searching for trustworthy information" and "Making sense of the new information" based on six sub-categories that together illustrate the participants' thoughts and beliefs about being physically active despite LBP. Their lives were negatively affected by not fully understanding the cause of their pain or what they can do to alleviate it. They wanted information tailored to their specific needs and searched for support and guidance to feel safe and gain confidence in the ability of their body to move and exercise.

CONCLUSION

The participants were aware of the benefits of remaining physically active despite LBP but were unsure how to apply this knowledge. Healthcare professionals should support adolescents with LBP by means of person-centered guidance about how they can turn information about pain and activity into health-promoting knowledge. It is of the utmost importance to apply a person-centered approach when providing evidence-based information.

Self-management versus usual care for greater trochanteric pain syndrome (the HIPS trial): study protocol for a randomised controlled trial

INTRODUCTION

Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterised by lateral hip pain. The condition often persists for several months, and there is low evidence for any superior treatment. The aim of this study protocol is to describe a randomised controlled trial (RCT) investigating the effectiveness of a self-management programme versus usual care for patients with GTPS.

METHODS AND ANALYSIS

The study is designed as an observer-blinded, parallel group, superiority RCTcomparing a self-management programme (n=55) with usual care (n=55). Eligible patients with GTPS will be included based on reproduction of pain on palpation in the greater trochanteric region and at least one positive clinical provocation test. The self-management programme includes 3-5 individual sessions with a physiotherapist over 12 weeks, addressing physical, emotional and behavioural factors deemed relevant by the patient. Usual care will receive general information about GTPS, activity management and are free to seek further treatment in primary care as wanted. The primary outcome measure is the Norwegian version of the Victorian Institute of Sports Assessment for gluteal tendinopathy questionnaire (VISA-G-Norwegian). Outcomes will be assessed at baseline, 3, 6 and 12 months. A longitudinal mixed effects model will be used to assess the effectiveness of treatment on pain and disability across all time points, with the primary endpoint at 6 months. Cost-effectiveness will be expressed by mean incremental cost-effectiveness ratios (ICERs) from a societal and healthcare perspective. Bootstrapping will be used to estimate ICER uncertainty.

ETHICS AND DISSEMINATION

The Norwegian Regional Committees for Medical and Health Research Ethics have approved the project (2023/590816), and it will be in accordance with recommendations from the Data Inspectorate at Oslo University Hospital (22/26396). The results from the study will be disseminated through publications in peer-reviewed journals, in conference presentations and through the user representative.

TRIAL REGISTRATION NUMBER

NCT06297148.

Effects of an app-assisted self-management intervention for urinary incontinence on self-efficacy and related outcomes in men with prostate cancer: A randomized controlled feasibility trial

PURPOSE

To assess the feasibility, acceptability, and effectiveness of an app-assisted self-management intervention for urinary incontinence (App-SMI-UI) in men with prostate cancer.

METHODS

We recruited men (n = 85) who had been diagnosed with prostate cancer and experienced urinary incontinence following radical prostatectomy. Participants were randomly assigned to the self-management group (n = 43) or the attrition control group (n = 42). The self-management group underwent a 12-week App-SMI-UI while the control group received a single session of multimedia dietary information. Data was collected at baseline, week 12, and week 16. The variables measured were cancer-related self-efficacy, urinary symptoms, social participation, demoralization, resilience, and satisfaction with the intervention.

RESULTS

Compared to the control group, the self-management group had fewer urinary symptoms and a higher willingness to engage in and satisfaction with social activity participation at week 12. By week 16, the self-management group exhibited higher cancer-related self-efficacy, greater participation in interpersonal relationship activities, and continued willingness to engage in and satisfaction with social activity participation.

CONCLUSION

The App-SMI-UI contributes to improving urinary symptoms, self-efficacy, and social participation among men with prostate cancer. Healthcare providers can use self-management programs to manage urinary incontinence and support prostate cancer men.

Life 2.0: a comprehensive cross-sectional profiling of long-term allogeneic hematopoietic cell transplantation survivors compared to a matched general population cohort

Long-term survivors after allogeneic cell transplantation (HCT) have unique needs. We performed a cross-sectional case-control study to describe the survivorship profile of 244 adult allogeneic transplantation recipients at a median of 8.4 years post-HCT and compared it to controls from the general population (matched 1:3 based on age, gender, and province of residence). The most prevalent medical complications were graft versus host disease (46.7%), impaired kidney function (63.9%), and the presence of a metabolic syndrome (33.6%). Survivors were significantly more likely to report a sub-optimal perceived health status than controls (82.0% versus 52.1% respectively, OR 4.57, p < 0.0001). They also reported significantly lower employment rates (42.6% versus 55.6% respectively, OR 0.389, p < 0.0001) and more polypharmacy (32.0% versus 9.6% respectively, OR 5.0, p < 0.0001) than matched counterparts. Social support and mental health were generally preserved. Apart for a concerning tendency to medication non-adherence, low physical activity (54.5%), and inappropriate exposition to UV (44.7%), health-related behavior was adequate. Many survivors have a health status comparable to chronically ill patients and, if so, should be managed as such. Novel patient-centered initiatives based on chronic care models could support survivors in preventing and dealing with long-term complications, regaining functionality, and returning to their role in society.

Outcome measures reported by cancer patients treated with tyrosine kinase inhibitors: a methodological study

OBJECTIVES

to validate the content of an outcome measurement instrument with expert judges and to assess the understandability and suitability of this validated instrument with cancer patients undergoing tyrosine kinase inhibitor (TKI) therapy.

METHODS

a methodological study, which included the development of an instrument through integrative review, content validity, using the Delphi technique with expert judges, and pilot testing, to verify users' understandability and suitability to the instrument.

RESULTS

literature review allowed constructing PRO-CTCAE® Estudo PROM-TKI Brasil, with 16 items, which was later submitted to validity using the Delphi technique. After the second round, the final instrument consisted of 20 items, with a Content Validity Index (CVI) of 0.878. The pilot test showed that the instrument is understandable and suitable for the target population (CVI of 1.0).

CONCLUSIONS

PRO-CTCAE® Estudo PROM-TKI Brasil obtained evidence of validity for use during TKI therapy.

Pain Self-Management Behaviors in Breast Cancer Survivors Six Months Post-Primary Treatment: A Mixed-Methods, Descriptive Study

Background/Objectives: One-third of breast cancer (BC) survivors experience chronic treatment-related pain (CTP) that requires multimodal management strategies, which may include pain self-management behaviors (PSMBs). Most studies exploring PSMBs focus on patients with advanced cancer, who may differ from survivors in their pain management needs and access to resources. This mixed-methods study explored PSMBs of survivors of BC, referral sources, and goals for pain relief, and examined the relationship between PSMB engagement and pain intensity/interference. Methods: Survivors of BC who were six months post-treatment completed measures assessing their pain intensity/interference and PSMB engagement. Purposive sampling identified a subset of participants who completed interviews, which were analyzed using thematic analysis. Results: Participants (n = 60) were 60 ± 10 years old. Worst Pain Intensity and Pain Interference were 3.93 ± 2.36 and 2.09 ± 2.11, respectively. Participants engaged in 7 ± 3.5 PSMBs. The most common were walking (76%) and distraction (76%). PSMBs described in the interviews (n = 10) were arm stretching and strengthening exercises, seeking specialized pain management services, and avoidance. Most PSMBs were self-directed or suggested by friends. All pain relief goals were to minimize pain interference. PSMB engagement was not associated with Worst, Least, or Average Pain Intensity (all rs ≤ -0.2, p ≥ 0.05) but was associated with Pain Interference (rs = 0.3, p ≤ 0.01). Conclusions: The survivors of BC engaged in many PSMBs, with varying levels of effectiveness and a varying quality of supporting evidence. Most PSMBs were self-directed and some required intervention from healthcare providers or other people, while others required access to limited specialized pain management services.

The Association Between Lifestyle and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis: A 3-year Prospective, Observational Study

Purpose

Lifestyle is one of the important factors affecting health. There are few studies that comprehensively analyze the impact of a combination of lifestyle factors on mortality in patients undergoing maintenance hemodialysis. So, to measure the association between lifestyle factors and mortality for patients undergoing maintenance hemodialysis.

Patients and Methods

A prospective, observational study design was employed. Through convenience sampling, the patients who are over 18 years old and have undergone dialysis for at least 3 months, from the hemodialysis center outpatient in two hospitals of Xi'an were selected. The questionnaires of this study include sociodemographic characteristics and lifestyle-related scales, such as nutrition, sleep and self-management scales. The differences between the deceased group and the surviving group were analyzed using the t-test or Mann-Whitney tests and chi-square tests. Logistic regression analysis was applied to identify the association between lifestyle factors and mortality.

Results

In this study, 286 patients who completed the questionnaire were screened. During the follow-up of this 3 years, patients who transferred to another hospital (n=31), kidney transplantation (n=6) and termination of dialysis (n=13) were excluded. Finally, 236 participants were tracked to the final outcome. Of these 236 patients, 66.95% were men. The proportion of patients under 60 years old is slightly higher than that of patients over 60 years old. More than half (64.83%) of the patients have a lower education level. And the main primary disease of ESRD was diabetic nephropathy (39.83%). Through a 3-year follow-up study, 73 patients died, accounting for 30.93%. The results showed that compared with surviving patients, deceased patients had significantly lower scores of self-management (Z=-2.09, P=0.036) and higher scores of malnutrition-inflammation score (Z=-2.31, P=0.021). Moreover, deceased patients had a significantly higher proportion of poor sleepers (χ2=4.38, P=0.036) and No exercise (χ2=5.16, P=0.023). However, there were no statistically significant differences in BMI, smoking history and drinking history between the two groups. In logistic analyses, age (χ2=19.63, P<0.001, OR=0.26, 95% CI=0.14~0.47) and self-management score (χ2=3.82, P=0.051, OR=1.03, 95% CI=1.00~1.06) were major factors related to mortality.

Conclusion

Self-management and age are closely related to the mortality rate of patients. And our study showed that the relationship between self-management and mortality is strongest, so doctors and nurses at dialysis centers should pay more attention to and actively improve self-management level of patients undergoing maintenance hemodialysis.

Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas

Background

With approximately 1-in-10 Texas estimated to be living with Type 2 Diabetes Mellitus (T2DM), and the steadily rising healthcare costs associated with non-managed T2DM, efforts are needed to help patients manage their diabetes and avoid costly health consequences. While many diabetes self-management interventions and solutions exist to improve health among people living with T2DM, less is known about the relative effectiveness of these interventions based on their delivery format and when used in combination. The purpose of this study was to identify the effectiveness of three intervention modalities to reduce hemoglobin A1c (A1c) among Texans with T2DM living in rural and urban settings.

Methods

A three-arm randomized controlled trial (RCT) was conducted from November 2020 through March 2022. The three modalities included: (1) asynchronous virtual education and support program with one-on-one follow-up counseling [i.e., virtual Making Moves with Diabetes (vMMWD)]; (2) technology-based education and support (i.e., TBES); and (3) combined modality where participants sequentially received vMMWD and TBES (i.e., combined). Data were collected at baseline and again at 3- and 6-month follow-up. Using an intent-to-treat analysis, constrained longitudinal data analysis models were fitted to identify and compare changes in A1c over time.

Results

Findings demonstrate the positive effects of all three intervention modalities (i.e., vMMWD, TBES, and combined) to significantly reduce A1c among participants. Longitudinal analyses identified that initial reductions in A1c at 3-month follow-up were sustained at 6-month follow-up. Findings were consistent among rural- and urban-residing participants.

Conclusion

This RCT highlights the universal benefits of self-paced virtual diabetes self-management interventions to reduce A1c among Texans with unmanaged T2DM. Such low-cost interventions may be widely applicable for different settings and populations.

Feasibility and usability evaluation of a gamified fatigue management mobile application for persons with multiple sclerosis in everyday life

BACKGROUND

Fatigue is the most debilitating and prevalent symptom of multiple sclerosis (MS), affecting up to 80 % of patients and significantly impairing quality of life (QoL). Managing MS fatigue is challenging due to its multifactorial nature, encompassing physical, cognitive, and psychosocial components. Mobile health (mHealth) tools offer promising approaches for self-management, but most lack personalization and rigorous validation. More Stamina, a gamified mHealth application, was developed to support MS patients by tracking energy expenditure and facilitating fatigue management.

METHODS

A 60-day mixed-methods pilot study was conducted with 20 participants recruited from Oulu University Hospital, Finland. Participants, meeting predefined criteria for MS diagnosis and digital health literacy, tracked daily activities using More Stamina. Standardized instruments assessed fatigue: Fatigue Severity Scale (FSS), QoL (15D), System Usability Scale (SUS), and eHealth literacy (eHEALS). App engagement patterns were analyzed using log data, while think-aloud protocols and semi-structured interviews captured qualitative insights into user experience.

RESULTS

Participants were segmented into power, regular, and light users based on level of engagement. Power users reported higher fatigue severity (mean FSS = 6.31) but better QoL (mean inverted HRQoL = 0.58) compared to light users. More Stamina usability scores improved over time (SUS mean: Day 1 = 27.75; Day 60 = 35.88), reflecting growing fluency of use. Activity tracking included physical, cognitive, and social tasks, revealing subjective differences in perceived energy costs. Participants highlighted the app's role in increasing self-awareness of fatigue and facilitating communication with family and healthcare providers. Emerging uses included journaling and tracking fatigue patterns for medical consultations. Challenges included technical issues and the cognitive burden of repetitive data entry.

CONCLUSIONS

More Stamina is a feasible and acceptable gamified mHealth app for MS fatigue management. It seems to improve self-awareness and supports proactive energy planning, particularly for users with severe fatigue. Despite initial technical challenges, the app shows potential for integration into broader MS management strategies. Larger, long-term studies are needed to evaluate clinical efficacy and optimize design for sustained engagement.

Experiences of a digital group intervention 'the health web': a case study of older adults

BACKGROUND

Within the development of new interventions, it is of highly important to address social participation since it is associated with improved physical and mental health. Therefore, a new intervention in occupational therapy, 'The health Web' was developed.

AIM

The aim of this study was to explore and describe how older adults experienced the intervention process of 'The Health Web' provided by an occupational therapist, and whether the intervention has the potential to promote social participation.

MATERIAL AND METHODS

An exploratory descriptive case study was designed. Five older adults and an occupational therapist were included. Interviews, self-assessments, registration forms and field-notes were used to collect data. The data were analysed using pattern-matching.

RESULTS

The results consist of two cases: A) Continuous engagement promoted the development of strategies and: B) Uneven engagement inhibited the development of strategies. Each case is described with three categories representing the experienced intervention process of the older adults in the respective case.

CONCLUSIONS AND SIGNIFICANCE

The results suggest that the intervention has some potential to support older adults' in using strategies supporting social participation. This study provides valuable insights for the continued development of the intervention.

Knowledge, perceptions, facilitators, and barriers towards asthma self-management among patients: A systematic review of the literature

Background

Asthma self-management is an effective approach that empowers patients with asthma to control their condition and reduce its impact on their daily lives.

Objective

This systematic review aims to synthesize evidence regarding the knowledge, perceptions, facilitators, and barriers related to asthma self-management among patients.

Methods

A systematic literature search was conducted across five databases (PubMed, Science Direct, Scopus, Web of Science, and Google Scholar) using specific key terms. Studies that reported knowledge, perceptions, facilitators and barriers towards asthma self-management were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to report this review. All the data from included studies were analyzed through narrative synthesis approach.

Results

A total of 17 studies were included in this review. The findings indicated that most patients had inadequate knowledge of asthma self-management, particularly regarding asthma fundamentals, and inhaler techniques. Patients' cultural beliefs, and perceived social stigma influenced their self-management practices. Facilitators of asthma self-management included strong partnerships with healthcare providers, social support, access to medication, and having a written asthma action plan. Conversely, poor communication with healthcare professionals, travel, smoking, and workplace challenges were identified as barriers.

Conclusion

There is a pressing need for education and training programs to enhance understanding of the disease, and inhaler technique in patients with asthma. Healthcare professionals should create tailored asthma action plans according to patients' beliefs and needs. Moreover, healthcare policies should be developed to promote facilitators and address barriers, to ensure effective asthma management.

Educational or Behavioural Interventions to Improve Long-Term Haemodialysis Vascular Access Self-Management: A Systematic Review

BACKGROUND

Globally, haemodialysis is the most frequent type of kidney replacement therapy and necessitates access to the bloodstream either through a native arteriovenous fistula, arteriovenous graft or central venous catheter. Vascular access complications are a major cause of morbidity and mortality in adults receiving haemodialysis, and effective vascular access self-management is required.

OBJECTIVE

To examine the effectiveness of educational or behavioural interventions designed to improve self-management of long-term vascular access in adults receiving haemodialysis.

DESIGN

Systematic review.

METHOD

English language publications from January 2013 to May 2023 retrieved from PubMed, Embase, CINAHL, Cochrane Library, PsycINFO and Joanna Briggs Institute (JBI) databases were undertaken. Two independent reviewers identified studies for full-text review, data extraction and quality assessment. Data synthesis and quality assessment followed the JBI guidelines for quantitative reviews.

RESULTS

Seven studies involving 540 participants were included: two studies were randomised control trials and five were quasiexperimental. All studies involved patient education, predominantly provided by nurses, and employed a variety of teaching resources, such as education booklets, practical demonstrations and videos. Outcomes measured included vascular access self-management behaviours, self-efficacy and vascular access knowledge although there was no consistency between studies. Overall, vascular access self-management significantly improved following education.

CONCLUSION

Educational interventions led to improvements in self-management behaviours in adults with long-term haemodialysis vascular access. However, there was insufficient evidence for the delivery and duration of intervention education. Further research is needed. An evidence-based nurse-led codesign intervention could lead to improvements in vascular access self-management.

Curricular Self-management for patients on ventricular assist device support decreases depression: A multicenter randomized controlled trial

BACKGROUND

Utilization of ventricular assist device (VAD) support in patients with end-stage heart failure is well advanced. Recent studies emphasize the need to develop and evaluate evidence-based psychosocial support interventions for patients following VAD implantation.

METHODS

A national, multi-center study in four established German heart centers was initiated. An evidence-based VAD curriculum was developed; a randomized controlled trial evaluated the impact of the interprofessional intervention over time. Primary combined endpoint was the occurrence of adverse events (thromboembolic events, driveline infections, bleeding, rehospitalization, and death); secondary endpoints were psychosocial outcomes (anxiety, depression [HADS], quality of life [QoLVAD], social support [FSoZu], and self-management [SELMA]). A total of 140 patients were randomized block-wise to intervention (IG n = 70) or control (CG n = 70). Center-effects were considered. Instruments were completed at four time points (T0-T3).

RESULTS

At baseline, intervention group (IG) patients were 19% female (control group [CG] 19%; p = 0.982); 58 ± 11 years. (CG 58 ± 11 years.; p = 0.966); 80% were implanted electively (CG 79%; p = 0.968). No significant difference in primary endpoint was found between IG versus CG (p > 0.05). For secondary endpoints, mixed linear regression revealed a significant reduction in depression scores in IG compared to CG (est. 1.18; 95% CI -2.17 to -0.18; p = 0.021). Clinically significant reductions in anxiety were greater in IG patients between T0 and T3 (IG 51.9%; CG 40.7%); increased anxiety was reported in 3.7% IG (11.1% CG). Mixed linear regression analyses favored IG (all >0.05) for QoL, social support, and self-management.

CONCLUSION

A comprehensive curricular VAD intervention has potential to decrease depression levels and improve psychosocial outcomes of patients on VAD support.

Tailored personas for self-management in home-based cardiac rehabilitation for patients with coronary heart disease: A qualitative study

BACKGROUND

Self-management is a key factor determining recovery outcomes in home-based cardiac rehabilitation. However, the impact of individual differences on self-management in patients with coronary heart disease is particularly significant, and standardised approaches often fail to fully meet the needs of this heterogeneous group.

OBJECTIVE

This study aimed to explore the heterogeneity of self-management among patients with coronary heart disease undergoing home-based cardiac rehabilitation and construct patient personas to address the unique challenges and needs of diverse patient groups.

METHODS

A qualitative descriptive study was conducted at a cardiac rehabilitation centre in mainland China from April to July 2024. Purposive sampling was used to select patients with coronary heart disease. Semi-structured interviews were conducted to capture their self-management experiences during home-based cardiac rehabilitation. Content analysis was used to extract factual labels and construct dimensional models. Patient personas were developed by categorising patients based on these dimensions, and their self-management personas were visualised using labelled personas.

RESULTS

A total of 28 eligible patients with coronary heart disease participated in the study. Three key dimensions were identified to construct the personas: descriptions, characteristics, and needs. Five distinct personas were developed based on individual attributes, highlighting the varying self-management behaviours and needs of patients with coronary heart disease. The personas were categorised as follows: patients who actively seek cooperation in health management, patients with limited knowledge and poor management behaviour, patients with management deficiencies under high work demands, patients with prominent symptoms but strong awareness, and patients with impaired motivation for self-management.

CONCLUSION

Precise interventions based on patient personas are essential for enhancing self-management behaviours during home-based cardiac rehabilitation among patients with coronary heart disease. This study developed five patient personas for self-management in home-based cardiac rehabilitation, providing a basis for precise interventions to address the heterogeneous needs of this patient group.

Treatments of fatigue after spinal cord injury: a systematic review and meta-analysis

STUDY DESIGN

Systematic Review and Meta-analysis.

SETTING

Canada.

OBJECTIVES

Fatigue is one of the most common consequences of spinal cord injury (SCI). In this systematic review and meta-analysis, we examined interventions for fatigue in SCI and evaluated their effectiveness.

METHODS

MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched up to January 2024 inclusive. Randomized controlled trials (RCTs) that assessed any intervention for at least one fatigue outcome in people with SCI were included. Study quality was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Initial screening identified 282 studies from which six RCTs were included in the review (N = 249). One study found that moderate-intensity arm-crank exercise significantly improved fatigue compared to a control group (p = 0.036) with a large effect size (standard mean difference [SMD] = 1.05; 95% confidence interval [CI], 0.10-2.00). Two studies assessing behavioral interventions found a moderate effect on fatigue (SMD = 0.46; 95% CI, -0.00-0.92; p = 0.05). Two studies did not find an effect of massage therapy on fatigue (SMD = 0.06; 95% CI, -0.38-0.50; p = 0.80). The risk of bias was classified as High for all but two of the RCTs.

CONCLUSIONS

These findings suggest that exercise and behavioral interventions promoting an active lifestyle may have a positive effect on fatigue. More research with larger sample sizes, including controls for co-morbid conditions like pain and depression, is needed to establish evidence-based treatments for reducing fatigue in people with SCI.

User Personas for eHealth Regarding the Self-Management of Depressive Symptoms in People Living With HIV: Mixed Methods Study

BACKGROUND

eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users.

OBJECTIVE

This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth.

METHODS

We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase.

RESULTS

Three types of user personas could be identified, including "high-level self-managers" (254/572, 44.4%), "medium-level self-managers" (283/572, 49.5%), and "low-level self-managers" (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost ("free of charge").

CONCLUSIONS

The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites.

The effects of self-management education on self-efficacy, self-esteem, and health behaviors among patients with stroke

The concept of self-management has become one of the most critical concepts in stroke rehabilitation. This study examined the impact of a 2-week stroke self-management program on the self-efficacy, self-esteem, and health behaviors of stroke patients. This retrospective study was conducted from January 2022 to October 2022 with 116 patients who had been admitted to the hospital with a stroke diagnosis after admission to the hospital. This study had 4 primary outcomes: self-efficacy, self-esteem, and health behaviors. Each of those outcomes was assessed at baseline, postintervention, and 1 month postintervention. Fifty-one participants were enrolled in the intervention group and 49 participants were enrolled in the control group. According to the baseline data, there was no significant difference between the 2 groups regarding demographics, clinical characteristics, self-efficacy, self-esteem, and health behaviors of participants (P > .05). Moreover, the difference between the mean scores of self-efficacy, self-esteem, and health behaviors between the 3 measurement time points was not significant (P > .05) in the control group, but there were considerable differences between the mean scores of all 3 factors in the intervention group (P < .05). A significant difference was observed between the groups in terms of self-efficacy, self-esteem, and health behaviors after the educational program (P < .05). Patients with stroke can significantly improve their self-efficacy, self-esteem, and health behaviors as a result of self-management education.

The effectiveness of a transition programme based on the integrated theory of health behavior change in adolescents with chronic kidney disease: a quasi-experimental study

BACKGROUND

To validate the effectiveness of the application of a transition programme for adolescents with chronic kidney disease based on the Integrated Theory of Health Behavior Change.

METHODS

This study was a quasi-experiment study. We included 76 adolescents with chronic kidney disease, and based on their willingness to undergo transition intervention, participants were assigned to either the intervention group or the control group. The intervention group received the transition intervention guided by the Integrated Theory of Health Behavior Change, while the control group received standard care and education, remaining unaware of the intervention group's existence. The data of the intervention group were collected before and after the intervention. Because the total intervention lasted approximately 4 weeks, the data of the control group were collected at baseline (T0) and 1 month (T1). We chose transition readiness as the primary outcome. The secondary outcomes included medication adherence and self-efficacy.

RESULTS

At the final assessment (T1), the scores related to transition readiness, medication adherence, self-care self-efficacy, and adolescent exercise and eating behavior self-efficacy in the intervention group were significantly higher than those in the control group (P < 0.05). Compared with those at T0, the scores of all the constructs in the intervention group increased at T1, and these differences were statistically significant. There was a weak positive correlation between participants' transition readiness and their medication adherence (r = 0.389, P < 0.01), self-care self-efficacy (r = 0.501, P < 0.01), exercise behavior self-efficacy (r = 0.237, P < 0.05), and eating behavior self-efficacy (r = 0.481, P < 0.01).

CONCLUSIONS

Based on the Integrated Theory of Health Behavior Change, the transition program for adolescents with chronic kidney disease significantly improved participants' transition readiness, self-care self-efficacy, and exercise and eating behavior self-efficacy. While the study's design limits definitive conclusions on the program's impact on medication adherence, the observed improvements suggest that potential benefits warrant further investigation.

TRIAL REGISTRATION

The study obtained approval from the local institutional review board and was registered on https://www.chictr.org.cn (Clinical Trial Number: ChiCTR2300077149) prior to the enrollment of the first subject on October 31, 2023.

A self-management intervention for newly diagnosed with inflammatory arthritis: a randomized controlled feasibility and fidelity study

BACKGROUND

Inflammatory arthritis affects approximately 2-3% of adults worldwide. For patients newly diagnosed with arthritis, effective self-management is crucial, as they often face several physiological, emotional, and social challenges. A self-management intervention called NISMA was thus developed to cater to this group. This study aimed to evaluate the feasibility and fidelity of this intervention before conducting a full-scale randomized controlled trial.

METHODS

This feasibility study was conducted as a single-center randomized controlled trial. Twenty participants were expected to be sufficient for assessing the feasibility outcomes. The control group received only the usual care, while the intervention group received the NISMA intervention in addition, which involved individual and group sessions in a multidisciplinary setting. Feasibility was evaluated based on the recruitment, data collection, retention, and randomization processes. The patient-reported outcome measures and clinical measures were collected to review their potential for inclusion in a future randomized controlled trial. Fidelity was assessed by using documentation sheets filled in by the health professionals and audio recordings of the sessions to examine whether the intervention's principles and components were adequately addressed.

RESULTS

Among 47 eligible patients, we recruited 23 participants during a period of 4 months. The recruitment rate was 47% and the retention rate 91%. Randomization, although accepted, led to some disappointment in the control group. Data collection was effective, with only minimal missing data (< 1%). The fidelity was considered as high, as results indicated that nurses effectively engaged in collaborative partnerships with patients, utilizing planned questioning techniques and self-management strategies for problem-solving and resource utilization. However, action planning was inconsistently applied.

CONCLUSION

The study demonstrated the feasibility and the overall high fidelity of delivering the NISMA intervention to patients newly diagnosed with inflammatory arthritis. The insights from the study are useful for identifying the areas that require modifications before initiating a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT06063252. Registered 02 October 2023 - retrospectively registered.

How Do People With Schizophrenia Manage Their Daily Life? A Qualitative Study

Due to the rising number of long-term mental health conditions, there has been a shift in therapeutic focus from curing these conditions, to living a meaningful life with them. Self-management is described as the ability to live with the emotional, life role and medical consequences of long-term conditions such as schizophrenia. However, the perspective of people with schizophrenia on self-management in current literature is missing. A lack of understanding of strategies used by people with schizophrenia to self-manage, could adversely affect the use of self-management interventions. Therefore, this study aims to identify how people with schizophrenia manage their daily life. Semi-structured interviews (n = 9) were conducted in a qualitative descriptive design. The study is reported by using the COREQ checklist. All participants, recruited through purposive sampling, have been stabilised after a schizophrenic episode and have been reintegrated into their community. The data were analysed through thematic analysis. Self-management for people with schizophrenia is an individualised process that revolves around performing day-to-day activities according to the participant's wishes. In addition, participants tried to prevent relapse by self-managing daily life. Personal-, social- and schizophrenia-related factors were seen as barriers and/or facilitators in their self-management. These barriers and/or facilitators were self-managed using daily activities. Current self-management interventions for this population often aim at improving medication adherence. Self-management interventions facilitated by health care professionals should (i) focus more on supporting patients in finding their daily structure through meaningful activities and (ii) be mindful of the duality contained within self-management of people with stabilised schizophrenia.

Factors influencing the use of an artificial intelligence-based app (selfBACK) for tailored self-management support among adults with neck and/or low back pain

PURPOSE

Tailored self-management support is recommended as first-line treatment for neck and low back pain, for which mHealth applications could be promising. However, there is limited knowledge about factors influencing the engagement with such apps. The aim of this study was to assess barriers and facilitators for engaging with a self-management mHealth app among adults suffering from neck and/or low back pain.

MATERIALS AND METHODS

We carried out a qualitative descriptive study among adults with neck and/or low back pain. The artificial intelligence-based selfBACK app supports tailored self-management of neck and low back pain and was used for 6 weeks. After these 6 weeks, participants were interviewed by phone.

RESULTS

Thirty-two adults (17 males) with neck and/or low back pain participated (mean age = 54.9 (SD = 15.8)). Our results show that the mode of delivery and the novelty of the selfBACK app were perceived most often as a barrier to use the app. The action plans of the app and health-related factors were perceived most often as facilitating factors.

CONCLUSIONS

This study provides insight into possible strategies to improve an mHealth service. Furthermore, it shows that adults with neck and/or low back pain are willing and ready to receive blended treatment.

Protocol for a feasibility study evaluating a supported self-management intervention for stroke survivors with aphasia (StarStep study)

BACKGROUND

There is a growing evidence base to support the use of self-management interventions for improving quality of life after stroke. However, stroke survivors with aphasia have been underrepresented in research to date. It is therefore unclear if self-management is an appropriate or effective approach for this group. To address this gap in the evidence base, we have developed a supported self-management intervention (the 'Living with Aphasia' intervention) specifically for stroke survivors with aphasia in the first year after stroke. The StarStep study aims to assess the feasibility of implementing and evaluating the intervention (including the feasibility of participant recruitment, the feasibility of delivering facilitator training, the acceptability of the intervention, the fidelity of intervention delivery and outcome data completeness).

METHODS

StarStep is a mixed-methods, non-randomised feasibility study. The Living with Aphasia intervention will be facilitated by speech and language therapists and implemented in two community stroke teams in the north of England. We aim to recruit 30 stroke survivors who have aphasia (and/or their family members) and who are ≤ 12-month post-stroke to participate in data collection for the study. Following informed consent, participants will complete a baseline data collection questionnaire which will include measures of quality of life, symptoms of depression and perceived communicative effectiveness. Follow-up questionnaires will be completed at 3-month post-intervention. Qualitative data collection will include implementation groups and semi-structured interviews with speech and language therapists, semi-structured interviews with stroke survivors with aphasia (and/or their family members) and observations of the delivery of the intervention. A joint display table will be used to integrate findings from each element of data collection in order to consider overall feasibility.

DISCUSSION

This study will provide the information necessary to optimise data collection processes and to optimise the implementation and delivery of the self-management intervention. Feasibility data will inform decision-making regarding progression to a future definitive cluster randomised controlled trial to evaluate the effectiveness of the intervention.

TRIAL REGISTRATION

ISRCTN registry, trial registration number: ISRCTN10401966. Date of registration: 07/10/2023. URL of trial registry record: https://doi.org/10.1186/ISRCTN10401966 .

Self-Management in Children and Adolescents With Chronic Illness: An Evolutionary Analysis of the Concept

AIM

To increase conceptual clarity regarding the self-management of school-age children and adolescents with chronic illnesses in a community context.

DESIGN

Concept Analysis: Rodgers' evolutionary approach.

DATA SOURCES

Search conducted in the Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioural Sciences Collection, Nursing and Allied Health Collection, Academic Search Complete, Cochrane, Web of Science, Medical Literature Analysis and Retrieval System Online, Scopus, Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, Joanna Briggs Institute Evidence Synthesis. Thirty-one articles were identified, published between 2004 and 2023.

REPORTING METHOD

Followed the Enhancing the Quality and Transparency of Health Research guidelines-Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.

RESULTS

Self-management in children and adolescents with chronic illness, in school age, in a community context, consists of a process of acquiring knowledge and beliefs that promote the self-efficacy of this population in developing skills to face needs inherent to the health condition.

CONCLUSION

Promoting self-management goes beyond simply educating for skill acquisition. Participants with stronger beliefs in their ability to control their behaviours are more successful in self-management. The activation of resources that position the child as an agent of change is recommended.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

It contributes to the development of strategies that promote self-management across different healthcare disciplines, focusing on education and change, but also on psychological encouragement to foster confidence in change.

IMPACT

Competent self-management during childhood promotes autonomy, empowerment, and control of the condition, with consequent physical and emotional well-being, quality of life, family stability, and social development.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no direct contribution from patients or the public in this work (literature review).

Self-Management Strategies for Low Back Pain Among Horticulture Workers: Protocol for a Type II Hybrid Effectiveness-Implementation Study

BACKGROUND

Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date, no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP.

OBJECTIVE

This study will (1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods and (2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation.

METHODS

A pragmatic, mixed methods, hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English- and Spanish-speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, and at 3 and 6 months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators, and reasons for adoption.

RESULTS

The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, CDC NIOSH; U54OH011230-07S1), as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027.

CONCLUSIONS

We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing the use of nonpharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64817.

"I'm living in a 'no' world now…"- A qualitative study of the widespread impact of living with chronic breathlessness, and experiences of identification and assessment of this symptom in an older, frail community-based population

Chronic breathlessness is a debilitating symptom with detrimental impact on individuals and carers. However, little is known about the experiences of community-dwelling, frail, older adults living with chronic breathlessness. To explore, (i) the psychological impact of living with chronic breathlessness, (older frail adult patients, carers) and (ii) how patients, carers, and clinicians experience identification and assessment of chronic breathlessness in the primary care setting. In-depth semi-structured interviews with eligible older adults (≥65 years; moderate to severe frailty [electronic Frailty Index >0.36]), and carers recruited from a community-based Integrated Care Centre in England. Clinicians were recruited from the Centre and affiliated GP practices. Recorded in-person interviews were transcribed and subjected to reflexive thematic analysis using Total Dyspnoea and Breathing Space conceptual frameworks. 20 patients (9 females), carers (4 spouses, 1 daughter), and clinicians (5 GPs, 3 advanced clinical practitioners, 2 nurses) were interviewed. Four themes were identified: (1) Widespread negative impact of chronic breathlessness. Breathlessness adversely impacts physical and psychological wellbeing. (2) Barriers to optimal health-seeking and identification of chronic breathlessness. Breathlessness is 'one of many' symptoms, and not prioritised in 'one appointment, one problem' consultations. Clinicians do not routinely ask about breathlessness. Patients are unaware of breathlessness-specific therapies. (3) Variations in chronic breathlessness management. Management is limited; few are offered evidence-based treatments (e.g., handheld fan) and patients find their own strategies. (4) Need for education and information. Clinicians felt helpless about breathlessness management, and patients lacked understanding and had low expectations of receiving help for this symptom. Breathlessness adversely impacts the psychological wellbeing of older frail adults. Chronic breathlessness in older, frail adults is invisible, unidentified and unmanaged in primary care. Evidence-based breathlessness interventions are available, but not routinely implemented with few patients accessing them. Proactive identification, assessment and management of breathlessness in primary care is needed to support adults living with chronic breathlessness.

Patient Performance of Care Tasks During Acute Hospitalisation: A Scoping Review

BACKGROUND

Patient self-care is established as improving outcomes, yet acute care in hospitals is provided such that patients tend to be passive recipients of care. Little is known about the extent and type of patient participation in treatment care tasks in acute hospital settings.

AIMS

To map and synthesise available literature on self-performance of care tasks in acute hospital settings.

DESIGN

A scoping review was conducted guided by JBI methodology.

METHODS

A literature search was conducted in July 2021 and updated in March 2024 across five databases: Scopus, PubMed, CINAHL, Embase and Web of Science. Studies were screened using predefined eligibility criteria. Full-text screening and data extraction were performed independently by two researchers. Data were collected using a template specifically designed for this review. Reporting followed the PRISMA-ScR guideline.

RESULTS

Of the 31,361 articles identified, 35 were included. Most of the articles were experimental (n = 20) and conducted in Europe (n = 13), North America (n = 10) and Australia (n = 3). Studies were classified according to investigation of the performance of care tasks (n = 6) or of the outcomes of the performance of the self-care task (n = 29). Most tasks performed involved self-administration of medication (n = 31), only 4 articles referred to other care tasks. Most articles focused on acute tasks (n = 18), while 15 articles referred to chronic care tasks. Ostomy self-care (n = 2) was a separate category, being an acute task that continued into chronic self-care.

CONCLUSION

Performance of care tasks by patients in acute care settings are predominantly related to chronic and pain medication administration.

IMPLICATIONS FOR CARE

Patient preferences and competency to self-perform care tasks during hospitalisation should be assessed and monitored and supported accordingly. Utilising hospitalisation time to observe and assess self-care practices could provide additional teaching opportunities to patient self-care and improve overall care continuity.

REPORTING METHOD

The PRISMA-ScR guideline was followed.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL AND PROTOCOL REGISTRATION

This review was registered on Open Science Framework before running the final search: (https://doi.org/10.17605/OSF.IO/D8KS2).

The Development and Feasibility Testing of the Nurse-Led Transitioning Adolescents Off Cancer Treatment (TACT) Intervention

AIM

To develop and assess the feasibility of a nurse-led intervention aimed at improving the transition from cancer treatment to survivorship for adolescents by providing personalised information and psychosocial and self-management support.

DESIGN

Intervention development through co-creation with adolescent patients with cancer, their parents and health care professionals, based on the MRC framework and qualitative feasibility testing.

METHODS

The intervention development involved three steps: (a) identifying the problem through interviews with key stakeholders and by reviewing existing evidence on transition tools and practices; (b) designing the intervention through co-creation workshops with stakeholders and (c) assessing feasibility, acceptability and participants' experiences of the intervention through interviews with adolescents, parents, healthcare professionals and teachers.

RESULTS

The Transitioning Adolescents with Cancer off Treatment (TACT) intervention was developed, and feasibility was tested between October 2021 and October 2022. TACT included two nurse-led consultations addressing transition concerns and a videoconference with local support networks to inform and activate stakeholders. Communication tools were developed and successfully used to address adolescents' needs, tailor information and support self-management.

CONCLUSION

The nurse-led TACT intervention appears feasible and acceptable for clinical practice, with no major changes needed. Participants reported that the intervention helped prepare adolescent cancer patients to transition to survivorship by providing tailored information and psychosocial and self-management support.

IMPACT

Despite high survival rates of childhood cancers and the growing awareness of the challenges adolescents and their families face when transitioning off treatment to survivorship, few interventions are available. The novel TACT intervention indicates that nurses are well-positioned to provide broad, tailored care addressing survivors' multi-faceted needs and challenges associated with this transition.

REPORT METHOD

Consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

Adolescent survivors, their parents, nurses and physicians involved in their care contributed through co-creation groups, contributing feedback that shaped and refined the TACT intervention.

Development of an eHealth Intervention Including Self-Management for Reducing Sedentary Time in the Transition to Retirement: Participatory Design Study

BACKGROUND

Having a great amount of sedentary time is common among older adults and increases with age. There is a strong need for tools to reduce sedentary time and promote adherence to reduced sedentary time, for which eHealth interventions have the potential to be useful. Interventions for reducing sedentary time in older adults have been found to be more effective when elements of self-management are included. When creating new eHealth interventions, accessibility and effectiveness can be increased by including end users as co-designers in the development process.

OBJECTIVE

The aim was to explore the desired features of an eHealth intervention including self-management for reducing sedentary time and promoting adherence to reduced sedentary time in older adults transitioning from working life to retirement. Further, the aim was to develop a digital prototype of such an eHealth intervention.

METHODS

The study used the participatory design approach to include end users, researchers, and a web designer as equal partners. Three workshops were conducted with 6 older adults transitioning to retirement, 2 researchers, and 1 web designer. Thematic analysis was used to analyze the data from the workshops.

RESULTS

Participants expressed a desire for an easy-to-use eHealth intervention, which could be accessed from mobile phones, tablets, and computers, and could be individualized to the user. The most important features for reducing sedentary time were those involving finding joyful activities, setting goals, and getting information regarding reduced sedentary time. Participants expressed that the eHealth intervention would need to first provide the user with knowledge regarding sedentary time, then offer features for measuring sedentary time and for setting goals, and lastly provide support in finding joyful activities to perform in order to avoid being sedentary. According to the participants, an eHealth intervention including self-management for reducing sedentary time in older adults in the transition to retirement should be concise, accessible, and enjoyable. A digital prototype of such an eHealth intervention was developed.

CONCLUSIONS

The developed eHealth intervention including self-management for reducing sedentary time in older adults transitioning to retirement is intended to facilitate behavior change by encouraging the user to participate in autonomously motivated activities. It uses several behavior change techniques, such as goal setting and action planning through mental contrasting and implementation intention, as well as shaping knowledge. Its active components for reducing sedentary time can be explained using the integrated behavior change model. Further research is needed to evaluate the feasibility and effectiveness of the eHealth intervention.

The Association Between Psychological Capital and Self-Management Behaviors in Men with Gout: A Cross-Sectional Study in Southwest China

Purpose

Gout is a common, chronic inflammatory joint disease, and men are more likely to suffer from gout. Improving patient self-management behaviors is a priority in gout healthcare. Psychological capital is associated with self-management behaviors in chronic diseases and can be improved through a number of interventions. However, this topic has not been well studied in gout patients. The aim of this study was to determine the level of psychological capital among male gout patients in Southwest China and to compare differences in self-management behaviors among patients with different levels of psychological capital.

Patients and Methods

This was a cross-sectional study. A total of 242 male gout patients were recruited from West China Hospital of Sichuan University, and demographic characteristics, clinical characteristics, psychological capital, and behavioral variables related to patient self-management were collected. K-Means cluster analysis was used to characterize psychological capital.

Results

The total psychological capital score of the participants was 134.5 (SD = 21.3). Cluster analysis of the four dimensions of psychological capital yielded three clusters, namely, Cluster 1 (higher level, 29.8%), Cluster 2 (moderate level, 52.3%), and Cluster 3 (poor level, 17.9%). The differences in the self-management behaviors among the three clusters, the differences were statistically significant. Post hoc analyses revealed that cluster 1 scored higher on the self-Management behaviors and its four dimensions than either cluster 2 or cluster 3 (p < 0.05).

Conclusion

The psychological capital of men with gout in Southwest China could be improved, and moderate and low levels of psychological capital are associated with suboptimal self-management behaviors. Healthcare providers may target gout patients with low or moderate levels of psychological capital as an intervention and take steps to improve their levels of psychological capital. These results may assist in decision-making for self-management behavioral interventions for gout patients.

Experience with a Self-Management Education Program for Adolescents with Type 1 Diabetes: A Qualitative Study

Background/Objectives: Adolescents with type 1 diabetes face complex challenges associated with the disease, underscoring the importance of developing self-management skills. This study examined participants' perspectives on a type 1 diabetes self-management education program. Methods: Focus group interviews were conducted with 32 adolescents with type 1 diabetes who participated in the program and six expert patients. Both thematic analysis and content analysis were conducted using NVIVO software, version 1.6.1. Results: Two dimensions emerged: expert patient roles and program evaluation. Expert patient roles were viewed positively, with an emphasis on responsibility, sharing experiences, and being a role model. Program evaluation emphasized peer-to-peer sharing and educational sessions, with increased knowledge of the disease and management strategies. Expert patients also benefited from the program by developing a sense of responsibility, serving as role models for adolescents, and improving their disease self-management. Conclusions: The adolescents emphasized that the program was a learning tool and the expert patient's view of their role emerges, highlighting modelling as a facilitator of learning and of the responsibility and commitment of the mentors. This study reinforces the benefits of peer-to-peer interaction in a camp setting, including rich experiences.

Navigating choices: understanding the decision-making journey of patients with localised kidney cancer

OBJECTIVE

To explore patients' experience of decision making regarding treatment of localised kidney cancer.

METHODS

A total of 21 patients with localised kidney cancer, across three countries, participated in either four focus groups or seven semi-structured interviews that lasted on average 2 h. Focus groups and interviews were all conducted in the participants' native language, recorded, transcribed and (if applicable) translated into English. Thematic analysis was used to develop a codebook and identify themes.

RESULTS

All participants expressed a desire to be actively involved in the treatment decision-making process. However, due to the emotional toll of the cancer journey, which often necessitates quick decisions, actively engaging in the decision-making process was described as challenging. The study revealed 12 key themes. These themes included the impact of diagnostic paths, patient characteristics, patient empowerment, health literacy, source of support, fear of recurrence, trust in treatment and healthcare providers, shared decision making (SDM), professional interaction, personal belief system, and organisational and administrative issues.

CONCLUSIONS

The findings highlight the complexity of decision making, underscoring the desire for patient involvement, SDM, and clear communication. We reveal a significant gap between research recommendations and clinical practice, emphasising the need to translate research findings to clinical application to enhance patient-centred care.

The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study

BACKGROUND

Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population.

OBJECTIVE

This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool.

METHODS

Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed.

RESULTS

Participants reported two key benefits of using the web-based self-management tool: (1) the tool's emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients' independence in managing their own recovery.

CONCLUSIONS

Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use.

Effectiveness of Fewer Falls, an online group-based self-management fall prevention programme for people with multiple sclerosis: protocol of a randomised controlled trial

INTRODUCTION

Fewer Falls is a manualised self-management fall prevention programme co-developed for and with ambulatory and non-ambulatory people with multiple sclerosis (PwMS). Findings from a feasibility study indicate the necessity of a full-scale randomised controlled trial (RCT).

METHODS AND ANALYSIS

A parallel-group RCT with a mixed methods process evaluation as well as a cost-effectiveness evaluation will be conducted. We aim to recruit 240 PwMS, who will be stratified by ambulation level and randomised 1:1 in blocks of eight to intervention or control. The group-based self-management fall prevention intervention involves eight 2-hour online synchronous sessions (approximately eight participants/group) facilitated by a licensed healthcare professional and home assignments to be completed by participants between sessions. The setting is online, and participants can be located anywhere in Sweden. The control and intervention groups will also receive a brochure on fall risk factors and fall prevention in addition to their standard MS care and rehabilitation. Data collection will be performed at baseline and 3, 6 and 12 months after the start of the intervention. Falls will be monitored via a short message service every week during 1 year from the start of the intervention. The primary outcome is fall frequency (falls/person/year). Secondary outcomes include injurious falls, falls control, fear of falling, falls self-efficacy, activity curtailment, perceived effect of MS, self-rated health and cost-effectiveness.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Swedish Ethical Review Authority (registration numbers 2022-06667-01 and 2023-07723-02). The RCT will adhere to the Declaration of Helsinki. Written consent to participate will be obtained from all participants. Study-related information about participants will be stored securely at Karolinska Institutet. The results will be presented in peer-reviewed journals, through the patient organisation Neuro Sweden, at conferences, and in social media.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT05789225.

Case management for people with acquired brain injury: feasibility and effectiveness of a two-year pragmatic randomized controlled trial

BACKGROUND

Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM.

METHODS

Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation.

RESULTS

There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information.

DISCUSSION

CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.

Evaluation of the quality and self-management related content of websites promoting physical activity engagement after myocardial infarction or cardiac surgery: A scoping review

INTRODUCTION

Uncertainty about safe engagement in activity during early recovery after cardiac events is common. Websites are a potential source of health information, especially for those unable to access follow-up support from health professionals. The variability in online health information quality is concerning as poor web-based information can negatively impact patient health outcomes and the ability to self-manage.

OBJECTIVE

To evaluate the quality and self-management-related content of websites providing information about physical activity following an MI or cardiac surgery.

METHODS

Patient-facing websites were searched using three search engines (Google, Bing, and Yahoo). Information about activities of daily living (ADLs), exercise (aerobic and resistance), and safety considerations were explored. Self-management strategies for physical activity were evaluated using a customized 9-item checklist. Website quality was assessed using the 4-item JAMA framework criteria.

RESULTS

31 websites were included. Aerobic exercise, ADLs, and safety considerations were the most comprehensively covered topics. Resistance exercise was less frequently and comprehensively covered. The median self-management checklist score was 3/9 (with nine being the highest possible score). Partnering with healthcare professionals, decision-making, action planning, and verbal persuasion were the most common self-management skills addressed by the websites. In contrast, ten or fewer websites modelled mastery experiences, vicarious experiences, reflection, problem-solving, and resource utilization. The median JAMA score for website quality was 2/4 (with four being the highest possible score).

CONCLUSIONS

The findings highlight quality improvement opportunities for web providers and provide insight for patients and clinicians regarding the highest quality websites that best meet the information and self-management needs following an MI or cardiac surgery.

The Perspectives and Experiences of Physiotherapists on Implementing Self-Management Support in Inpatient Hospital Settings

BACKGROUND AND PURPOSE

As health systems come under increasing pressure, supporting patients to self-manage their own condition is becoming increasingly important. A shift towards a more holistic, person-centred approach to healthcare in the hospital setting, through enhancing self-management support (SMS), is required to empower patients to increase independence in managing their own conditions. The study aim was to explore how physiotherapists perceive and implement SMS with patients in hospital inpatient settings.

METHODS

A qualitative study approach was taken using semi-structured interviews (n = 8). Physiotherapists with at least 6 months experience working in the inpatient hospital setting were invited to participate. Interview data were analysed using the General Inductive Approach.

RESULTS

Four themes were identified: (1) physiotherapists understanding and perceptions of implementation of SMS in the hospital, (2) SMS facilitates a person-centred and collaborative approach to healthcare, (3) SMS is beneficial to patients, physiotherapists, and the healthcare system, and (4) perceived challenges and potential solutions for SMS implementation.

DISCUSSION

Overall, physiotherapists value the use of self-management support in the hospital. SMS was implemented by partnering with patients, facilitating patients to problem solve and providing education so that patients could play an active role in decision making and independently participate in their rehabilitation. However, there appears to be scope to improve physiotherapists' knowledge of SMS to enable implementation of a wider range of SMS tools in clinical practice. A limitation of this study is that most participants were New Zealand European and, therefore, the findings are not generalisable to all physiotherapists working in New Zealand.

IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE

Physiotherapists perceive SMS to have a place in the inpatient hospital setting and can lead to better patient outcomes and reduce burden on the healthcare system. Enhancing physiotherapists' understanding of SMS and exploring other ways to implement SMS in hospital settings, may help to facilitate appropriate implementation.

Preventing falls in multiple sclerosis: a qualitative study on user requirements for a self-management programme

PURPOSE

To explore perspectives of ambulatory and non-ambulatory people with MS (PwMS) and health care professionals (HCPs) on falls and falls management to gain a deeper understanding of how a self-management programme can be designed to fit the needs of end users.

MATERIALS AND METHODS

Twelve PwMS and seven HCPs participated in three four-hour workshops based on Design Thinking. Collected data were field notes and digital post-it notes gathered at the workshops. Data were analyzed using qualitative content analysis with an inductive approach.

RESULTS

Two main categories, "Managing the complexity of fall-risk behaviour" and "Embracing diversity to establish group engagement", comprising a total of seven categories were constructed from the analysis. The first main category reflects the challenges PwMS face in managing fall risk in their daily lives, and the support needed to address these challenges. The second main category highlights how engaging in peer learning activities can fulfil individual needs and improve learning outcomes for PwMS.

CONCLUSION

A self-management fall prevention programme that is relevant to PwMS regardless of ambulation level should include the development of self-tailored behavioural strategies to prevent falls along with interactive learning activities with other PwMS.

Experiences with healthcare for unilateral vocal fold paralysis: A qualitative study of the patient's perspective

OBJECTIVE

Unilateral vocal fold paralysis (UVFP) frequently causes severe dysphonia, which necessitates multidisciplinary treatment. Literature on outcomes of interventions has primarily focused on vocal fold motility or instrumental vocal outcomes, but the perspectives of patients about the treatment process have not yet been investigated. The purpose of the study was therefore to explore patient experiences with healthcare for UVFP.

METHODS

Twenty-four adults with UVFP (age range: 39 - 84 years) participated in the study. Semi-structured interviews were conducted, transcribed, and analyzed with the software program NVivo. An inductive thematic approach was used to code and analyze the interviews.

RESULTS

Three themes were identified through the qualitative analyses: (1) the healthcare professional (HCP), (2) experiences with treatment, and (3) patient support. The laryngologist and speech-language pathologist (SLP) were crucial HCPs during treatment, and patients relied heavily on their advice, so they expected them to be knowledgeable about UVFP and empathic towards their patients. Voice therapy was mostly a positive experience due to the collaborative therapeutic relationship with the SLP, even though it did not yield sufficient voice improvements. Medialization surgery was a relief for some participants, while others expected more or felt too vulnerable to undergo surgery. Sources of patient support included personal connections such as relatives and fellow patients, but participants expressed a need for increased support and guidance from the healthcare system.

CONCLUSION

Overall, participants were satisfied with the care that they had received, but certain barriers and needs within UVFP healthcare were identified. The findings from the current study can help guide the development of initiatives to better support patients and HCPs and improve patient-centered care in UVFP.

The Mediating Role of General Self-Efficacy in Health Self-Management and Psychological Stress Among Older Adults in Shanghai: A Structural Equation Modeling Analysis

BACKGROUND

Given the demographic shift towards an older population, it is crucial to understand the determinants and implications of psychological distress among this demographic group. This study explores the relationship between health self-management and psychological distress in older Chinese adults, focusing on the mediating role of general self-efficacy (GSE).

METHODS

We conducted a cross-sectional study in five districts of Shanghai from 1 November to 31 December 2021, employing a random cluster sampling method. Data were collected using the Health Self-Management Scale, the General Self-Efficacy Scale (GSES), and the Kessler-10 Scale. Out of 2050 participants approached, 1905 completed the survey, resulting in a response rate of 91.76%. Data analysis included correlation studies, hierarchical linear regression, and structural equation modeling.

RESULTS

The average Kessler-10 score among elderly individuals in Shanghai was 15.59 ± 6.35. Of these, 22.10% had mild psychological distress, 11.92% had moderate stress, and 5.30% had severe stress. We found significant negative correlations between psychological distress and health self-management (r = -0.34, p < 0.05) and GSE (r = -0.26, p < 0.05). Health self-management had a total effect of -0.284 (95%CI: -0.330 to -0.234) on psychological distress, with GSE mediating approximately 20.42% of this effect.

CONCLUSIONS

GSE plays a significant mediating role between health self-management and psychological distress. These findings highlight the importance of promoting health self-management and GSE to alleviate psychological distress among older adults in Shanghai. This approach could enhance holistic health outcomes and improve the quality of life within this growing population segment.

Development and Validation of the Self-Management Questionnaire for Patients with Lower Extremity Arterial Disease Who Underwent Endovascular Revascularization

Introduction

To develop and psychometrically validate the Self-management Questionnaire for Patients with Lower Extremity Arterial Disease Patients Who Underwent Endovascular Revascularization (LESQ).

Methods

We developed the LESQ and validated it in a Chinese population. A three-round cross-sectional descriptive survey in six hospitals in China, involving samples of 271, 269, and 623 participants, respectively. The surveys were conducted between February 2021 to March 2022.

Results

The final version of the LESQ, with 22 items, was divided into three domains using exploratory factor analysis: medical management, rehabilitation exercise management, and daily life management. The questionnaire had good internal consistency reliability, with a Cronbach's α of 0.953 and good retest reliability, with the coefficients of 0.917, respectively. The content validity of the LESQ was 0.939. The three domains of the questionnaire were confirmed by confirmatory factor analysis. The optimal cut-off points were 52 and 70, respectively, using latent profile analysis.

Discussion

The LESQ is a new self-report questionnaire for measuring self-management ability with good reliability and validity through validation.