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Stenov V, Cleal B, Willaing I, Christensen JN, Jensen CG, Mouritsen JD, Due-Christensen M. An evidence-based nurse-led intervention to reduce diabetes distress among adults with type 1 diabetes and diabetes distress (REDUCE): Development of a complex intervention informed by the Medical Research Council framework. JMIR Form Res 2024. [PMID: 39239797 DOI: 10.2196/58658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes and is occurring in more than 40 % of adults with type 1 diabetes. However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. OBJECTIVE To modify and adapt existing, evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with type 1 diabetes and moderate to severe diabetes distress. METHODS The overall framework of this study was informed by the initial phase of the Medical Research Council complex intervention framework undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at two specialised diabetes centres in Denmark from November 2019 to June 2021. A total of 36 adults with type 1 diabetes participated in 10 parallel workshops. Twelve diabetes-specialised nurses were interviewed and participated in one co-creation workshop and 12 multidisciplinary specialists (psychologists, educational specialists, and researchers) participated in four co-creation workshops and 14 feedback meetings. Data were analysed by applying a deductive analytical approach. RESULTS The intervention included five bi-weekly 2½-hour small group sessions with adults with type 1 diabetes and diabetes distress delivered by two trained diabetes specialist nurses guided by a detailed step-by-step manual. The intervention material includes visual conversation tools, covering seven diabetes-specific sources derived from the 28-item diabetes distress scale for measuring diabetes distress: 1) powerlessness, 2) self-management, 3) fear of hypoglycaemia, 4) food and eating, 5) friends and family, 6) negative social perception, and 7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections as well as plenary- and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries, and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention nurses needed increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. CONCLUSIONS This co-design study has described the adaption of a complex intervention with a strong evidence base including detailed reporting of the theoretical underpinnings and core mechanisms. CLINICALTRIAL
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Affiliation(s)
- Vibeke Stenov
- Steno Diabetes Center Copenhagen- Copenhagen University Hospital, Department of Prevention, Health Promotion and Community Care, Borgmester Ib Juels Vej 83, Herlev, DK
| | - Bryan Cleal
- Steno Diabetes Center Copenhagen- Copenhagen University Hospital, Department of Prevention, Health Promotion and Community Care, Borgmester Ib Juels Vej 83, Herlev, DK
| | - Ingrid Willaing
- Copenhagen University, Department of Public Health, Section of Health Services Research, Copenhagen, DK
| | - Jette Normann Christensen
- Steno Diabetes Center Copenhagen- Copenhagen University Hospital, Department of Diabetes Care, Herlev, DK
| | - Christian Gaden Jensen
- Aarhus University, Foundation for Mental Health and Cognitive Neuroscience Research Unit, Aarhus, DK
| | | | - Mette Due-Christensen
- Steno Diabetes Center Copenhagen- Copenhagen University Hospital, Department of Prevention, Health Promotion and Community Care, Borgmester Ib Juels Vej 83, Herlev, DK
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Kashyap N, Sebastian AT, Lynch C, Jansons P, Maddison R, Dingler T, Oldenburg B. Engagement With Conversational Agent-Enabled Interventions in Cardiometabolic Disease Management: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e52973. [PMID: 39110504 PMCID: PMC11339562 DOI: 10.2196/52973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases (CMDs) are a group of interrelated conditions, including heart failure and diabetes, that increase the risk of cardiovascular and metabolic complications. The rising number of Australians with CMDs has necessitated new strategies for those managing these conditions, such as digital health interventions. The effectiveness of digital health interventions in supporting people with CMDs is dependent on the extent to which users engage with the tools. Augmenting digital health interventions with conversational agents, technologies that interact with people using natural language, may enhance engagement because of their human-like attributes. To date, no systematic review has compiled evidence on how design features influence the engagement of conversational agent-enabled interventions supporting people with CMDs. This review seeks to address this gap, thereby guiding developers in creating more engaging and effective tools for CMD management. OBJECTIVE The aim of this systematic review is to synthesize evidence pertaining to conversational agent-enabled intervention design features and their impacts on the engagement of people managing CMD. METHODS The review is conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be conducted in the Ovid (Medline), Web of Science, and Scopus databases, which will be run again prior to manuscript submission. Inclusion criteria will consist of primary research studies reporting on conversational agent-enabled interventions, including measures of engagement, in adults with CMD. Data extraction will seek to capture the perspectives of people with CMD on the use of conversational agent-enabled interventions. Joanna Briggs Institute critical appraisal tools will be used to evaluate the overall quality of evidence collected. RESULTS This review was initiated in May 2023 and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in June 2023, prior to title and abstract screening. Full-text screening of articles was completed in July 2023 and data extraction began August 2023. Final searches were conducted in April 2024 prior to finalizing the review and the manuscript was submitted for peer review in July 2024. CONCLUSIONS This review will synthesize diverse observations pertaining to conversational agent-enabled intervention design features and their impacts on engagement among people with CMDs. These observations can be used to guide the development of more engaging conversational agent-enabled interventions, thereby increasing the likelihood of regular intervention use and improved CMD health outcomes. Additionally, this review will identify gaps in the literature in terms of how engagement is reported, thereby highlighting areas for future exploration and supporting researchers in advancing the understanding of conversational agent-enabled interventions. TRIAL REGISTRATION PROSPERO CRD42023431579; https://tinyurl.com/55cxkm26. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52973.
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Affiliation(s)
- Nick Kashyap
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
| | - Ann Tresa Sebastian
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Melbourne, Australia
| | - Chris Lynch
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia
| | - Paul Jansons
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Ralph Maddison
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Melbourne, Australia
| | - Tilman Dingler
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Delft University of Technology, Delft, Netherlands
| | - Brian Oldenburg
- Baker Department of Cardiovascular Research, Translation and Implementation, La Trobe University, Melbourne, Australia
- Centre for Research Excellence in Digital Technology to Transform Chronic Disease Outcomes, National Health and Medical Research Council, Melbourne, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology & Public Health, La Trobe University, Melbourne, Australia
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Evans E, Zengul A, Knight A, Willig A, Cherrington A, Mehta T, Thirumalai M. Stakeholders' Perspectives, Needs, and Barriers to Self-Management for People With Physical Disabilities Experiencing Chronic Conditions: Focus Group Study. JMIR Rehabil Assist Technol 2023; 10:e43309. [PMID: 38109170 PMCID: PMC10758937 DOI: 10.2196/43309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND While self-management programs have had significant improvements for individuals with chronic conditions, less is known about the impact of self-management programs for individuals with physical disabilities who experience chronic conditions, as no holistic self-management programs exist for this population. Similarly, there is limited knowledge of how other stakeholders, such as caregivers, health experts, and researchers, view self-management programs in the context of disability, chronic health conditions, and assistive technologies. OBJECTIVE This study aimed to obtain insight into how stakeholders perceive self-management relating to physical disability, chronic conditions, and assistive technologies. METHODS Nine focus groups were conducted by 2 trained facilitators using semistructured interview guides. Each guide contained questions relating to stakeholders' experiences, challenges with self-management programs, and perceptions of assistive technologies. Focus groups were audio recorded and transcribed. Thematic analysis was conducted on the focus group data. RESULTS A total of 47 individuals participated in the focus groups. By using a constructivist grounded approach and inductive data collection, three main themes emerged from the focus groups: (1) perspectives, (2) needs, and (3) barriers of stakeholders. Stakeholders emphasized the importance of physical activity, mental health, symptom management, medication management, participant centeredness, and chronic disease and disability education. Participants viewed technology as a beneficial aide to their daily self-management and expressed their desire to have peer-to-peer support in web-based self-management programs. Additional views of technology included the ability to access individualized, educational content and connect with other individuals who experience similar health conditions or struggle with caregiving duties. CONCLUSIONS The findings suggest that the development of any web-based self-management program should include mental health education and resources in addition to physical activity content and symptom management and be cost-effective. Beyond the inclusion of educational resources, stakeholders desired customization or patient centeredness in the program to meet the overall needs of individuals with physical disabilities and caregivers. The development of web-based self-management programs should be holistic in meeting the needs of all stakeholders. TRIAL REGISTRATION ClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/study/NCT05481593.
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Affiliation(s)
- Eric Evans
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Ayse Zengul
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amy Knight
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Amanda Willig
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andrea Cherrington
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tapan Mehta
- Department of Family and Community Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mohanraj Thirumalai
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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Vickery KD, Ford BR, Gelberg L, Bonilla Z, Strother E, Gust S, Adair E, Montori VM, Linzer M, Evans MD, Connett J, Heisler M, O'Connor PJ, Busch AM. The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness. Front Psychol 2023; 14:1225777. [PMID: 37794913 PMCID: PMC10546874 DOI: 10.3389/fpsyg.2023.1225777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Compared to stably housed peers, people experiencing homelessness (PEH) have lower rates of ideal glycemic control, and experience premature morbidity and mortality. High rates of behavioral health comorbidities and trauma add to access barriers driving poor outcomes. Limited evidence guides behavioral approaches to support the needs of PEH with diabetes. Lay coaching models can improve care for low-resource populations with diabetes, yet we found no evidence of programs specifically tailored to the needs of PEH. Methods We used a multistep, iterative process following the ORBIT model to develop the Diabetes Homeless Medication Support (D-HOMES) program, a new lifestyle intervention for PEH with type 2 diabetes. We built a community-engaged research team who participated in all of the following steps of treatment development: (1) initial treatment conceptualization drawing from evidence-based programs, (2) qualitative interviews with affected people and multi-disciplinary housing and healthcare providers, and (3) an open trial of D-HOMES to evaluate acceptability (Client Satisfaction Questionnaire, exit interview) and treatment engagement (completion rate of up to 10 offered coaching sessions). Results In step (1), the D-HOMES treatment manual drew from existing behavioral activation and lay health coach programs for diabetes as well as clinical resources from Health Care for the Homeless. Step (2) qualitative interviews (n = 26 patients, n = 21 providers) shaped counseling approaches, language and choices regarding interventionists, tools, and resources. PTSD symptoms were reported in 69% of patients. Step (3) trial participants (N = 10) overall found the program acceptable, however, we saw better program satisfaction and treatment engagement among more stably housed people. We developed adapted treatment materials for the target population and refined recruitment/retention strategies and trial procedures sensitive to prevalent discrimination and racism to better retain people of color and those with less stable housing. Discussion The research team has used these findings to inform an NIH-funded randomized control pilot trial. We found synergy between community-engaged research and the ORBIT model of behavioral treatment development to develop a new intervention designed for PEH with type 2 diabetes and address health equity gaps in people who have experienced trauma. We conclude that more work and different approaches are needed to address the needs of participants with the least stable housing.
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Affiliation(s)
- Katherine Diaz Vickery
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Becky R. Ford
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Zobeida Bonilla
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Ella Strother
- The Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Susan Gust
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Edward Adair
- The Quorum for Community Engaged Wellness Research, Minneapolis, MN, United States
| | - Victor M. Montori
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, United States
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Michael D. Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Michele Heisler
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Patrick J. O'Connor
- Center for Chronic Care Innovation, HealthPartners Institute, Bloomington, MN, United States
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- The Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
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Evans M, Liu Y, Wu X, Cai C, Tang PY, Maggy Coufal M, Qian Y, Fisher EB, Jia W. Community organization guides standardization, adaptability, and innovation: lessons from peer support in the Shanghai Integration Model. Transl Behav Med 2023; 13:519-532. [PMID: 37406180 PMCID: PMC10848216 DOI: 10.1093/tbm/ibac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Although there is broad evidence for the value of peer support (PS) in preventing and managing diabetes and other chronic diseases, identifying approaches to stage, scale, and adapt PS interventions is a challenge. Community organization may provide a process for such adaptation of standardized PS and diabetes management to individual communities. This community organization approach was used to develop PS in 12 communities in Shanghai, China. Through a convergent mixed methods design, project records, semi-structured interviews, and an implementation assessment characterized processes of adaptation of standardized materials, examined the extent to which the program was implemented, and identified key success factors and challenges. Findings from both interviews and the implementation assessment indicated that communities adapted standardized intervention components to meet the needs of their communities and assumed responsibility for implementation of different components of the program based on their community's available capacity. Additionally, community innovations occurring as part of the project were reported and standardized for dissemination in future iterations of the program. Key success factors identified included cooperation and collaboration among varied partners within and across communities. Two challenges illustrate the resilience of the community organization model in response to COVID-19 and the need for further adaptation in rural communities. Community organization provided a useful approach to standardization, adaptation, innovation, and reporting of PS interventions for diabetes management.
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Affiliation(s)
- Megan Evans
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
| | - Yuexing Liu
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, 200233 Shanghai, China
| | - Xiaoyu Wu
- Department of Health Promotion, Shanghai Municipal Health Commission, Shanghai, China
| | - Chun Cai
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, 200233 Shanghai, China
| | - Patrick Y Tang
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
| | - Muchieh Maggy Coufal
- Asian Center for Health Education, 3916 Gettysburg Circle, Plano, TX, 75023, USA
| | - Yiqing Qian
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
| | - Edwin B Fisher
- Peers for Progress, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Campus Box 7440, Chapel Hill, NC, 27599-7440, USA
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, 200233 Shanghai, China
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Ahmad F, Joshi SH. Self-Care Practices and Their Role in the Control of Diabetes: A Narrative Review. Cureus 2023; 15:e41409. [PMID: 37546053 PMCID: PMC10402910 DOI: 10.7759/cureus.41409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Diabetes mellitus (DM) is a long-standing, continuously growing metabolic ailment in which levels of glucose in the blood increase due to a total (DM of type 1) or incomplete (DM of type 2) decrease in the level of the hormone insulin. Diabetes mellitus affects a large number of individuals worldwide, and as more people develop the disease, the burden will double from what it is now. The requirements of people suffering from diabetes are not only confined to the control of blood glucose; there is also a need to prevent disabilities, side effects, and difficulties in rehabilitation. Studies suggest that seven self-care practices for individuals suffering from this disease have shown good outcomes. Those practices include assessment of sugar levels in the blood, consuming healthy foods, remaining physically active, taking medications regularly and on time, maintaining healthy behavior, and decreasing risk factors. All of these practices collectively have shown good results in maintaining blood glucose levels, decreasing side effects, and increasing life expectancy in people with diabetes mellitus. Those who have DM and practice self-care have shown positive results by reducing the complications of DM, decreasing its progression, and leading to a huge reduction in the burden due to DM. Despite these positive changes, people sticking to these self-care practices are very few, specifically when we see broad and chronic changes. There are many positive contributing factors, such as social factors, demographic factors, and various socio-economic factors, but the role of physicians in increasing the practices associated with personal care for people with this disease is crucial and most important for the desired outcome. Keeping in mind the burden and multidimensional nature of the disorder, proper systematic and combined efforts are needed to increase these self-care practices in patients with diabetes to reduce any chronic side effects and complications.
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Affiliation(s)
- Farhan Ahmad
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shiv H Joshi
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhang F, Fu L, Wang L, Xing L, Liu K, Jiang X. The effectiveness of self-management programme based on multilevel social resources utilization in diabetes mellitus patients: A randomized controlled study. Int J Nurs Pract 2023:e13138. [PMID: 36754582 DOI: 10.1111/ijn.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/10/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
AIMS This study aimed to test the effects of a novel diabetes self-management education (DSME) programme focused on multilevel social resources utilization on improving self-management behaviour, social resources utilization and haemoglobin Alc (HbA1c ) in patients with type 2 diabetes mellitus (T2DM). METHODS A randomized controlled design was used. A total of 118 participants with T2DM from two communities were recruited through randomized sampling, and randomly assigned to the novel DSME group or the traditional DSME group. DSME focusing on multilevel social resources utilization was implemented in the novel DSME group. Data were collected at baseline (T0 ), at the end of the intervention (T1 ) and 3 months after the end of intervention (T2 ) from 3 March to 16 November 2014. RESULTS Comparing these two groups, the participants in the novel DSME group reported significantly better improvement in self-management behaviour and social resources utilization at T1 and T2 (all p < 0.01). A significant difference was found in the mean improvement of HbA1c level between the two groups at T2 (p < 0.05). CONCLUSIONS The novel DSME programme focused on multilevel social resources utilization can effectively enhance T2DM patients' self-management behaviour and social resource utilization and lower HbA1c levels. More importantly, the effects could last longer.
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Affiliation(s)
- Feifei Zhang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Liyan Fu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Lei Wang
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Xing
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Liu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolian Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Strong S, Letts L, Gillespie A, Martin ML, McNeely HE. Preparing an integrated self-management support intervention for people living with schizophrenia: Creating collaborative spaces. J Eval Clin Pract 2023; 29:22-31. [PMID: 35749613 DOI: 10.1111/jep.13728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This article describes the planning and development of a novel self-management support protocol, self-management engaging together (SET) for Health, purposefully designed and embedded within traditional case management services to be accessible to people living with schizophrenia and comorbidities. Drawing on established self-management principles, SET for Health was codesigned by researchers, healthcare providers and clients, to create a practical and meaningful intervention to support the target group to manage their own health and wellness. Decision making is described behind tailoring the self-management innovation to meet the needs of an at risk, disadvantaged group served by tertiary, public health care in Canada. METHOD This integrated knowledge translation (IKT) study used a descriptive approach to document the process of planning and operationalizing the SET for Health intervention as a part of routine care in two community-based teams providing predominantly schizophrenia services. Diffusion of innovations literature informed planning. The setting was strategically prepared for organizational change. A situational assessment and theoretical frameworks identified contextual elements to be addressed. Existing established self-management approaches for mental illness were appraised. RESULTS When a review of established approaches revealed incongruence with the aims and context of service delivery, common essential elements were distilled. To facilitate collaborative client-provider self-management conversations and self-management learning opportunities, core components were operationalized by the use of tailored interactive tools. The materials coproduced by clients and providers offered joint reference tools, foundational for capacity-building and recognition of progress. CONCLUSION Planning and developing a model of self-management support for integration into traditional schizophrenia case management services required attention to the complex social ecological nature of the treatment approach and the workplace context. Demonstration of proof of concept is described in a separate paper.
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Affiliation(s)
- Susan Strong
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lori Letts
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alycia Gillespie
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mary-Lou Martin
- Forensic Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather E McNeely
- Schizophrenia and Community Integration Service, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Glenn LE, Thurlow CB, Enriquez M. The "Ups and Downs" of Living With Type 2 Diabetes Among Working Adults in the Rural South. J Prim Care Community Health 2022; 13:21501319221143715. [PMID: 36564892 PMCID: PMC9793025 DOI: 10.1177/21501319221143715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the "ups and downs" of living with diabetes. Four major themes emerged from the data: "the struggle," "doing things together," "diabetes is not the priority," and "we're lucky to have what we have." Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.
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Affiliation(s)
- Lynn E. Glenn
- Augusta University, Augusta, GA,
USA,Lynn E. Glenn, College of Nursing, Augusta
University, 1120 15th Street EC 4338, Augusta, GA 30912, USA.
| | | | - Maithe Enriquez
- Research College of Nursing, Kansas
City, MO, USA,University of Missouri, Columbia, MO,
USA
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Montt-Blanchard D, Dubois-Camacho K, Costa-Cordella S, Sánchez R. Domesticating the condition: Design lessons gained from a marathon on how to cope with barriers imposed by type 1 diabetes. Front Psychol 2022; 13:1013877. [PMID: 36420398 PMCID: PMC9677098 DOI: 10.3389/fpsyg.2022.1013877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2023] Open
Abstract
Through analytical autoethnographic analysis of marathon preparation, this study examines challenges faced by people with Type 1 Diabetes (T1D) who engage in high-performance sports. Autoethnographer and second-person perspectives (T1D runners, family members, and health providers) were collected through introspective activities (autoethnographic diary and in-depth interviews) to understand the T1D runner's coping experience. Six insights involved in T1D self-management were identified and analyzed with reference to related design tools (prototyping, archetyping and journey mapping). Finally, we conclude with a discussion of how endurance physical activity (PA) such as running helps to "domesticate" T1D, a term coined to reflect the difficulties that T1D presents for PA accomplishment and how T1D runners' experiences give them an opportunity to overcome PA barriers promoting physical culture and enriching further health psychology studies.
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Affiliation(s)
| | - Karen Dubois-Camacho
- Faculty of Medicine, Institute of Biomedical Sciences, Universidad de Chile, Santiago, Chile
| | - Stefanella Costa-Cordella
- Faculty of Psychology, Universidad Diego Portales, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Raimundo Sánchez
- Faculty of Engineering and Sciences, Universidad Adolfo Ibañez, Santiago, Chile
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11
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Vasconcelos Silva C, Bird D, Clemensen J, Janda M, de Camargo Catapan S, Fatehi F, Gray L, Menon A, Russell A. A qualitative analysis of the needs and wishes of people with type 2 diabetes and healthcare professionals for optimal diabetes care. Diabet Med 2022; 39:e14886. [PMID: 35593646 PMCID: PMC9544593 DOI: 10.1111/dme.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022]
Abstract
AIM Globally, type 2 diabetes care is often fragmented and still organised in a provider-centred way, resulting in suboptimal care for many individuals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia. METHODS Our project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019-January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model. RESULTS People with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways. CONCLUSIONS We conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system.
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Affiliation(s)
| | - Dominique Bird
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Jane Clemensen
- H.C. Andersen Children Hospital and Centre for Innovative Medical TechnologyOdense University HospitalOdenseDenmark
- University of Southern DenmarkOdenseDenmark
| | - Monika Janda
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Soraia de Camargo Catapan
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- Public Health DepartmentFederal University of Santa CatarinaFlorianopolisBrazil
| | - Farhad Fatehi
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- School of Psychological SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Len Gray
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
| | - Anish Menon
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Diabetes and EndocrinologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Anthony Russell
- Centre for Health Services ResearchThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Diabetes and EndocrinologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Department of Diabetes and Endocrinology, The AlfredMelbourneVictoriaAustralia
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12
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Broekhuis M, van Velsen L, De Franco D, Pease A, Hermens H. Contextual Health Information Behavior in the Daily Lives of People with Type 2 Diabetes: A Diary Study in Scotland. HEALTH COMMUNICATION 2022; 37:272-284. [PMID: 33135473 DOI: 10.1080/10410236.2020.1837426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Changes in lifestyle can have positive effects on treating type 2 diabetes (T2D), like sporting or healthy eating. Therefore, a person diagnosed with T2D is often advised to make healthy choices throughout the day, in addition to other interventions such as medication. To do this, he or she needs health information to support decision-making. Literature describes ample categorizations of types of (health) information behavior and theoretical models that explain the factors that drive people to search for, encounter or avoid information. However, there are few longitudinal studies about triggers and factors in daily life that affect health information behavior (HIB). This study was set up to identify triggers, actions and outcomes for active, passive and avoidant HIB situations in daily life among Scots with Type 2 diabetes (T2D) to identify points of attention for communication strategies. Twelve participants took part in a four-week diary study. Every day, participants received an online diary form to describe active, passive or avoidant HIB situations. Data collection resulted in 53 active, 120 passive and 25 avoidant diary entries. Seven active HIB contexts (e.g., experiencing symptoms, cooking dinner, sports training) and five passive HIB contexts (e.g., home, work, medical facility) were identified. Four motivations for avoidance were found (e.g., time constraints, no health trigger). These results can be used to supplement the theoretical models of health information behavior. Furthermore, health professionals can use these results to support their clients with T2D in the self-management of their health, by guiding them to trustworthy sources of health information and lowering barriers for searching health information.
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Affiliation(s)
- Marijke Broekhuis
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
| | - Lex van Velsen
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
| | - Dominic De Franco
- Centre for Argumentation Technology, School of Science and Engineering, University of Dundee
| | - Alison Pease
- Centre for Argumentation Technology, School of Science and Engineering, University of Dundee
| | - Hermie Hermens
- Roessingh Research and Development, eHealth Group
- Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS), University of Twente
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13
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Renneberg B, Schulze J, Böhme S, West SG, Schüz B. Effectiveness and equity evaluation of an insurance-wide telephone-counseling program for self-management of chronic diseases: The Health Coach Study. Appl Psychol Health Well Being 2021; 14:606-625. [PMID: 34796658 DOI: 10.1111/aphw.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
Trajectories of chronic illnesses depend on patient socioeconomic status (SES). This study examines main and equity effects (age, gender, education, region of residence) of a brief telephone self-management intervention on self-rated health and depressive symptoms of health insurance clients with chronic illnesses. Randomized invitation design (n = 2628) with predominantly male (82%) older individuals (modal age = 65-74) with one or more chronic illnesses. Primary outcomes: Self-rated health and depressive symptoms. Intervention: Brief CBT-based telephone counseling. Propensity score matching was used to equate intervention and control groups (n = 1314 pairs). Change score models were used to analyze changes in health-related outcome measures. The intervention resulted in improvements in self-rated health (d = .37) and fewer depressive symptoms (d = .17) over 4 and 6 months. There were comparable effects across education and regions, but younger and female participants profited more from the intervention compared with older and male participants. A brief telephone-based intervention led to improved self-rated health and well-being in a large sample of participants with chronic health conditions. This effect was observed over and above regular medical care. The intervention was equitable with respect to education and region, but not age and gender.
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Affiliation(s)
- Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Julian Schulze
- Division of Psychological Assessment, Differential and Personality Psychology, Freie Universität Berlin, Berlin, Germany
| | - Sylvia Böhme
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Stephen G West
- Psychology Department, Arizona State University, Tempe, Arizona, USA
| | - Benjamin Schüz
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
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14
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Applications of a Chronic Care Model for Self-Management of Type 2 Diabetes: A Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010840. [PMID: 34682611 PMCID: PMC8549014 DOI: 10.3390/ijerph182010840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 01/07/2023]
Abstract
The main aim of this study was to explore the suitability, practicality, and acceptability of the self-management support and delivery system design components of the Chronic Care Model (CCM) in type 2 diabetes self-management in primary care settings in rural Pakistan. Thirty patients living with type 2 diabetes and 20 healthcare professionals (10 general practitioners and 10 nurses) were recruited from Al-Rehman Hospital at Abbottabad, Pakistan. The study data were collected using semi-structured interviews and analyzed using thematic analysis. The self-management element of the CCM played an important role in managing type 2 diabetes, and self-efficacy in relation to diet and diabetes management were the most effective strategies. Surprisingly, considering the local culture around diabetes, patient care reflecting their cultural background was identified as an important factor by patients not healthcare professionals. The delivery system design element of the CCM promoted multidisciplinary teamwork. Our findings suggest that the self-management support and delivery system design components of the CCM provided an effective framework for supporting diabetes self-management education and support in rural areas.
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15
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Takasaki H. Content validity and reliability of the modified Japanese version of the Healthcare Providers Patient-Activation Scale: self-reported adherence to patient-centered physical therapy scale. Physiother Theory Pract 2021; 38:3082-3089. [PMID: 34633908 DOI: 10.1080/09593985.2021.1987602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Modifications to the Healthcare Providers Patient-Activation Scale (HP-PAS), which evaluates attitudes toward the importance of using a patient-centered approach (PCA), are required. PURPOSE Content validity and reliabilities of a scale developed from the HP-PAS to evaluate self-reported adherence to patient-centered physical therapy were preliminarily investigated. METHODS A total of 86 Japanese physical therapists completed the validity assessments in an anonymous survey. Among them, 53 completed the reliability assessments in a named survey. The HP-PAS was modified to mark the most suitable frequency for each item, creating an 11-point scale. For the validity assessments, the participants assigned each item to a therapist-centered approach or PCA using a 5-point scale. Content validity was considered when the proportion of scores 4 and 5 ("possibly" or "definitely" a PCA) with respect to the total number of scores was > 50%. Ceiling and flooring effects were considered when the response proportions of scores of 10 and 0, respectively, on an 11-point scale were > 20%. Items with an intraclass correlation coefficient (ICC) < 0.4 in the test-retest reliability from the item list were excluded. RESULTS Of the 20 items, 6 were excluded, developing a 14-item self-reported adherence to a patient-centered physical therapy scale (SAPCPTS), which exhibited good internal consistency (Cronbach's α = 0.95, 95% confident intervals [CIs] = 0.93-0.96) and test-retest reliability (ICC = 0.84, 95% CIs = 0.75-0.91). CONCLUSION This study identified that the 14-item SAPCPTS demonstrated preliminary evidence of content validity and reliability.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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16
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Takasaki H. Rasch Analysis of Self-Reported Adherence to Patient-Centered Physical Therapy Scale among Japanese Physical Therapists: Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10282. [PMID: 34639583 PMCID: PMC8508273 DOI: 10.3390/ijerph181910282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
This study primarily aimed to develop a shorter version of the self-reported adherence to patient-centered physical therapy (s-SAPCPTS) by using Rasch analysis and secondarily aimed to preliminarily investigate the relationship between the s-SAPCPTS scores and demographics (i.e., age, sex, final academic degree (non-postgraduate degrees or postgraduate degrees), and practice environment). In an online anonymous survey, 110 Japanese physical therapists completed the self-reported adherence to patient-centered physical therapy and provided data on their demographics. Through the Rasch analysis, items were excluded in a stepwise manner, until certain pre-established criteria of the unidimensionality were satisfied. Subsequently, a conversion table for the Rasch score was developed. Furthermore, multiple regression analysis was conducted by using the independent variables age, sex, and final academic degree. Using the Kruskal-Wallis test, we compared the Rasch s-SAPCPTS scores among four practice environments. Consequently, the seven-item s-SAPCPTS was developed by excluding seven items through the Rasch analysis. Postgraduate degree was a statistically significant contributing factor for Rasch s-SAPCPTS scores (p = 0.038, β = 0.20). The Kruskal-Wallis test demonstrated statistically significant differences in the Rasch s-SAPCPTS scores among the four practice environments (p = 0.006). In conclusion, the seven-item s-SAPCPTS was developed with the preliminary evidence of construct validity. It was also found that the final academic degree and practice environment could be the contributing factors of s-SAPCPTS scores.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya 343-8540, Japan
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17
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Ansari RM, Harris M, Hosseinzadeh H, Zwar N. Healthcare Professionals' Perspectives of Patients' Experiences of the Self-Management of Type 2 Diabetes in the Rural Areas of Pakistan: A Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189869. [PMID: 34574792 PMCID: PMC8465148 DOI: 10.3390/ijerph18189869] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/21/2022]
Abstract
The main objective of this research work was to explore the healthcare professionals’ perspectives of type 2 diabetes patients’ experiences of self-management of diabetes in the rural area of Pakistan. In this study, we have carried out a methodological approach to use a self-management framework to direct the interview guide for healthcare professionals to examine their perceptions and expectations of their diabetes patients’ adherence to the medications prescribed. Twenty healthcare professionals were recruited in this study consisting of ten general practitioners and ten nurses from various clinics (medical centres) of Al-Rehman Hospital at Abbottabad, Pakistan. This qualitative study explored the feelings and opinions of general practitioners on patients’ compliance and adherence by using the semi-structured interview guide using a methodological framework. All interviews of participants were audiotaped and transcribed for content analysis. Six major themes were identified: patient–doctor relationship; patient’s non-adherence to diet and exercise; conflicts with the patients; low self-efficacy and feeling of “resignation with poor care”; the influence of culture on patients’ self-management activities and lack of support for patients by health care providers, patients, and their families. We have derived relevant solutions from qualitative studies and considered that communication, tailored, and shared care is the best approach for patient adherence to treatment. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase adherence. The results of this qualitative health research highlighted the challenges healthcare professionals are facing in rural Pakistan in managing patients with type 2 diabetes and supporting their management activities. Healthcare professionals and patients may benefit by adopting a methodological framework approach to ensure meaningful participation and adjusting the patient–doctor relationship, and setting up achievable management and self-management goals.
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18
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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19
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Evans M, Tang PY, Bhushan N, Fisher EB, Dreyer Valovcin D, Castellano C. Standardization and adaptability for dissemination of telephone peer support for high-risk groups: general evaluation and lessons learned. Transl Behav Med 2021; 10:506-515. [PMID: 32542342 DOI: 10.1093/tbm/ibaa047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Beyond demonstrated effectiveness, research needs to identify how peer support can be implemented in real-world settings. Telephone peer support offers one approach to this. The purpose of this study is to evaluate telephone peer support provided by trained peer staff for high-risk groups, implemented according to key tasks or functions of the Reciprocal Peer Support model (RPS) providing both standardization and adaptability. The methods used in the study include the review of contact data for years 2015-2016 from telephone peer support services of Rutgers Health University Behavioral Health Care, serving veterans, police, mothers of children with special needs, and child protection workers; structured interviews with peer supporters and clients; and audit of case notes. Across 2015-2016, peer supporters made 64,786 contacts with a total of 5,616 callers. Adaptability was apparent in 22% of callers' relationships lasting ≤1 month and 43% ≥1 year, voicemails valued as communicating presence, 92% of callers receiving support with psychosocial issues, 65% with concrete problems, such as medical or other services, 88% receiving social support, and 88% either resolving an issue (e.g., finding employment) or making documented progress (e.g., getting professional treatment, insurance, or children's services). With the balance of standardization and adaptability provided by the RPS, telephone peer support can address diverse needs and provide diverse contact patterns, assistance, support, and benefits.
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Affiliation(s)
- Megan Evans
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Y Tang
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Nivedita Bhushan
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Edwin B Fisher
- Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Dawn Dreyer Valovcin
- Rutgers University Behavioral Health Care National Call Center for Peer Support, Rutgers University, Piscataway, NJ, USA
| | - Cherie Castellano
- Rutgers University Behavioral Health Care National Call Center for Peer Support, Rutgers University, Piscataway, NJ, USA
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Alexandre K, Campbell J, Bugnon M, Henry C, Schaub C, Serex M, Elmers J, Desrichard O, Peytremann-Bridevaux I. Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews. JBI Evid Synth 2021; 19:1003-1118. [PMID: 33741836 DOI: 10.11124/jbies-20-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this review was to identify and describe the factors influencing diabetes self-management in adults by summarizing the available evidence concerning their types, categories, and relative importance. INTRODUCTION A wide range of factors, acting simultaneously, influence diabetes self-management and interfere with its actual application by patients. There is a variety of systematic reviews of these factors; however, a more thorough examination of their influences was lacking. INCLUSION CRITERIA Systematic reviews of qualitative or quantitative literature focusing on factors influencing adult diabetes self-management in general or on individual behaviors (ie, management of oral antidiabetic medication and insulin injections, self-monitoring of blood glucose, foot care, healthy eating, regular exercise, and smoking cessation) will be included. METHODS We performed an extensive search of 11 bibliographic databases, including gray literature, up to June 2019. Quantitative and qualitative findings were summarized separately and labeled according to their types (eg, facilitator/barrier, strength and direction of association), categories (eg, demographic, social), and frequency of occurrence. RESULTS We identified 51 types of factors within 114 systematic reviews, which mostly addressed medication-taking behavior. Thirty-two (62.7%) factors were reported in both qualitative and quantitative literature. The predominant influences were psychological factors and behavioral attributes/skills factors. The most frequently reported facilitators of diabetes self-management were motivation to diabetes self-management, a favorable attitude to diabetes self-management, knowledge about the disease, medication and behaviors associated with diabetes self-management, skills, and self-efficacy/perceived behavioral control. The predominant barriers were the presence of depression, and polypharmacy or drug regimen complexity. The demographic factor of female sex was frequently reported for its negative influence on diabetes self-management, whereas older age was a positive factor. The social/cultural and physical environment were the least-studied categories. Other factors such as social support from family, friends, or networks; interventions led by health professionals; and a strong community environment with good social services favoring diabetes self-management were reported as major facilitators of diabetes self-management. CONCLUSIONS Essential components of interventions to promote effective diabetes self-management should aim to help adults manage the effects of specific factors related to their psychological and practical self-management experience. Screening for depression, in particular, should become an integral part of the support for adult diabetes self-management, as depression is a particular obstacle to the effectiveness of diabetes self-management. Future studies should more deeply examine the influence of factors identified in the sociocultural and physical environment categories. Research should properly consider and invest efforts in strengthening social support and innovative community care approaches, including pharmacist- and nurse-led care models for encouraging and improving adult diabetes self-management. Finally, researchers should examine non-modifiable factors - age, sex, or socioeconomic status - in the light of factors from other categories in order to deepen understanding of their real-world patterns of action on adult diabetes self-management. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018084665.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Joan Campbell
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Marie Bugnon
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
| | - Cristina Henry
- Association Vaudoise d'Aide et de Soins À Domicile (AVASAD), Lausanne, Switzerland
| | - Corinne Schaub
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Magali Serex
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTique exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Jolanda Elmers
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland
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21
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Chima CC, Swanson B, Anikpezie N, Salemi JL. Alleviating diabetes distress and improving diabetes self-management through health coaching in a primary care setting. BMJ Case Rep 2021; 14:14/4/e241759. [PMID: 33879465 PMCID: PMC8061809 DOI: 10.1136/bcr-2021-241759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Considering the rising global burden of diabetes and its complications, effective interventions for addressing barriers to diabetes self-management are needed. Diabetes distress, a psychological barrier to diabetes self-management, has become increasingly recognised in the literature, but effective and feasible ways of addressing it in routine primary care settings are not known. We present the case of a middle-aged non-Hispanic white American woman with poorly controlled diabetes (haemoglobin A1c (HbA1c): 13.9%) and elevated diabetes distress (baseline Diabetes Distress Scale Score: 2.53) who participated in a health coaching intervention. After the 5-month programme, which included eight 45 minute long sessions with a trained health coach, the patient achieved and sustained a 0.8-point reduction in diabetes distress, an improvement in insulin adherence and a 3.6-point reduction in HbA1c. This case demonstrates a novel approach to managing diabetes distress that entails providing patients a safe, nonjudgemental space to express their feelings and explore challenges with diabetes self-management.
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Affiliation(s)
- Charles C Chima
- Department of Population Health Science, The University of Mississippi Medical Center, Jackson, Mississippi, USA .,Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Brenna Swanson
- Department of Nutrition and Dietetics, University of North Dakota, Grand Forks, North Dakota, USA
| | - Nnabuchi Anikpezie
- Department of Population Health Science, The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jason L Salemi
- Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA.,College of Public Health, University of South Florida, Tampa, Florida, USA
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Oh H, Um MY, Garbe R. Social Networks and Chronic Illness Management among Low-Income Tenants in Publicly Subsidized Housing: Findings from a Pilot Study. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:405-418. [PMID: 33771075 DOI: 10.1080/19371918.2021.1900012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Low-income tenants in publicly subsidized housing (PSH) have higher rates of chronic illnesses than non-PSH-based residents, making the implementation of chronic illness management (CIM) essential. Based on the person-in-environment framework used in social work practice, which emphasizes the importance of interactions between clients and their social environment, this pilot study used personal network analysis (PNA), a variant of social network analysis, to explore what attributes of social networks are relevant to CIM among 26 low-income tenants independently living in a PSH in the Southwest United States. Tenants with a smaller network size and effective size presented better self-efficacy to manage chronic disease (SEMCD) and lower levels of depressive symptoms. Being connected to a higher proportion of alters (i.e., network members) with whom they discussed health matters was also associated with high SEMCD. As for CIM implementation, being connected to a doctor and a lower proportion of alters who have chronic illnesses were associated with doing aerobic exercise. Tenants with a larger proportion of alters serving multiple functions reported more frequent vegetable and fruit consumption, while those with a higher share of kin alters and lower share of alters living in the same PSH reported less frequent high-fat food consumption. Our findings help social workers discover relevant social networks and dynamics that low-income tenants at PSH capitalize to locate resources for CIM. Further studies are recommended to adopt PNA to expand practice-related knowledge that social workers can use for health promotion among low-income tenants with chronic illness.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University, USA
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23
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Chen WC, Kuo CC, Lin CC, Wu CC. A preliminary study on the effects of the Peer-Led Self-Management (PLSM) program on self-efficacy, self-management, and physiological measures in older adults with diabetes: A block randomized controlled trial. Geriatr Nurs 2021; 42:386-396. [DOI: 10.1016/j.gerinurse.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 02/08/2023]
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Kolb L. An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™. Sci Diabetes Self Manag Care 2021; 47:30-53. [PMID: 34078208 DOI: 10.1177/0145721720978154] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The ADCES7 Self-Care Behaviors™ (ADCES7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the Association of Diabetes Care and Education Specialists (ADCES) that at the cornerstone of diabetes self-management education and support, the ADCES7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The ADCES7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management as well as diabetes self-management education and support, ADCES has evaluated the ADCES7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and ADCES's vision and expansion beyond diabetes to refresh the ADCES7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- From the Association of Diabetes Care and Education Specialists, Chicago, Illinois
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25
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Alexandre K, Vallet F, Peytremann-Bridevaux I, Desrichard O. Identification of diabetes self-management profiles in adults: A cluster analysis using selected self-reported outcomes. PLoS One 2021; 16:e0245721. [PMID: 33481883 PMCID: PMC7822269 DOI: 10.1371/journal.pone.0245721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
The present study describes adult diabetes self-management (DSM) profiles using self-reported outcomes associated with the engagement in diabetes care activities and psychological adjustment to the disease. We used self-reported data from a community-based cohort of adults with diabetes (N = 316) and conducted a cluster analysis of selected self-reported DSM outcomes (i.e., DSM behaviors, self-efficacy and perceived empowerment, diabetes distress and quality of life). We tested whether clusters differed according to sociodemographic, clinical, and care delivery processes variables. Cluster analysis revealed four distinct DSM profiles that combined high/low levels of engagement in diabetes care activities and good/poor psychological adjustment to the disease. The profiles were differently associated with the variables of perceived financial insecurity, taking insulin treatment, having depression, and the congruence of the care received with the Chronic Care Model. The results could help health professionals gain a better understanding of the different realities facing people living with diabetes, identify patients at risk of poor outcomes related to their DSM, and lead to the development of profile-specific DSM interventions.
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Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fanny Vallet
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
| | | | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
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26
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Cadel L, Cimino SR, Rolf von den Baumen T, James KA, McCarthy L, Guilcher SJT. Medication Management Frameworks in the Context of Self-Management: A Scoping Review. Patient Prefer Adherence 2021; 15:1311-1329. [PMID: 34163148 PMCID: PMC8216068 DOI: 10.2147/ppa.s308223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Many individuals take multiple prescribed and unprescribed medications, also known as polypharmacy, which can be problematic. Improving medication self-management is important; however, most medication management frameworks focus on adherence and limit the integration of the core components of self-management. Therefore, the objective of this scoping review was to identify what is reported in the literature on medication management frameworks or models within the context of self-management. METHODS Electronic databases (Medline, Embase, CINAHL and Cochrane Library) and grey literature (healthcare and government organization websites) were searched for articles that described a framework or model developed or adapted for medication management, included components of self-management and was published from January 2000 to January 2020. During the screening of titles and abstracts, 5668 articles were reviewed, 5242 were excluded and 426 were then assessed at the full-text level. Thirty-nine articles met the eligibility criteria and were included in the review. RESULTS About half of the frameworks were newly developed (n=20), while the other half were adapted from, or applied, a previous model or framework (n=19). The majority of frameworks focused on medication adherence and most of the self-management domains were categorized as medical management, followed by emotional and role management. CONCLUSION Medication self-management is a complex process and often impacts multiple areas of an individual's life. It is important for future frameworks to incorporate a comprehensive, holistic conceptualization of self-management that is inclusive of the three self-management domains - medical, emotional and role management.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab, Sunnybrook Health Sciences Centre, North York, Ontario, Canada
| | | | - Kadesha A James
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Correspondence: Sara JT Guilcher Leslie Dan Faculty of Pharmacy, 144 College Street, Room 604, Toronto, ON, M5S 3M2, CanadaTel + 1-416-946-7020 Email
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Davari M, Moghaddam HR, Soola AH. Identifying the Predictors of Self-Management Behaviors in Patients with Diabetes Based on Ecological Approach: A Systematic Review. Curr Diabetes Rev 2021; 17:e102620187197. [PMID: 33106146 DOI: 10.2174/1573399816666201026161009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recognizing and promoting the factors that affect the self-management behaviors of diabetes lead to a reduction in the number of patients and an improvement in the quality of care. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments. OBJECTIVE The purpose of this study was to identify the predictors of self-management behaviors with a comprehensive approach in these patients. METHODS The keywords were investigated in the relevant national and international databases, including PubMed, Google Scholar, Science Direct, Scopus, and Scientific Information Database, Magiran, and Iran Medex, to obtain the articles published from 2009 to 2019. The search and article selection strategy was developed based on the Prisma checklist and was carried out in three steps. RESULTS Most studies have shown that personal factors had the highest prediction power for the self-management of diabetes. The interpersonal factors, society and policy-making factors, and group and organization factors were then the most frequently reported predictors of self-management behaviors in diabetic patients. CONCLUSION Self-management of diabetes is necessary for controlling it because 95% of care is done by the patient. When designing self-management interventions, factors are based on the individual level that is to increase self-management behaviors.
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Affiliation(s)
- Mahnaz Davari
- Department of Emergency Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Aghil Habibi Soola
- Department of Medical- Surgical Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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28
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Miyamoto S, Takasaki H. Cross-cultural adaptation of the Healthcare Provider-Patient Activation Scale to Japanese. J Phys Ther Sci 2020; 32:810-815. [PMID: 33362351 PMCID: PMC7758605 DOI: 10.1589/jpts.32.810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/09/2020] [Indexed: 12/03/2022] Open
Abstract
[Purpose] This study aimed to investigate a cross-cultural adaptation of the 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). [Participants and Methods] We followed a guideline for cross-cultural adaptation that recommended using two forward and backward translations. In pilot testing, participants were Japanese physical therapists who provided comments about expression readability. Two authors independently categorized each comment as either "unable to understand" or "suggestion to enhance clarity", after which Cohen κ and % agreement were used to assess agreement. We then assessed the flooring and ceiling effects, internal consistency, and Spearman ρ between the factor scores of the patient-activation-approach and non-patient-activation-approach. [Results] A total of 58 Japanese physical therapists participated in the pilot test. The agreement on comments was κ=0.44 and 86.5%. We identified the flooring and ceiling effects for most items. In addition, the internal consistency was acceptable for each factor; however, the Spearman ρ between the patient-activation-approach and non-patient-activation-approach factor scores was positive when it should have been negative. [Conclusion] We developed a Japanese version of the HP-PAS which will serve as a foundation for future studies to establish a measurement method for the magnitude of patient activation in the physical therapist population.
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Affiliation(s)
- Shiori Miyamoto
- Department of Physical Therapy, Saitama Prefectural
University: 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
| | - Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural
University: 820 Sannomiya, Koshigaya, Saitama 343-8540, Japan
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29
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Cassimatis M, Kavanagh DJ, Smith AC. Perceived Needs for Supported Self‐management of Type 2 Diabetes: A Qualitative Investigation of the Potential for a Web‐based Intervention. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mandy Cassimatis
- Institute of Health and Biomedical Innovation, Queensland University of Technology,
| | - David J Kavanagh
- School of Psychology and Counselling, Queensland University of Technology,
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland,
- Queensland Children's Medical Research Institute, The University of Queensland,
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30
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Mphwanthe G, Carolan M, Earnesty D, Weatherspoon L. Perceived barriers and facilitators to diet and physical activity among adults diagnosed with type 2 diabetes in Malawi. Glob Public Health 2020; 16:469-484. [PMID: 32780630 DOI: 10.1080/17441692.2020.1805784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Diet and physical activity are crucial to Type 2 diabetes mellitus (T2DM) self-management. However, socio-environmental, and cultural factors can impede lifestyle behaviours, and hence T2DM management. This study aimed to identify barriers, facilitators and support for diet and physical activity among adults with T2DM in Malawi selected from a larger clinical assessment study, conducted in urban and semi-urban public hospitals. Four focus group discussions were conducted, and audio-recorded, transcribed verbatim, coded, then organised and analysed using thematic analysis. Emergent themes included: family, friends, and health worker ties that facilitated both diet and physical activity as socio-support systems. Diabetes peer groups occurred more often in urban than semi-urban areas. Dietary barriers to self-management of T2DM included: cost and access to food; lack of knowledge on what and how much to eat; challenges of separate preparation and purchase of food; dilemmas of what to eat during functions and travel; and conflicting dietary information from different sources. Comorbidities and fear of public ridicule were key perceived barriers to participants being physically active. Therefore, socio-environmental factors should be considered by nutritionists, dietitians, and health workers when developing and providing nutrition and physical activity education to adults with T2DM in Malawi.
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Affiliation(s)
- Getrude Mphwanthe
- Department of Food Science, and Human Nutrition, Michigan State University, East Lansing, MI, USA.,Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Marsha Carolan
- Department of Human Development, and Family Studies, Michigan State University, East Lansing, MI, USA
| | - Dawn Earnesty
- Michigan State University Extension, East Lansing, MI, USA
| | - Lorraine Weatherspoon
- Department of Food Science, and Human Nutrition, Michigan State University, East Lansing, MI, USA
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31
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Eassey D, Reddel HK, Ryan K, Smith L. 'It is like learning how to live all over again' A systematic review of people's experiences of living with a chronic illness from a self-determination theory perspective. Health Psychol Behav Med 2020; 8:270-291. [PMID: 34040872 PMCID: PMC8143269 DOI: 10.1080/21642850.2020.1794879] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 07/03/2020] [Indexed: 10/28/2022] Open
Abstract
Objective: To conduct a systematic review and synthesis of qualitative evidence exploring the views and experiences of people living with a chronic illness that utilised self-determination theory. Methods: We searched MEDLINE via OvidSP, PsycINFO via OvidSP, PubMed, CINAHL, EMBASE, Google Scholar, the journals Qualitative Health Research and Qualitative Research. Studies were included if they used qualitative methods, explored the subjective experiences of people living with a chronic illness and underpinned the analysis with self-determination theory. Results: From 4605 articles, six met the inclusion criteria. The synthesis culminated in a line of argument that patients endeavoured to be 'free from disease'. People's desire to live a life free from disease required nurturing their: (1) need to feel empowered (autonomy), (2) perceived ability to self-care (competence) and, (3) their need to feel a sense of belonging (relatedness). Conclusion: This review has highlighted that the majority of studies included in this review focused on the clinical aspects of managing a chronic condition and changing patient health behaviours. This suggests that there is a need for deep reflection on the current practice of caring for patients with a chronic illness. Exploring the lived experience has the potential to unravel the psychological and emotional needs of those living with a chronic illness.
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Affiliation(s)
- Daniela Eassey
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Helen K. Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Kath Ryan
- School of Pharmacy, University of Reading, Reading, UK
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors ®. DIABETES EDUCATOR 2020; 46:139-160. [PMID: 31928334 DOI: 10.1177/0145721719894903] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The AADE7 Self-Care Behaviors® (AADE7) is a robust framework for self-management of diabetes and other related conditions, such as prediabetes and cardiometabolic diseases. It is the position of the American Association of Diabetes Educators (AADE) that, at the cornerstone of diabetes self-management education and support, the AADE7 is the framework for achieving behavior change that leads to effective self-management through improved behavior and clinical outcome measures. The AADE7 model guides the health care team in effective person-centered collaboration and goal setting to achieve health-related outcomes and improved quality of life. Continued research and evidence are critical to expand this model and broaden its application to other chronic conditions. Given the advances in the science of diabetes management, as well as in diabetes self-management education and support, AADE has evaluated the AADE7 within the framework of these advances, including the digital and dynamic health care landscape. CONCLUSION This revised position statement blends the updates in research and AADE's vision and expansion beyond diabetes to refresh the AADE7 framework. This revision reflects the perspectives of all members of the health care team as they problem solve with individuals who are at risk for or who have diabetes and related conditions to achieve healthier outcomes.
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Affiliation(s)
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- American Association of Diabetes Educators, Chicago, Illinois
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33
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Health Risk Assessment Indicators for the Left-Behind Elderly in Rural China: A Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010340. [PMID: 31947818 PMCID: PMC6981890 DOI: 10.3390/ijerph17010340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/25/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Abstract
In China, many young and middle-aged rural residents move to urban areas each year. The rural elderly are left behind. The number of the rural left-behind elderly is increasing with urbanization, but it is unclear which indicators can be used to assess their health condition. The health risk assessment index system was developed to improve the health level of the rural left-behind elderly. A two-round web-based Delphi process was used to organize the recommendations from fifteen Chinese experts in geriatrics, health management, social psychology who participated in this study. Meaningfulness, importance, modifiability, and comprehensive value of the health risk assessment indicators in the index system were evaluated. The effective recovery rates of the two-round Delphi were 86.67% and 92.31%, respectively. The judgement coefficient and the authority coefficient were 0.87 and 0.82, respectively. The expert familiarity was 0.76. Ultimately, the health risk assessment index system for the rural left-behind elderly consisted of five first-level indicators, thirteen second-level indicators, and sixty-six third-level indicators. The final indicators can be used to evaluate the health of the rural left-behind elderly and provide the basis for additional health risk interventions.
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34
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Shand L, Higgins R, Murphy B, Jackson A. Development and validation of the healthcare providers patient-activation scale. PATIENT EDUCATION AND COUNSELING 2019; 102:1550-1557. [PMID: 30885404 DOI: 10.1016/j.pec.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/20/2019] [Accepted: 03/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE It has become increasingly important to assess healthcare providers' role in chronic disease self-management (CDSM) and patient activation (PA). The present study extends previous work relating to patients' behaviours by assessing healthcare providers' own behaviours in supporting PA. METHOD 50 items were generated: half assessed a PA approach; half reflected a non-patient-activation approach. 105 healthcare providers working in cardiac rehabilitation who were participants in a CDSM online training program completed the items pre- and post-training. Factor analysis determined the presence of higher order factors. Item responses pre- and post-training were compared to assess sensitivity to change. RESULTS Results indicated the presence of two factors: 'patient-activation approach' and 'non-patient-activation approach'. While both demonstrated good internal consistency, the' non-PA approach' had superior discriminatory validity and sensitivity to change. CONCLUSION Healthcare providers' beliefs about the importance of patient-activation behaviours can be measured by 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). The scale could be easily converted to measure healthcare providers' actual PA behaviours. PRACTICE IMPLICATIONS The HP-PAS could be used to assess the effectiveness of clinician training for healthcare providers working in cardiac rehabilitation and other areas of CDSM. Further reliability and validity testing within other healthcare provider samples is warranted.
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Affiliation(s)
- Lyndel Shand
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rosemary Higgins
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Department of Physiotherapy, University of Melbourne, Victoria, Australia
| | - Barbara Murphy
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Department of Psychology, University of Melbourne, Victoria, Australia.
| | - Alun Jackson
- Australian Centre for Heart Health, Melbourne, Victoria, Australia; Faculty of Health, Deakin University, Burwood, Victoria, Australia; Centre on Behavioural Health, Hong Kong University, Hong Kong
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Ansari RM, Hosseinzadeh H, Harris M, Zwar N. Self-management experiences among middle-aged population of rural area of Pakistan with type 2 diabetes: A qualitative analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ould Brahim L. Reconsidering the 'self' in self-management of chronic illness: Lessons from relational autonomy. Nurs Inq 2019; 26:e12292. [PMID: 31020781 DOI: 10.1111/nin.12292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 01/12/2023]
Abstract
Self-management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self-management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self-interested, and self-governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of self-management and the traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self-management will be valuable in guiding its progression and elaborate ways in which self-management research and practice could benefit from incorporating a relational approach to autonomy.
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Affiliation(s)
- Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
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37
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Caperon L, Arjyal A, K. C. P, Kuikel J, Newell J, Peters R, Prestwich A, King R. Developing a socio-ecological model of dietary behaviour for people living with diabetes or high blood glucose levels in urban Nepal: A qualitative investigation. PLoS One 2019; 14:e0214142. [PMID: 30908526 PMCID: PMC6433239 DOI: 10.1371/journal.pone.0214142] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Abstract
Instances of non-communicable diseases such as diabetes are on the rise globally leading to greater morbidity and mortality, with the greatest burden in low and middle income countries [LMIC]. A major contributing factor to diabetes is unhealthy dietary behaviour. We conducted 38 semi structured interviews with patients, health professionals, policy-makers and researchers in Kathmandu, Nepal, to better understand the determinants of dietary behaviour amongst patients with diabetes and high blood glucose levels. We created a social ecological model which is specific to socio-cultural context with our findings with the aim of informing culturally appropriate dietary behaviour interventions for improving dietary behaviour. Our findings show that the most influential determinants of dietary behaviour include cultural practices (gender roles relating to cooking), social support (from family and friends), the political and physical environment (political will, healthy food availability) and individuals' motivations and capabilities. Using these most influential determinants, we suggest potentially effective dietary interventions that could be implemented by policy makers. Our findings emphasise the importance of considering socio-cultural context in developing interventions and challenges one-size-fits-all approaches which are often encouraged by global guidelines. We demonstrate how multifaceted and multi layered models of behavioural influence can be used to develop policy and practice with the aim of reducing mortality and morbidity from diabetes.
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Affiliation(s)
- Lizzie Caperon
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Abriti Arjyal
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - Puja K. C.
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - Jyoti Kuikel
- HERD International, Prasuti Griha Marg, Kathmandu, Nepal
| | - James Newell
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Remco Peters
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Andrew Prestwich
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
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Novak JR, Gast J, Peak T, Johnson R, Morrey R, Smith M, Souders M. A Case Study of Health-Related Support Processes in 2 Happy, Gay Couples. Am J Lifestyle Med 2019; 12:462-471. [PMID: 30783399 DOI: 10.1177/1559827618788854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/31/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022] Open
Abstract
The purpose of this case study was to explore 2, early-relationship, same-sex couples on the strategies used to support their partner's engagement in health promoting behaviors. A semistructured interview protocol was used to conduct 120-minute interviews with each couple and analyzed using grounded theory methods. Five organizing categories emerged during the analysis, resulting in a conceptual process model of health-related support in same-sex relationships. These categories, provided a snapshot of how processes interact with each other; they were context, relationship dynamics, health support processes, couple adaptation, and balancing physical/relational health. Couples described the balancing of relational and physical health as an ongoing, important theme in the success of health support. Implications for both health prevention and intervention are discussed.
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Affiliation(s)
- Josh R Novak
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Julie Gast
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Terry Peak
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Rhees Johnson
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Rachel Morrey
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Madeline Smith
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
| | - Marissa Souders
- Department of Human Development and Family Studies (JRN, RJ), Utah State University, Logan, Utah.,Department of Kinesiology and Health Sciences (JG, RM, M Smith, M Souders), Utah State University, Logan, Utah.,Sociology, Social Work, and Anthropology Department (TP), Utah State University, Logan, Utah
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Kowitt SD, Donahue KE, Fisher EB, Mitchell M, Young LA. How is neighborhood social disorganization associated with diabetes outcomes? A multilevel investigation of glycemic control and self-reported use of acute or emergency health care services. Clin Diabetes Endocrinol 2018; 4:19. [PMID: 30377539 PMCID: PMC6194713 DOI: 10.1186/s40842-018-0069-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023] Open
Abstract
Background Diabetes management is influenced by a number of factors beyond the individual-level. This study examined how neighborhood social disorganization (i.e., neighborhoods characterized by high economic disadvantage, residential instability, and ethnic heterogeneity), is associated with diabetes-related outcomes. Methods We used a multilevel modeling approach to investigate the associations between census-tract neighborhood social disorganization, A1c, and self-reported use of acute or emergency health care services for a sample of 424 adults with type 2 diabetes. Results Individuals living in neighborhoods with high social disorganization had higher A1c values than individuals living in neighborhoods with medium social disorganization (B = 0.39, p = 0.01). Individuals living in neighborhoods with high economic disadvantage had higher self-reported use of acute or emergency health care services than individuals living in neighborhoods with medium economic disadvantage (B = 0.60, p = 0.02). Conclusions High neighborhood social disorganization was associated with higher A1c values and high neighborhood economic disadvantage was associated with greater self-reported use of acute or emergency health care services. Controlling for individual level variables diminished this effect for A1c, but not acute or emergency health care use. Comprehensive approaches to diabetes management should include attention to neighborhood context. Failure to do so may help explain the continuing disproportionate diabetes burden in many neighborhoods despite decades of attention to individual-level clinical care and education. Trial registration For this study, we used baseline data from a larger study investigating the impacts on patient-centered outcomes of three different approaches to self-monitoring of blood glucose among 450 adults with non-insulin dependent type 2 diabetes living in North Carolina. This study was registered as a clinical trial on 1/7/2014 (https://clinicaltrials.gov/ct2/show/NCT02033499).
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Affiliation(s)
- Sarah D Kowitt
- 1Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 USA.,2Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Katrina E Donahue
- 2Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA.,3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Edwin B Fisher
- 1Peers for Progress and Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440 USA
| | - Madeline Mitchell
- 3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Laura A Young
- 4Division of Endocrinology & Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Alexandre K, Desrichard O, Burnand B, Peytremann-Bridevaux I. Factors influencing self-management in adults with diabetes: an umbrella review protocol. ACTA ACUST UNITED AC 2018; 15:2630-2637. [PMID: 29135745 DOI: 10.11124/jbisrir-2016-003318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
REVIEW OBJECTIVES The aim of this umbrella review is to identify and describe factors influencing diabetes self-management (DSM) in adults with diabetes. More specifically, we will address DSM-related factors and their relationships, considering both qualitative and quantitative components of available literature.The review question for the qualitative component of the umbrella review is:The review questions for the quantitative component of the umbrella review are:An additional question will be applied to both the qualitative and quantitative components of the overview.
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Affiliation(s)
- Ketia Alexandre
- 1School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland 2Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence, Lausanne, Switzerland 3Faculté de Psychologie et des Sciences de l'Education, University of Geneva, Geneva, Switzerland 4Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
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Mills SL, Brady TJ, Jayanthan J, Ziabakhsh S, Sargious PM. Toward consensus on self-management support: the international chronic condition self-management support framework. Health Promot Int 2018; 32:942-952. [PMID: 27242377 DOI: 10.1093/heapro/daw030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Self-management support (SMS) initiatives have been hampered by insufficient attention to underserved and disadvantaged populations, a lack of integration between health, personal and social domains, over emphasis on individual responsibility and insufficient attention to ethical issues. This paper describes a SMS framework that provides guidance in developing comprehensive and coordinated approaches to SMS that may address these gaps and provides direction for decision makers in developing and implementing SMS initiatives in key areas at local levels. The framework was developed by researchers, policy-makers, practitioners and consumers from 5 English-speaking countries and reviewed by 203 individuals in 16 countries using an e-survey process. While developments in SMS will inevitably reflect local and regional contexts and needs, the strategic framework provides an emerging consensus on how we need to move SMS conceptualization, planning and development forward. The framework provides definitions of self-management (SM) and SMS, a collective vision, eight guiding principles and seven strategic directions. The framework combines important and relevant SM issues into a strategic document that provides potential value to the SMS field by helping decision-makers plan SMS initiatives that reflect local and regional needs and by catalyzing and expanding our thinking about the SMS field in relation to system thinking; shared responsibility; health equity and ethical issues. The framework was developed with the understanding that our knowledge and experience of SMS is continually evolving and that it should be modified and adapted as more evidence is available, and approaches in SMS advance.
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Affiliation(s)
- Susan L Mills
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, BC, CanadaV6T 1Z3
| | - Teresa J Brady
- U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Oh H, Ell K. Associations Between Changes in Depressive Symptoms and Social Support and Diabetes Management Among Low-Income, Predominantly Hispanic Patients in Patient-Centered Care. Diabetes Care 2018; 41:1149-1156. [PMID: 29588293 DOI: 10.2337/dc17-2000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/04/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. RESEARCH DESIGN AND METHODS Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a self-management intervention assisted by a promotora (Hispanic community health worker). Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. RESULTS Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. CONCLUSIONS Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University, Phoenix, AZ
| | - Kathleen Ell
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
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Abstract
The People's Republic of China (herein referred to as China) has witnessed one of the most dramatic rises in diabetes prevalence anywhere in the world. The latest epidemiological study suggests that approximately 11% of the population has diabetes, with a significant proportion remaining undiagnosed. Risk factors for diabetes in the Chinese population are similar to those in other populations, though gestational diabetes and young-onset diabetes is becoming increasingly common. Data on the prevalence of diabetic complications remain limited, though cardio-renal complications account for significant morbidity and mortality. Other diabetes-related comorbidities are becoming increasingly common, with cancer emerging as a major cause of mortality among individuals with diabetes. There are many challenges and obstacles that impede effective diabetes prevention and the delivery of care, though much progress has occurred over recent years. Lessons learnt from how China has responded to the challenges posed by the diabetes epidemic will be invaluable for other countries facing the many threats of diabetes and its complications.
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Affiliation(s)
- Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- Chinese University of Hong Kong and Shanghai Jiao Tong University (CUHK-SJTU) Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Wang JW, Zhang CG, Deng QL, Chen WL, Wang X, Yu JM. The associations of comorbidities and consumption of fruit and vegetable with quality of life among stomach cancer survivors. Health Qual Life Outcomes 2018; 16:62. [PMID: 29650050 PMCID: PMC5898008 DOI: 10.1186/s12955-018-0886-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/27/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Stomach cancer survivors (SCS) often carry the dual burden of the cancer itself and other comorbidities; meanwhile, they are highly motivated to seek health advice about lifestyles to improve their health and quality of life (QOL). The associations of the comorbidity and the consumption of vegetable and fruit with QOL remain even less clear among the SCS. This study aimed to investigate the associations of comorbidities and consumption of fruit and vegetable with QOL among SCS. METHODS A cross-sectional study was conducted among 969 SCS between April and July 2015 in Shanghai, People's Republic of China. Data were collected using a self-reported questionnaire, which included questions on sociodemographic characteristics, comorbidities and fruit and vegetable consumption, and a simplified Chinese version of the European Organization for Research and Treatment quality of life version 3 (EORTC QLQ-C30) questionnaire. In order to mitigate the bias caused by confounding factors, multiple linear regression models were employed to calculate the adjusted means of QOL scores. RESULTS The proportion of participants without any comorbidity was only 23.3%, and the most common comorbidity among SCS was digestive diseases (49.8%). Participants with comorbidity generally reported lower scores for global health and functioning subscales and higher scores for symptom in EORTC QLQ-C30 compared to participants without comorbidity, indicating poorer QOL. Higher scores in most functioning subscales and lower scores in some symptoms subscales were found in participants (38.7%) who ate more than 250 g vegetables every day, compared to participants with less vegetable consumption, and in participants (58.1%) who ate fruit every day, compared to participants who didn't eat fruit every day indicating better QOL. CONCLUSIONS The comorbidities are common health problems among SCS and have significantly negative influence on QOL, and participants with comorbidities generally reported lower QOL scores. The enough vegetables and fruit consumption are positively associated with QOL of SCS. These findings suggested that a multidisciplinary team approach and a variety of delivery systems are needed to address the medical, psychosocial, and lifestyle components for enriching patient-centered care among SCS.
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Affiliation(s)
- Ji-Wei Wang
- Key Lab of Health Technology Assessment of National Health Commission and Key Lab of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Cheng-Gang Zhang
- Shanghai Xuhui Center for Disease Control and Prevention, 50 Young-Chuan Road, Shanghai, 200237 China
| | - Qing-Long Deng
- Key Lab of Health Technology Assessment of National Health Commission and Key Lab of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Wan-Li Chen
- Key Lab of Health Technology Assessment of National Health Commission and Key Lab of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
| | - Xian Wang
- Shanghai Xuhui Center for Disease Control and Prevention, 50 Young-Chuan Road, Shanghai, 200237 China
| | - Jin-Ming Yu
- Key Lab of Health Technology Assessment of National Health Commission and Key Lab of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, 130 Dong-An Road, Shanghai, 200032 China
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Chen YC, Chang LC, Liu CY, Ho YF, Weng SC, Tsai TI. The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease. J Nurs Scholarsh 2018; 50:265-275. [DOI: 10.1111/jnu.12377] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Yu-Chi Chen
- Lambda Beta-at-Large , Associate Professor, Institute of Clinical Nursing, School of Nursing; National Yang-Ming University; Taipei Taiwan ROC
| | - Li-Chun Chang
- Lambda Beta-at-Large , Associate Professor, School of Nursing; Chang Gung University of Science and Technology; Tao-Yuan Taiwan ROC
| | - Chieh-Yu Liu
- Associate Professor, Department of Midwifery and Women Health Care; National Taipei University of Nursing and Health Sciences; Taipei City Taiwan ROC
| | - Ya-Fang Ho
- Lambda Beta-at-Large , PhD Candidate, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
| | - Shuo-Chun Weng
- PhD Candidate, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, and Attending Physician, Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine; Taichung Veterans General Hospital; Taichung Taiwan ROC
| | - Tzu-I Tsai
- Professor, Department of Nursing, School of Nursing; National Yang-Ming University; Taiwan ROC
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Lozano P, Houtrow A. Supporting Self-Management in Children and Adolescents With Complex Chronic Conditions. Pediatrics 2018; 141:S233-S241. [PMID: 29496974 DOI: 10.1542/peds.2017-1284h] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/24/2022] Open
Abstract
Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers. Evidence has guided the development of self-management support approaches and tools for adults and has led to an increased adoption of best practices in adult chronic illness care. However, adult models fail to account for some key differences between children and adults, namely, the integral role of parents and/or caregivers and youth development over time. There is a need for self-management support models that take into account the developmental trajectory across the pediatric age range. Effective approaches must also recognize that in pediatrics, self-management is really shared management between the youth and the parent(s) and/or caregiver(s). Health systems should design care to address self-management for pediatric patients. Although clinicians recognize the importance of self-management in youth with complex chronic conditions, they need standardized approaches and tools to do the following: assess the self-management skills of youth and families, assess modifiable environmental influences on chronic conditions, collaboratively set self-management goals, promote competence and eventual autonomy in youth, share the responsibility for self-management support among nonphysician members of the health care team, and leverage community resources for self-management support.
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Affiliation(s)
- Paula Lozano
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; and
| | - Amy Houtrow
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bee P, Pedley R, Rithalia A, Richardson G, Pryjmachuk S, Kirk S, Bower P. Self-care support for children and adolescents with long-term conditions: the REfOCUS evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BackgroundSelf-care support (e.g. education, training, peer/professional support) is intended to enhance the self-care capacities of children and young people, while simultaneously reducing the financial burden facing health-care systems.ObjectivesTo determine which models of self-care support for long-term conditions (LTCs) are associated with significant reductions in health utilisation and costs without compromising outcomes for children and young people.DesignSystematic review with meta-analysis.PopulationChildren and young people aged 0–18 years with a long-term physical or mental health condition (e.g. asthma, depression).InterventionSelf-care support in health, social care, educational or community settings.ComparatorUsual care.OutcomesGeneric/health-related quality of life (QoL)/subjective health symptoms and health service utilisation/costs.DesignRandomised/non-randomised trials, controlled before-and-after studies, and interrupted time series designs.Data sourcesMEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Science, NHS Economic Evaluation Database, The Cochrane Library, Health Technology Assessment database, Paediatric Economic Database Evaluation, IDEAS, reference scanning, targeted author searches and forward citation searching. All databases were searched from inception to March 2015.MethodsWe conducted meta-analyses, simultaneously plotting QoL and health utilisation effects. We conducted subgroup analyses for evidence quality, age, LTC and intervention (setting, target, delivery format, intensity).ResultsNinety-seven studies reporting 114 interventions were included. Thirty-seven studies reported adequate allocation concealment. Fourteen were UK studies. The vast majority of included studies recruited children and young people with asthma (n = 66, 68%). Four per cent of studies evaluated ‘pure’ self-care support (delivered through health technology without additional contact), 23% evaluated facilitated self-care support (≤ 2 hours’/four sessions’ contact), 65% were intensively facilitated (≥ 2 hours’/four sessions’ contact) and 8% were case management (≥ 2 hours’ support with multidisciplinary input). Self-care support was associated with statistically significant, minimal benefits for QoL [effect size (ES) –0.17, 95% confidence interval (CI) –0.23 to –0.11], but lacked clear benefit for hospital admissions (ES –0.05, 95% CI –0.12 to 0.03). This finding endured across intervention intensities and LTCs. Statistically significant, minimal reductions in emergency use were observed (ES –0.11, 95% CI –0.17 to –0.04). The total cost analysis was limited by the small number of data. Subgroup analyses revealed statistically significant, minimal reductions in emergency use for children aged ≤ 13 years (ES –0.10, 95% CI –0.17 to –0.04), children and young people with asthma (ES –0.12, 95% CI –0.18 to –0.06) and children and young people receiving ≥ 2 hours per four sessions of support (ES –0.10, 95% CI –0.17 to –0.03). Preliminary evidence suggested that interventions that include the child or young person, and deliver some content individually, may optimise QoL effects. Face-to-face delivery may help to maximise emergency department effects. Caution is required in interpreting these findings.LimitationsIdentification of optimal models of self-care support is challenged by the size and nature of evidence available. The emphasis on meta-analysis meant that a minority of studies with incomplete but potentially relevant data were excluded.ConclusionsSelf-care support is associated with positive but minimal effects on children and young people’s QoL, and minimal, but potentially important, reductions in emergency use. On current evidence, we cannot reliably conclude that self-care support significantly reduces health-care costs.Future workResearch is needed to explore the short- and longer-term effects of self-care support across a wider range of LTCs.Study registrationThis study is registered as PROSPERO CRD42014015452.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Penny Bee
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amber Rithalia
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Steven Pryjmachuk
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Susan Kirk
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Vanstone M, Rewegan A, Brundisini F, Giacomini M, Kandasamy S, DeJean D. Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis. Chronic Illn 2017; 13:217-235. [PMID: 27884930 DOI: 10.1177/1742395316675024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.
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Affiliation(s)
- Meredith Vanstone
- 1 Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Alex Rewegan
- 3 MA Program in Social Anthropology, York University, Hamilton, ON, Canada
| | - Francesca Brundisini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,4 Health Policy PhD Program, McMaster University, Hamilton, ON, Canada
| | - Mita Giacomini
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Sujane Kandasamy
- 5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Deirdre DeJean
- 2 Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.,5 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
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Papoutsi C, Hargreaves D, Colligan G, Hagell A, Patel A, Campbell-Richards D, Viner RM, Vijayaraghavan S, Marshall M, Greenhalgh T, Finer S. Group clinics for young adults with diabetes in an ethnically diverse, socioeconomically deprived setting (TOGETHER study): protocol for a realist review, co-design and mixed methods, participatory evaluation of a new care model. BMJ Open 2017; 7:e017363. [PMID: 28637744 PMCID: PMC5726054 DOI: 10.1136/bmjopen-2017-017363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Young adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional one-to-one consultations, by engaging young people through life stage-, context- and culturally-sensitive approaches. In this study, we will co-design and evaluate a group-based care model for young adults with diabetes and complex health and social needs in socioeconomically deprived areas. METHODS AND ANALYSIS This participatory study will include three phases. In phase 1, we will carry out a realist review to synthesise the literature on group-based care for young adults with diabetes. This theory-driven understanding will provide the basis for phase 2, where we will draw on experience-based co-design methodologies to develop a new, group-based care model for young adults (aged <25 years, under the care of adult diabetes services). In phase 3, we will use a researcher-in-residence approach to implement and evaluate the co-designed group clinic model and compare with traditional care. We will employ qualitative (observations in clinics, patient and staff interviews and document analysis) and quantitative methods (eg, biological markers, patient enablement instrument and diabetes distress scale), including a cost analysis. ETHICS AND DISSEMINATION National Health Service ethics approval has been granted (reference 17/NI/0019). The project will directly inform service redesign to better meet the needs of young adults with diabetes in socioeconomically deprived areas and may guide a possible cluster-randomised trial, powered to clinical and cost-effectiveness outcomes. Findings from this study may be transferable to other long-term conditions and/or age groups. Project outputs will include briefing statements, summaries and academic papers, tailored for different audiences, including people living with diabetes, clinicians, policy makers and strategic decision makers. REGISTRATION DETAILS PROSPERO (CRD42017058726).
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dougal Hargreaves
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | - Grainne Colligan
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ann Hagell
- Association for Young People’s Health, London, UK
| | - Anita Patel
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Russell M Viner
- UCL Great Ormond St. Institute of Child Health, University College London, London, UK
| | | | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Finer
- Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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