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Wang Z, Zhou Z, Liu G, Lu J, Zhai X, Fan X, Lai S, Wang Y. Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China. Front Public Health 2024; 12:1398271. [PMID: 39045166 PMCID: PMC11263186 DOI: 10.3389/fpubh.2024.1398271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/25/2024] [Indexed: 07/25/2024] Open
Abstract
Background The reallocation of health resources, epidemic prevention and control measures during the COVID-19 pandemic triggered widespread restricted health service utilization, some residents and patients tried positive self-care behavior to maintain their health, yet the efficacy of this intervention remains unclear. Object Based on the reasoned action approach (RAA) theory, this study aimed to investigate the correlation between self-care behavior and restricted health service utilization among adults in China, trying to discover the vulnerable groups and external and intrinsic factors that affect self-care behavior among Chinese adults. Methods Data on demographics, socioeconomic, health status, and self-care behavior were collected in "The Early China COVID-19 Survey," a cross-sectional anonymous online survey of the general population in China. Self-care behavior was measured by four indicators: weight control (WC), physical activity (PA), prevention behavior (PB), and online medical consultation (OMC). The multiple linear models and binary logistic regression were used to examine whether restricted health service utilization (RHSU) is associated with self-care behaviors; also, adjusted multivariate logistic regression was used to analyze subgroup heterogeneity. Results In total, 8,428 adult participants completed the survey, the mean OMC score was 1.51 (SD 1.34), the mean PB score was 18.17 (SD 3.44), and the proportion of participants who engaged in WC and PA was 42.30 and 62.57%, respectively. According to the multiple regression model, the RHSU was significantly positively correlated with all four indicators of self-care (WC: OR = 1.34, p < 0.001, PA: OR = 1.34, p < 0.05, MC: OR = 1.30, p < 0.001, PB: coef = 0.16, p < 0.05). We also observed some significant differences in the intensity of this relationship by subgroup analysis, precisely, OMC (high vs. moderate vs. low infection-risk level: OR = 1.48; 1.41; 1.19, p < 0.1), PA (male vs. female: OR = 1.27;1.06; p < 0.05, high vs. Moderate and low infection-risk level: OR = 1.51; 1.17; 1.02, p < 0.05), PB (Chronic disease groups vs. no: coef = 0.46; 0.1, p < 0.05). Conclusion Restricted health service utilization predicts more positive self-care behavior, and the intensity of partial correlation was significantly different in the subgroups of sex, actual infection risk level of the living area, and chronic diseases. These findings highlight the urgent demand for self-care behavior among Chinese adults during the pandemic and provide new insights for developing self-care and reducing the burden on the healthcare system in the long term.
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Affiliation(s)
- Zhichao Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jiao Lu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Sha Lai
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Youfa Wang
- School of Public Health, Global Health Institute, Xi’an Jiaotong University Health Science Center, Xi’an, China
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García-Ovejero E, Pisano-González M, Salcedo-Diego I, Serrano-Gallardo P. Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain. Healthcare (Basel) 2024; 12:811. [PMID: 38667573 PMCID: PMC11049834 DOI: 10.3390/healthcare12080811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.
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Affiliation(s)
- Ester García-Ovejero
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- National Centre for Epidemiology, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marta Pisano-González
- General Directorate of Social and Health Care and Coordination, Ministry of Health of the Principality of Asturias, 33005 Asturias, Spain
- Research Group “Person-Centered Care” of the Research Institute of Asturias (ISPA), 33005 Asturias, Spain
| | - Isabel Salcedo-Diego
- Puerta de Hierro Majadahonda University Hospital, 28222 Majadahonda, Spain
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
| | - Pilar Serrano-Gallardo
- Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain;
- Puerta de Hierro-Segovia de Arana Health Research Institute (IDIPHISA), 28222 Majadahonda, Spain
- Interuniversity Institute “Advanced Research on Evaluation of Science and the University” (INAECU), 28029 Madrid, Spain
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Knudsen LR, Lomborg K, Hauge EM, Zangi HA, de Thurah A. The WebRA study: Opportunities and challenges in digital patient education from the perspective of patients with rheumatoid arthritis: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 116:107969. [PMID: 37672918 DOI: 10.1016/j.pec.2023.107969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE To explore patients' perceptions of digital patient education (PE), and how this contributes to self-management of rheumatoid arthritis (RA). METHODS Individual interviews based on 'interpretive description' methodology. The patients were purposively selected from a randomized controlled trial that investigated the effects of digital PE. The analysis included a descriptive section, followed by the interpretation and extraction of the main messages. RESULTS Overall, participants had positive perceptions of the e-learning program. Advantages were flexibility, the possibility for repetition, entertainment, availability, and learning in familiar surroundings. Disadvantages were unmet relational support needs due to missing dialogue with health care providers (HCPs). For the majority, a need for insight into the condition led to an active approach to using e-learning. The e-learning program facilitated knowledge acquisition about RA, but relational support from HCPs and a positive attitude toward living with RA were also important for achieving self-management. CONCLUSION Digital PE is useful for self-management support in RA, however different forms and combinations of PE must be offered in the future to accommodate various needs throughout the disease course. PRACTICE IMPLICATIONS These results may inform future development and implementation of digital PE that adequately takes individual preferences for self-management support into account.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
| | - Kirsten Lomborg
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Heidi A Zangi
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Health, VID Specialized University, Oslo, Norway
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Holman EA, Cramer SC. Lifetime and Acute Stress Predict Functional Outcomes Following Stroke: Findings From the Longitudinal STRONG Study. Stroke 2023; 54:2794-2803. [PMID: 37767737 PMCID: PMC10615770 DOI: 10.1161/strokeaha.123.043356] [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] [Received: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as predictors of 3- and 12-month functional status. We also compare acute stress and baseline National Institutes of Health Stroke Scale as predictors of poststroke functional status. METHODS Between 2016 and 2020 the STRONG Study (Stroke, Stress, Rehabilitation, and Genetics) enrolled adults with new radiologically confirmed stroke 2 to 10 days poststroke onset at 28 acute care US hospitals. Participants were interviewed 3 times: acute admission (acute stress; Acute Stress Disorder Interview), 3 months (Fugl-Meyer Upper Extremity motor impairment [Fugl-Meyer Upper Arm Assessment; N=431], modified Rankin Scale [3 months; N=542], Stroke Impact Scale-Activities of Daily Living [3 months; N=511], Lifetime Stress Exposure Inventory), and 12 months (modified Rankin Scale, N=533; Stroke Impact Scale 3.0 Activities of Daily Living; N=485; Telephone Montreal Cognitive Assessment; N=484) poststroke. Structural equation models examined whether acute stress predicted 3- and 12-month functional outcomes, and mediated an association between lifetime stress and outcomes controlling for demographics and initial National Institutes of Health Stroke Scale. Standardized betas are reported. RESULTS Sample (N=763) was 19 to 95 years old (mean=63; SD=14.9); 448 (58.7%) were male. Acute stress scores ranged from 0 to 14 (mean, 3.52 [95% CI, 3.31-3.73]). Controlling for age, gender, baseline National Institutes of Health Stroke Scale, and race and ethnicity, higher lifetime stress predicted higher acute stress (β=0.18, P<0.001), which predicted lower 3-month Fugl-Meyer Upper Arm Assessment scores (β=-0.19, P<0.001), lower Stroke Impact Scale 3.0 Activities of Daily Living scores at 3 months (β=-0.21, P<0.001) and 12 months (β=-0.21, P<0.001), higher modified Rankin Scale scores at 3 months (β=0.23, P<0.001) and 12 months (β=0.22, P<0.001), and lower 12-month Telephone Montreal Cognitive Assessment scores (β=-0.20, P<0.001). Acute stress predicted 12-month tMoCA (χ2[1]=5.29, P=0.022) more strongly, 3-month and 12-month modified Rankin Scale and SIS scores as strongly (all Ps>0.18), but Fugl-Meyer scores (χ2[1]=7.01, P=0.008) less strongly than baseline National Institutes of Health Stroke Scale. CONCLUSIONS Lifetime stress/trauma is associated with more poststroke acute stress, which is associated with greater motor and cognitive impairment and disability 3 and 12 months poststroke. Poststroke interventions for acute stress may help mitigate stroke-related disability.
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Affiliation(s)
- E. Alison Holman
- Sue & Bill Gross School of Nursing, Room 4517, Nursing & Health Sciences Hall, University of California, Irvine, CA 92697
- Department of Psychological Science, 4201 Social & Behavioral Sciences Gateway, University of California, Irvine, CA 92697
| | - Steven C. Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute
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Reistetter T, Hreha K, Dean JM, Pappadis MR, Deer RR, Li CY, Hong I, Na A, Nowakowski S, Shaltoni HM, Bhavnani SK. The Pre-Adaptation of a Stroke-Specific Self-Management Program Among Older Adults. J Aging Health 2023; 35:632-642. [PMID: 36719035 PMCID: PMC10387498 DOI: 10.1177/08982643231152520] [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: 02/01/2023]
Abstract
Objectives: Managing multimorbidity as aging stroke patients is complex; standard self-management programs necessitate adaptations. We used visual analytics to examine complex relationships among aging stroke survivors' comorbidities. These findings informed pre-adaptation of a component of the Chronic Disease Self-Management Program. Methods: Secondary analysis of 2013-2014 Medicare claims with stroke as an index condition, hospital readmission within 90 days (n = 42,938), and 72 comorbidities. Visual analytics identified patient subgroups and co-occurring comorbidities. Guided by the framework for reporting adaptations and modifications to evidence-based interventions, an interdisciplinary team developed vignettes that highlighted multimorbidity to customize the self-management program. Results: There were five significant subgroups (z = 6.19, p < .001) of comorbidities such as obesity and cancer. We constructed 6 vignettes based on the 5 subgroups. Discussion: Aging stroke patients often face substantial disease-management hurdles. We used visual analytics to inform pre-adaptation of a self-management program to fit the needs of older adult stroke survivors.
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Affiliation(s)
- Timothy Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900
| | - Kimberly Hreha
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, School of Medicine, Duke University, 40 Duke Medicine Circle, Durham, NC 27710
| | - Julianna M. Dean
- Department of Clinical, Health, and Applied Sciences, College of Human Sciences and Humanities, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058
| | - Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Rachel R. Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, 135 Backun Hall, Yonsei Univroad 1, Wonju, Gangwon-do, Republic of Korea, 26493
| | - Annalisa Na
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, 1601 Cherry Street, Philadelphia, PA 19102
| | - Sara Nowakowski
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Hashem M. Shaltoni
- Department of Neurology, University of Texas Medical Branch, 300 University Blvd, Galveston, TX 77555
| | - Suresh K. Bhavnani
- Department of Population Health and Health Disparities, School of Public and Population Health, 300 University Blvd, Galveston, TX 77555
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Sze WT, Waki K, Enomoto S, Nagata Y, Nangaku M, Yamauchi T, Ohe K. StepAdd: A personalized mHealth intervention based on social cognitive theory to increase physical activity among type 2 diabetes patients. J Biomed Inform 2023; 145:104481. [PMID: 37648101 DOI: 10.1016/j.jbi.2023.104481] [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: 02/27/2023] [Revised: 08/26/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Investigate the preliminary efficacy and feasibility of a personalized mobile health (mHealth) intervention based on social cognitive theory (SCT) to promote physical activity among type 2 diabetes patients via self-monitoring, goal setting, and automatic feedback. METHODS We conducted a pilot study involving 33 type 2 diabetes patients attending Mitsui Memorial Hospital in Japan using a pre-post evaluation design over 12 weeks. Participants measured daily step count, body weight, and blood pressure at home, with the measurements synchronized with the StepAdd application (app) automatically. Participants used the app to review daily results, update personalized step goals, identify individualized barriers to achieving the step goals, find coping strategies to overcome each barrier, and implement these strategies, thereby building effective coping skills to meet the goals. Pharmacists examined the usage of the app and provided coaching on lifestyle modifications. Ultimately, patients established skills to enhance diabetes self-care by using the app. RESULTS Daily step count increased dramatically with high statistical significance (p < 0.0001), from a mean of 5436 steps/day to 10,150 steps/day, an 86.7 % increase. HbA1c (p = 0.0001) and BMI (p = 0.0038) also improved. Diabetes self-care in diet, exercise, and foot care as well as self-management behavior, self-regulation, and self-efficacy in achieving daily step goals showed significant improvements. The retention rate of the study was very high, at 97.0 % (n = 32). CONCLUSIONS A personalized smartphone-based mHealth intervention based on SCT is feasible and effective at promoting physical activity among type 2 diabetes patients. The methodology of the intervention could be readily applied to other patient populations.
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Affiliation(s)
- Wei Thing Sze
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Kayo Waki
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan; Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Syunpei Enomoto
- Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuuki Nagata
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan
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Ismond KP, Spiers JA, Tandon P. Identifying opportunities for hepatic encephalopathy self-management: A mixed methods systematic review and synthesis. CANADIAN LIVER JOURNAL 2023; 6:215-233. [PMID: 37503524 PMCID: PMC10370725 DOI: 10.3138/canlivj-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 07/29/2023]
Abstract
Background Hepatic encephalopathy (HE) in cirrhosis is an extremely challenging complication for patients and care partners. To identify potentially modifiable factors to enhance HE self-management strategies, we conducted a synthesis of quantitative and qualitative research about real-world HE behaviours, knowledge, and experiences. Methods Using the EPPI-Centre's mixed methods synthesis procedure, a systematic literature search in five databases was completed; methods of selected articles underwent critical appraisal followed by descriptive analysis and coded line-by-line of content. Through refutational translation, the findings from the quantitative and qualitative syntheses were juxtaposed to highlight congruencies, incongruencies, or gaps. These findings informed generation of cross-analytical themes that were transformed into action statements. Results The quantitative narrative review of synthesis (n = 17) generated four themes (patients had low awareness of HE and low treatment adherence rates, physicians had a non-uniform approach to non-pharmaceutical therapies). Meta-aggregation of qualitative data from six articles yielded three themes (patients and care partners had low levels of HE awareness, were unfamiliar with HE self-management, and were adherent to treatments). Comparison of findings revealed three congruencies, two gaps, and one incongruency. The combined synthesis yielded two self-management themes: universal patient-oriented cirrhosis HE education and ensuring each health care encounter systematically addresses HE to guarantee health care is continuously modified to meet their needs. Conclusions By drawing on elements of Bloom's Taxonomy and distributed knowledge networks, deliberate patient-oriented HE messaging at all health care encounters is greatly needed to improve health outcomes and reduce care burdens related to HE.
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Affiliation(s)
- Kathleen P Ismond
- Division of Gastroenterology, Liver Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jude A Spiers
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Puneeta Tandon
- Division of Gastroenterology, Liver Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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McGowan P, Hofer S. The Victoria Assistive Devices and Coach (VADAC) study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:507-520. [PMID: 36508153 PMCID: PMC9744049 DOI: 10.17269/s41997-022-00717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
INTERVENTION A 90-day intervention employed peer coaching, with and without home-based electronic devices connected to an app, to assess effectiveness in enhancing self-reported health outcomes of older adults. RESEARCH QUESTION Does peer coaching aid older adults to better manage their chronic health conditions, and is the coaching further enhanced by home-based electronic devices? METHODS The study employed a pre-post intervention randomized controlled trial design with three groups: control (no coach, no devices), coach only, and coach + devices. Participants were 163 adults living in British Columbia, Canada, aged 65 to 98 years, with one or more chronic health conditions and access to a computer and Wi-Fi. Responses on five questionnaires assessed health outcomes pre- and post-intervention: Self-Efficacy Scale, PHQ-9, Medical Care, Patient Activation Measure and the RAND 36-Item Health Survey 1.0 Questionnaire. RESULTS Compared with the control group (no coach, no devices), participants with a coach reported decreased depression, higher activation levels and energy levels, and better handling of role limitations due to physical health, social functioning, and communication with their physician. Participants with coaches and devices showed similar improvements on these measures with further decreases in depression severity as well as improved self-efficacy, better handling of role limitations due to emotional problems, higher level of emotional well-being and general health ratings, and lower pain. CONCLUSION Peer coaches alone and in combination with assistive devices demonstrated several positive outcomes for older persons with chronic conditions that lasted at least 90 days. The program can enhance effectiveness of care provided by general practitioners.
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Affiliation(s)
- Patrick McGowan
- Institute on Aging & Lifelong Health, University of Victoria, Suite 210, 4907 Chisholm Street, Delta, BC, V4K 2K6, Canada.
| | - Scott Hofer
- Institute on Aging & Lifelong Health, University of Victoria, R Hut, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Bosma R, Bisson EJ, Cooper LK, Salomons TV, Galica J, Wilson R. Experience-based design: Empowering individuals while they wait for interprofessional chronic pain care. PATIENT EDUCATION AND COUNSELING 2023; 109:107623. [PMID: 36640452 DOI: 10.1016/j.pec.2023.107623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Chronic pain is highly prevalent and a leading cause of disability. Long wait times for interprofessional care provide an opportunity to introduce web-based interventions that improve psychosocial function and patients' readiness and ability to manage their condition. Here we describe the process of partnering with people with lived experience (PWLE) to develop an online self-management program enhanced by motivational interviewing. We also report the multiphase usability testing of the program. METHODS PWLE were included in all aspects of this project from program inception to content creation, module development, usability testing, and knowledge dissemination. Phase 1 included the development of the interactive, web-based modules. This process involved weekly meetings and asynchronous content creation with a core team of interprofessional pain experts, researchers, and PWLE. Phase 2 included usability testing by our PWLE and clinical expert advisory. Phase 3 included survey-based usability testing with a sample of 10 PWLE. RESULTS We created a chronic pain & motivational empowerment program includes a series of eight interactive educational web-based modules. Topics included: setting expectations, chronic pain explained, biopsychosocial factors, empowered management, self-awareness & compassion & acceptance, values, goal setting, and communication. The program is accompanied by a reflection journal and can be enhanced by one-on-one coaching sessions using a motivational interviewing approach. Phase two usability testing resulted in numerous content changes and the addition of accessibility features. Phase 3 usability testing with PWLE found the program highly accessible and easy to use. CONCLUSIONS The engagement of our PWLE team member and advisors made the online program more relevant, sensitive and helpful to the needs of people with pain. PRACTICAL VALUE This PWLE-centric project sets the foundation for future work to examine the feasibility and effectiveness of the program for supporting individuals with chronic pain self-manage.
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Affiliation(s)
- Rachael Bosma
- Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Canada.
| | - Etienne J Bisson
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lynn K Cooper
- Person with Lived Experience, Canadian Injured Workers Alliance, Canada
| | - Tim V Salomons
- Department of Psychology, Queen's University, Kingston, Canada
| | - Jacqueline Galica
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Rosemary Wilson
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada; School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
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Falasinnu T, Bao G, Brady TJ, Lim SS, Drenkard C. Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self-Management Program. Arthritis Care Res (Hoboken) 2023; 75:519-528. [PMID: 34738339 PMCID: PMC9065209 DOI: 10.1002/acr.24811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus erythematosus (SLE); however, little is known about predictors of participation among Black women with SLE. We examined factors associated with CDSMP initiation and completion in this population. METHODS We studied 228 Black women with SLE who consented to attend a CDSMP workshop. We used logistic regression to calculate unadjusted and adjusted odds ratios (ORs) for being a CDSMP initiator (a participant registered into the CDSMP who attended at least 1 of the first 2 weekly classes) and a CDSMP completer (a participant who completed at least 4 of 6 weekly classes). RESULTS The majority of participants were CDSMP initiators (74% [n = 168]). Of those, 126 (75%) were CDSMP completers. Older age (adjusted OR [ORadj ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) and unemployment/disability (ORadj 2.05 [95% CI 1.05-4.14]) increased the odds of being a CDSMP initiator. The odds of initiating the CDSMP decreased by 22% for each additional child in the household (OR 0.78 [95% CI 0.62-0.98]), but this association became nonsignificant in the adjusted model (ORadj 0.89 [95% CI 0.68-1.18]). The only factor that differed significantly between CDSMP completers and noncompleters was age, with 4% higher odds of being a completer for each additional year of age (ORadj 1.04 [95% CI 1.00-1.07]). CONCLUSION Our findings suggest that young Black women with SLE face barriers to attend and complete in-person CDSMP workshops, possibly in relation to work and child care demands.
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Affiliation(s)
| | | | | | - S Sam Lim
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cristina Drenkard
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
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Ulibarri-Ochoa A, Sánchez-Gómez S, Gamboa-Moreno E, Duo-Trecet I, Garate-Echenique L, Belarra-Tellechea B, de Retana-García LO. Impact of the "Looking after my health after cancer" peer-led active patient education program on cancer survivors and their caregivers: A qualitative study. PLoS One 2023; 18:e0282018. [PMID: 36827237 PMCID: PMC9955581 DOI: 10.1371/journal.pone.0282018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Cancer survival has doubled and is likely to continue increasing in the near future. Cancer survivors experience long-term adverse effects, with associated psychological changes, and often they have needs that are yet to be met. Recognizing the lack of continuity-of-care initiatives for cancer survivors and caregivers, Osakidetza Basque Health Service has started to implement through primary care a peer-led active patient education program called "Looking after my health after cancer". This study explores how cancer survivors and their caregivers rate the experience of participating in the program, to what extent the program helps them understand and address their unmet felt needs, and helps them improve their activation for self-care and self-management. METHODS A qualitative exploratory phenomenological study was conducted using five focus groups: four with cancer survivors (n = 29) and caregivers (n = 2), and one with peer leaders (n = 7). Narrative content analysis was performed using the constant comparison method, facilitated by Atlas-ti software. Descriptive analysis of sociodemographic and clinical data was performed. The study was developed according to the Consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS Five main themes emerged from the content analysis: 1) satisfaction with the program as a positive learning experience; 2) peer sharing and learning ("if they can, so can I"); 3) fears prior to attending the program; 4) becoming more aware of unmet felt needs and feeling understood in the "new normal"; and 5) a more positive view of their experience, helping them become active in self-care and empowered in the self-management of their condition. CONCLUSIONS The peer education program has shown to have a positive impact on cancer survivors and caregivers. It is necessary to design, implement and evaluate interventions of this type to address unmet felt needs during cancer survivorship and improve their quality of life.
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Affiliation(s)
- Ainhoa Ulibarri-Ochoa
- Bioaraba Health Research Institute, Clinical Nursing and Community Health Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Vitoria-Gasteiz, Spain
- Vitoria-Gasteiz School of Nursing, University of the Basque Country, Vitoria-Gasteiz, Spain
- * E-mail:
| | - Sheila Sánchez-Gómez
- Bioaraba Health Research Institute, Healthcare Research Group, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, Araba Integrated Health Organisation, Directorate for Healthcare Integration, Vitoria-Gasteiz, Spain
- Osakidetza Basque Health Service, General Directorate, Nursing Subcommittee, Araba Multidisciplinary Teaching Unit for Family and Community Healthcare, Vitoria-Gasteiz, Spain
| | - Estíbaliz Gamboa-Moreno
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, San Sebastián-Donostia, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS)
| | - Irene Duo-Trecet
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
| | - Lucia Garate-Echenique
- Osakidetza Basque Health Service, Coordination of Strategic Plans, Subdirectorate for Nursing, Vitoria-Gasteiz, Spain
| | - Begoña Belarra-Tellechea
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Osakidetza Basque Health Service, School of Health (Osasun Eskola), Subdirectorate for Primary Care Coordination, Vitoria-Gasteiz, Spain
| | - Lourdes Ochoa de Retana-García
- Biodonostia Health Research Institute, Primary Care Research Unit, San Sebastián-Donostia, Spain
- Osakidetza Basque Health Service, Active Patient Program (Paziente Bizia-Paciente Activo), Subdirectorate for Primary Care Coordination, San Sebastián-Donostia, Spain
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12
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Brown SE, Shah A, Czuber-Dochan W, Bench S, Stayt L. Non-pharmacological interventions for self-management of fatigue in adults: An umbrella review of potential interventions to support patients recovering from critical illness. J Crit Care 2023; 75:154279. [PMID: 36828754 DOI: 10.1016/j.jcrc.2023.154279] [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: 12/16/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Fatigue is a common symptom after critical illness. However, evidence-based interventions for fatigue after critical illness are lacking. We aimed to identify interventions to support self-management of fatigue caused by physical conditions and assess their effectiveness and suitability for adaptation for those with fatigue after critical illness. MATERIALS AND METHODS We conducted an umbrella review of systematic reviews. Databases included CINAHL, PubMed, Medline, PsycINFO, British Nursing Index (BNI), Web of Science, Cochrane Database of Systematic Reviews (CDSR), JBI Evidence Synthesis Database, and PROSPERO register. Included reviews were appraised using the JBI Checklist for Systematic Reviews and Research Syntheses. Results were summarised narratively. RESULTS Of the 672 abstracts identified, 10 met the inclusion criteria. Reviews focused on cancer (n = 8), post-viral fatigue (n = 1), and Systemic Lupus Erythematosus (SLE) (n = 1). Primary studies often did not address core elements of self-management. Positive outcomes were reported across all reviews, and interventions involving facilitator support appeared to be most effective. CONCLUSIONS Self-management can be effective at reducing fatigue symptoms and improving quality of life for physical conditions and has clear potential for supporting people with fatigue after critical illness, but more conclusive data on effectiveness and clearer definitions of self-management are required.
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Affiliation(s)
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Suzanne Bench
- Institute of Health and Social Care, London South Bank University, London, UK; Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Louise Stayt
- School of Health and Social Care, Oxford Brookes University, Oxford, UK.
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13
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Zhu J, Wang W, Wang J, Zhu L. Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China. Health Policy Plan 2023; 38:161-169. [PMID: 36420873 PMCID: PMC9923378 DOI: 10.1093/heapol/czac101] [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: 03/31/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.
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Affiliation(s)
- Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Wei Wang
- Department of Social and Preventive Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Jun Wang
- Center for Health Policy Research and Evaluation, School of Public Administration and Policy, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing 100872, China
| | - Liang Zhu
- Henan Province Yongcheng Central Hospital, Zhongyuan Road, Yongcheng, Shangqiu 476610, China
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Shi J, Ferretti L, McCallion P. Attending with family members, completion rate and benefits accrued from chronic disease self-management program. Chronic Illn 2022; 18:784-795. [PMID: 34282954 DOI: 10.1177/17423953211032263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Chronic Disease Self-Management Program (CDSMP) has been demonstrated effective in addressing the self-management of chronic conditions among older adults. With a higher attrition rate, this study investigated whether attending with family members influenced completion of and benefits accrued from the CDSMP. METHODS The baseline data were collected from CDSMP participants in New York State (n = 4184), and the follow-up data were collected from completers (attended 4+ sessions) (n = 293). Multi-level logistic regression was employed to predict the association between family accompany and program completion. Paired sample t-test was used to compare the differences in benefits from CDSMP after six months. RESULTS Attending with family members was associated with a higher likelihood of completing the CDSMP (OR = 1.626, p < .05). All completers reported small but significant improvements in self-rated health at six months (p < .001), and the changes were greater for those with family members. Males, caregivers, those aged 65 to 84 years old, with college or above education, were more accompanied by family members. Workshops in senior centers, libraries, or educational institutions attracted more family companions. DISCUSSION Engaging family members may increase CDSMP participants' motivation to complete the program. CDSMP providers should encourage participants to attend with their family members.
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Affiliation(s)
- Junrong Shi
- Department of Social Work, College of Health, Education, and Professional Studies, The University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Lisa Ferretti
- School of Social Work, Temple University, Philadelphia PA, USA
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Cruz TH, FitzGerald CA, Quintana V, Barnes J, Sanchez KE, Hirschl M, Lavender A, Caswell L. Healthy Here: A Promising Referral System Model for Community–Clinical Linkages to Prevent Chronic Disease. Health Promot Pract 2022; 23:153S-163S. [DOI: 10.1177/15248399221111192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Linking clinical services to community-based resources is a promising strategy for assisting patients with chronic disease prevention and management. However, there remains a gap in understanding how to effectively develop and implement community–clinical linkages (CCLs), especially in communities of color. The Healthy Here initiative used Stage Theory of organizational change to implement a centralized wellness referral system, linking primary care clinics to community organizations in majority Hispanic/Latinx and Native American communities. Data were collected using a standardized referral form. Facilitators and challenges were identified through semi-structured discussions with partner organizations. Between 2016 and 2021, 43 clinics and 497 health care providers made 7,465 referrals, the majority of which were from the focus populations. The average proportion of patients referred by clinic champions decreased significantly over time, reflecting diffusion of the intervention within clinics. Facilitators to system success included building on existing networked partnerships, utilizing a centralized referral center, leveraging funding, sharing data, addressing challenges collectively, incorporating multilevel leadership, and co-developing and testing a standardized referral form and process with a single clinic and provider before scaling up. Challenges included funding restrictions, decreasing referrals within clinics over time, changing availability of resources and programs, and the COVID-19 pandemic. This innovative initiative demonstrates that CCLs can be developed and implemented to successfully reach Hispanic/Latinx and Native American communities and provides strategies for overcoming challenges.
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Affiliation(s)
| | | | - Valerie Quintana
- Presbyterian Healthcare Services Community Health, Albuquerque, NM, USA
| | - Jesse Barnes
- First Choice Community Healthcare, Albuquerque, NM, USA
| | | | - Meta Hirschl
- Adelante Development Center Inc, Albuquerque, NM, USA
| | - Amy Lavender
- Adelante Development Center Inc, Albuquerque, NM, USA
| | - Leigh Caswell
- Presbyterian Healthcare Services Community Health, Albuquerque, NM, USA
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Self-Care and Sense of Coherence: A Salutogenic Model for Health and Care in Nursing Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159482. [PMID: 35954838 PMCID: PMC9368734 DOI: 10.3390/ijerph19159482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023]
Abstract
Background: Effective advocacy on self-care and the enhancement of a sense of coherence among nurses don’t only benefit control over one’s health and personal performance, but it may have a direct impact on clinical care and on the entire healing system. In this regard, nursing curricula grounded on a salutogenic model of health (SMH) operate with strategies to engage students in self-care and contribute to improving their mental health and wellbeing. The aim of this study was to explore the relationships between self-care agency and a sense of coherence as dependent variables and the age and self-reported academic performance as independent variables in nursing assistant students. Methods: For this cross-sectional study, data were collected from a full sample of 921 Certified Nursing Assistant (CNA) Spanish students. A self-administered questionnaire, including sociodemographic variables, the ‘appraisal of self-care agency’ (ASA), and the ‘sense of coherence’ (SOC) constructs, was administered. Results: Results: Older participants presented significantly stronger values of both constructs. Apart from a significant and positive correlation between ASAS and SOC, ANOVA analyses indicate signif-icant differences in terms of academic performance according to different ASAS and SOC de-grees. Conclusion: The findings of this study endorse the assumption that there is a consistent relationship between ASA and SOC constructs that might, indeed, have a potential effect on stu-dents’ academic performance. In practical terms, it seems relevant to try to recognise the stu-dents’ self-care agency and the sense of coherence as forceful predictive variables of mental health and wellbeing, in addition to academic success as a strength implied in the future career achievement.
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Patil SJ, Tallon E, Wang Y, Nayyar M, Hodges K, Phad A, Rodriguez E, Gefter L. Effect of Stanford Youth Diabetes Coaches' Program on Youth and Adults in Diverse Communities. FAMILY & COMMUNITY HEALTH 2022; 45:178-186. [PMID: 35385435 PMCID: PMC9156535 DOI: 10.1097/fch.0000000000000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The Stanford Youth Diabetes Coaches' Program (SYDCP) trains high school students to become diabetes coaches for friends and adult family members. The objective of this study was to assess effects of SYDCP participation on youth and adults from a rural and urban underserved high school community. We used a mixed-methods approach. Patient-Reported Outcomes Measurement Information System (PROMIS) measures for Pediatric Sense of Meaning and Purpose were measured in high school students. PROMIS Adult Global Health and Self-Efficacy was measured in coached adults. Paired t tests compared pre- and postintervention and 6-month follow-up scores. Thematic analysis was used to analyze focus group discussion of adults. Twenty-five students participated, 15 students coached adults with diabetes or prediabetes. Students' sense of meaning and purpose significantly improved postintervention compared to preintervention. Diet and physical activity behaviors improved. Adolescent-adult relationships mediated participation benefits. Our study showed SYDCP improved adolescents' sense of meaning and purpose. In addition, youth and adult relatedness led to improved health behaviors. These findings have important implications, as a sense of purpose and youth-adult connectedness are associated with health behaviors and psychological well-being. Further larger studies of health education programs that engage related youth-adult dyads and assess long-term behaviors and health outcomes are needed.
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Affiliation(s)
- Sonal J Patil
- Departments of Family and Community Medicine (Drs Patil, Wang, and Hodges) and Endocrinology (Dr Nayyar), University of Missouri, Columbia; University of Missouri Sinclair School of Nursing, Columbia (Ms Tallon); University of Missouri Institute for Data Science & Informatics, Columbia (Ms Tallon); Center for Diabetes Translation Research, Washington University in St Louis, St Louis, Missouri (Ms Phad); Department of Pediatrics, Li Ka Shing Learning and Knowledge Center (Dr Rodriguez), and Division of Primary Care and Population Health (Dr Gefter), Stanford University School of Medicine, Stanford, California. Dr Patil is now at the Department of Wellness & Preventive Medicine, Cleveland Clinic Community Care, Cleveland, Ohio
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Hreha K, Sonnenfeld M, Na A, Kitchens R, Reistetter TA. Lessons Learned and Future Actions: Modifying a Stroke Specific Self-Management Program. FRONTIERS IN HEALTH SERVICES 2022; 2:841082. [PMID: 36925874 PMCID: PMC10012748 DOI: 10.3389/frhs.2022.841082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/11/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Self-management programs have been shown to be effective at providing support to individuals who want to manage chronic health conditions independently. It has been shown that adapting self-management programs for different diagnostic groups, such as stroke, is essential. OBJECTIVE To report modifications made during trial implementation, the barriers identified during the delivery of an evidence based, stroke-specific self-management program and minor data (including strategies made) from a small cohort of stroke survivors with multiple chronic conditions. METHODS Prospective type III hybrid implementation-effectiveness trial for stroke survivors, with chronic conditions, living in the community, and interested in self-management. Modifications were reported by the following: (1) researcher reflections (2) barriers to implementation and (3) strategies used to address the barrier using the Consolidated Framework for Implementation Research (CFIR) guidelines from field notes. RESULTS Twenty-five individuals consented (42% of eligible sample) at the time of acute stroke and five were interested in continuing at the 3-month call. Multiple barriers to implementation were identified, resulting in modifications. For example, before the group sessions began, the COVID-19 pandemic necessitated changes to the intervention delivery. The protocol was modified to an online mode of delivery. In total, there were seven modifications made. CONCLUSIONS The CFIR was a facilitative tool to report barriers and strategies and emphasized the importance of comprehensive reporting. The modifications to the study were an essential first step to address the research climate and needs of this stroke cohort. Next steps include continued research with a larger cohort to implement effective strategies and answer the clinical question of effectiveness of the adapted and modified intervention.
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Affiliation(s)
- Kimberly Hreha
- Division of Occupational Therapy, Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, NC, United States
| | - Mandi Sonnenfeld
- University of Texas Medical Branch, Division of Rehabilitation Science, Galveston, TX, United States
| | - Annalisa Na
- Physical Therapy and Rehabilitation Sciences Department, Drexel University, Philadelphia, PA, United States
| | - Riqiea Kitchens
- University of Texas Medical Branch, Department of Occupational Therapy, Galveston, TX, United States
| | - Timothy A. Reistetter
- Department of Occupational Therapy University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
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Luu KL, Witkamp FE, Nieboer D, Bakker EM, Kranenburg LW, van der Rijt CCD, Lorig K, van der Heide A, Rietjens JAC. Effectiveness of the "Living with Cancer" peer self-management support program for persons with advanced cancer and their relatives: study protocol of a non-randomized stepped wedge study. Palliat Care 2022; 21:107. [PMID: 35692043 PMCID: PMC9188837 DOI: 10.1186/s12904-022-00994-5] [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] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Persons with advanced cancer and their relatives experience physical, emotional, and psychosocial consequences of the illness. Most of the time, they must deal with these themselves. While peer self-management support programs may be helpful, there is little evidence on their value for this population. We present the research protocol of our SMART study that will evaluate the effectiveness of the “Living with Cancer” peer self-management support program, aimed at improving self-management behaviors, self-efficacy, and health-related quality of life of persons with advanced cancer and their relatives. Methods We will conduct a non-randomized stepped wedge study in the Netherlands. We will include 130 persons with advanced cancer and 32 relatives. Participants can choose to either start the program within 4 weeks after inclusion or after eight to 10 weeks. The “Living with Cancer” is a peer self-management support program, based on the Chronic Disease Self-Management Program. It consists of six 1,5 hours video-conferencing group meetings with eight to 12 participants, preceded by two or three preparatory audio clips with supportive text per session. The program has the following core components: the learning of self-management skills (action-planning, problem-solving, effective communication, and decision-making), discussing relevant themes (e.g. dealing with pain and fatigue, living with uncertainty, and future planning), and sharing experiences, knowledge, and best practices. The primary outcome for both persons with advanced cancer and relatives is self-management behavior assessed by the subscale “constructive attitudes and approaches” of the Health Education Impact Questionnaire. Secondary outcomes are other self-management behaviors, self-efficacy, health-related quality of life, symptoms, depression and anxiety, and loneliness. Participants complete an online questionnaire at baseline, and after eight and 16 weeks. After each session, they complete a logbook about their experiences. Group meetings will be video recorded. Discussion SMART aims to evaluate an innovative program building on an evidence-based self-management program. New features are its use for persons with advanced cancer, the inclusion of relatives, and the video-conferencing format for this population. The use of both quantitative and qualitative analyses will provide valuable insight into the effectiveness and value of this program. Trial registration This study was registered in the Dutch Trial Register on October 2021, identifier NL9806. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00994-5.
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Affiliation(s)
- K L Luu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - F E Witkamp
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - D Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E M Bakker
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Lorig
- Stanford School of Medicine, CA, Stanford, USA
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A C Rietjens
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Alegría M, Zhen-Duan J, O’Malley IS, DiMarzio K. A New Agenda for Optimizing Investments in Community Mental Health and Reducing Disparities. Am J Psychiatry 2022; 179:402-416. [PMID: 35599537 PMCID: PMC9205621 DOI: 10.1176/appi.ajp.21100970] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Biden-Harris Administration's FY22 budget includes $1.6 billion for the Community Mental Health Services Block Grant program, more than double the FY21 allocation, given the rising mental health crises observed across the nation. This is timely since there have been two interrelated paradigm shifts: one giving attention to the role of the environmental context as central in mental health outcomes, the other moving upstream to earlier mental health interventions at the community level rather than only at the individual level. An opportunity to reimagine and redesign the agenda of mental health research and service delivery with marginalized communities opens the door to more community-based care interventions. This involves establishing multisector partnerships to address the social and psychological needs that can be addressed at the community level rather than the clinical level. This will require a shift in training, delivery systems, and reimbursement models. The authors describe the scientific evidence justifying these programs and elaborate on opportunities to target investments in community mental health that can reduce disparities and improve well-being for all. They select levers where there is some evidence that such approaches matter substantially, are modifiable, and advance the science and public policy practice. They conclude with specific recommendations and the logistical steps needed to support this transformational shift.
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Affiliation(s)
- Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Correspondence: Margarita Alegría, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, FL, USA
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Becetti K, Nguyen JT, Kwakkenbos L, Carrier ME, Tao L, Gordon JK, Mancuso CA, Welling J, Mouthon L, Bartlett SJ, Malcarne VL, Thombs BD, Spiera RF. Mental Health Care Use and Associated Factors in Systemic Sclerosis: A Scleroderma Patient-Centered Intervention Network Cohort Study. ACR Open Rheumatol 2022; 4:647-657. [PMID: 35603782 PMCID: PMC9374049 DOI: 10.1002/acr2.11439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Systemic sclerosis (SSc) has significant psychosocial implications. We aimed to evaluate the proportion of participants in a large international SSc cohort who used mental health services in a 3‐month period and to evaluate demographic, psychological, and disease‐specific factors associated with use. Methods Baseline data of participants enrolled in the Scleroderma Patient‐Centered Intervention Network Cohort were analyzed. We determined the proportion that used mental health services and the source of services in the 3 months prior to enrollment. Multivariable logistic regression was used to identify variables associated with service use. Results Of the 2319 participants included in the analysis, 417 (18%) used mental health services in the 3 months prior to enrollment. General practitioners were the most common mental health service providers (59%), followed by psychologists (25%) and psychiatrists (19%). In multivariable analysis, mental health service use was independently associated with higher education (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03‐1.11), smoking (OR 1.06, 95% CI 1.02‐1.11), being retired (OR 0.60, 95% CI 0.38‐0.93), having limited SSc (OR 1.39, 95% CI 1.02‐1.89), and having higher anxiety symptom scores (OR 1.04, 95% CI 1.03‐1.06) and lower self‐efficacy scores (OR 0.90, 95% CI 0.83‐0.97). Variables not significantly associated included age, race, disease manifestations, depression symptom scores, and body image distress. Conclusion About 18% of participants in a large international cohort received mental health services in a 3‐month period, of whom the majority received these services from a general practitioner.
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Affiliation(s)
| | | | - Linda Kwakkenbos
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Lydia Tao
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | | | | | - Joep Welling
- Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, the Netherlands, and Federation of European Scleroderma Associations, Brussels, Belgium
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris, and Hôpital Cochin, Paris, France
| | - Susan J Bartlett
- McGill University and McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | | | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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22
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Duca LM, Helmick CG, Barbour KE, Murphy LB, Guglielmo D, Odom EL, Boring MA, Croft JB. State-Specific Prevalence of Inactivity, Self-Rated Health Status, and Severe Joint Pain Among Adults With Arthritis - United States, 2019. Prev Chronic Dis 2022; 19:E23. [PMID: 35482547 PMCID: PMC9109641 DOI: 10.5888/pcd19.210346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Arthritis is associated with joint pain, disability, and physical inactivity, potentially resulting in poor quality of life. The Centers for Disease Control and Prevention analyzed 2019 Behavioral Risk Factor Surveillance System data to estimate state-specific arthritis prevalence and, among adults with arthritis, the prevalence of physical inactivity, fair/poor self-rated health status, and severe joint pain. Among adults with arthritis, age-standardized prevalences of physical inactivity, fair/poor health status, and severe joint pain were high in all states and highest in southeastern states. Increased promotion and use of evidence-based public health interventions for arthritis may improve health-promoting behaviors and health outcomes among adults with arthritis.
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Affiliation(s)
- Lindsey M Duca
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Division of Population Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop S107-6, Atlanta, GA 30341.
| | - Charles G Helmick
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Dana Guglielmo
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Erica L Odom
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael A Boring
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet B Croft
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Comparing Self-management Programs with and without Peer Support Among Patients with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2022; 19:1687-1696. [PMID: 35442179 DOI: 10.1513/annalsats.202108-932oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Self-management support (SMS) is an essential component of care for patients who have chronic obstructive pulmonary disease (COPD), but there is little evidence on how to provide SMS most effectively to these patients. Peer support (i.e. support provided by a person with a similar medical condition) has been successfully used to promote self-management among patients with various chronic conditions, yet no randomized studies have focused on testing its effects for patients with COPD. OBJECTIVES To assess whether adding peer support to healthcare professional support to help patients with COPD self-management results in better health-related quality of life (HRQOL) and less acute care use. METHODS A 2-arm randomized controlled trial (RCT) was performed at one academic and one community hospital, and their affiliate clinics. Study population included patients aged ≥40 years who had been diagnosed with COPD by a physician and were currently receiving daily treatment for it. Two SMS strategies were compared over six-months. One strategy relied on the healthcare professional (HCP) for COPD self-management (HCP Support); the other used a dual approach involving both healthcare professionals and peer supporters (HCP Plus Peer Support). The primary outcome was change in HRQoL measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months (range 0-100, lower is better; 4-point meaningful difference). Secondary outcomes included the COPD-related and all-cause hospitalizations and ED visits. Analysis was conducted under intention to treat. RESULTS The number of enrolled participants was 292. Mean age was 67.7 (SD 9.4) years; 70.9% white and 61.3% female . SGRQ scores were not significantly different between the study arms. HCP Plus Peer arm participants had fewer COPD-related acute care events at 3 months ( incidence rate ratio (IRR) 0.68 ; 95% CI 0.50 - 0.93), and 6 months ( IRR 0.84 ; 95% CI 0.71 - 0.99). CONCLUSIONS Adding peer support to HCP support to help patients self-manage COPD, did not further improve HRQoL in this study. However, it did result in fewer COPD-related acute care events during the 6-month intervention period. Clinical trial registered with ClinicalTrials.gov (NCT02891200).
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24
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Chen L, Gong Y, Yuan L. Health behaviour and its determinants in elderly patients with chronic diseases: evidence from Jiangsu Province, China. BMC Geriatr 2022; 22:297. [PMID: 35392819 PMCID: PMC8988547 DOI: 10.1186/s12877-022-03010-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/31/2022] [Indexed: 12/02/2022] Open
Abstract
Background Chronic disease is a major cause of mortality among elderly individuals in China, and treatment is a substantial public health burden. However, behavioural interventions may be more important than mere clinical treatment of these chronic diseases. Objective The paper aimed to assess the health behaviour of a sample of elderly individuals with chronic diseases in Jiangsu Province, China and to identify how demographic characteristics influence health behaviour. Furthermore, the group that would likely need the most health intervention was identified. Design A version of the Health Promoting Lifestyle Profile II (HPLP-II) was adapted to Chinese to evaluate health behaviours in six dimensions: nutrition, tobacco and alcohol use, physical activity, stress management, health responsibility, and spiritual growth. Multistage random sampling was conducted from October 2020 to May 2021. Questionnaires incorporating the adapted HPLP-II were distributed to 900 elderly patients (i.e., aged 60 and above) with chronic diseases in the three sampled prefectures of Jiangsu Province; of these questionnaires, 791 were completed. Univariate t tests, principal component analysis, and multivariate linear regressions were employed in the analysis. Results The average total score of respondents on health behaviour was 73.73. The dimensions (ordered from highest to lowest scores) are as follows: “nutrition”, “tobacco and alcohol use”, “health responsibility”, “spiritual growth”, “stress management”, and “physical activity”. The multivariate linear regression suggested that the determinants (P < 0.05) of health behaviour (total score) were income, sex, age, relationship status, residence, and education. Conclusions Elderly patients with chronic diseases in Jiangsu Province generally behaved in a healthy manner. “Physical activity”, “stress management”, and “spiritual growth” were the dimensions that would most benefit from health intervention, while elderly single/divorced/widowed patients with lower income and less education should be the target group for health intervention.
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Affiliation(s)
- Li Chen
- School of Economics, Changzhou University, Changzhou, 213000, People's Republic of China
| | - Yinghua Gong
- Shanghai National Accounting Institute, Shanghai, 201799, People's Republic of China.
| | - Liang Yuan
- College of Business, Shanghai University of Finance and Economics, Shanghai, 200433, People's Republic of China
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25
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Al-Jabi SW, Dalu AA, Koni AA, Khdour MR, Taha AA, Amer R, Zyoud SH. The relationship between self-efficacy and treatment satisfaction among patients with anticoagulant therapy: a cross-sectional study from a developing country. Thromb J 2022; 20:15. [PMID: 35379235 PMCID: PMC8978358 DOI: 10.1186/s12959-022-00374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thromboembolic events are a common complicated health problem. Although anticoagulants have several positive effects on these conditions, they also have several characteristics that strongly affect compliance and satisfaction. The purpose of this investigation is to explore the association between treatment satisfaction and self-efficacy in a sample of patients using anticoagulation therapy and determine the influence of sociodemographic and clinical factors on both aspects. METHODS This was a cross-sectional exploratory study carried out in Palestine. The Arabic version of the Anti-Coagulant Treatment Satisfaction Scale (ACTS) assessed treatment satisfaction. In addition, the Arabic version of the 6-Item Self-Efficacy for Managing Chronic Diseases (SES6C) was used to assess self-efficacy. RESULTS A total of 300 patients using anticoagulants (average age 51.95 and SD 17.98) were included. There is a modest correlation between treatment satisfaction and self-efficacy (r = 0.345; p < 0.001). The mean and median self-efficacy scores were 38.41 ± 9.88 and 39.00 (interquartile range: 33.00-46.00), respectively. Overall, patients reported a moderate burden and benefit score. The mean and median of the acting burden were 43.30 ± 10.45, and 43.30 (interquartile range: 36.00 to 51.00), respectively. The results showed that young age, higher education, employment, use of fewer medications, and having fewer diseases were significantly associated with higher self-efficacy behaviors. The results also showed that new oral anti-coagulants (NOACs) had a higher degree of self-efficacy and ACTS benefit scores (41.00 (33.75-47.00), p = 0.002; 13.00 (12.00-15.00), p < 0.001, respectively), than vitamin k antagonists (VKA). CONCLUSIONS The results demonstrated a significant relationship between treatment satisfaction and self-efficacy, and certain sociodemographic and clinical characteristics influence both. We found that there is a higher degree of self-efficacy and treatment satisfaction among patients who use NOACs than those who use UFH / VKA. Therefore, patients should be motivated to increase their knowledge about anticoagulant therapy. Healthcare providers should play an active role in educating patients, increasing their self-esteem, and awareness about anticoagulant drugs. Importantly, this study was an explanatory one, and it includes a low proportion of patients with venous thromboembolism. This encourages future research on a large scale of patients, considering the indications of anticoagulant therapy.
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Affiliation(s)
- Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amal Abu Dalu
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer A. Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Maher R. Khdour
- grid.16662.350000 0001 2298 706XFaculty of Pharmacy, Al-Quds University, Abu Deis, Jerusalem, 51000 Palestine
| | - Adham Abu Taha
- grid.11942.3f0000 0004 0631 5695Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Pathology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Riad Amer
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Jaritos VR, Vanegas E, Facundo Nogueira J, Leiva Agüero S, Giovini V, Rey de Castro J, Rodríguez Reyes Y, Luis Carrillo Alduenda J, Torres Gittaim P, Romero Z, Terán Pérez G, Angélica Bazurto M, Sarfraz A, Sarfraz Z, José Farfán Bajaña M, Mautong H, Felix M, Cherrez- Ojeda I. Frequency of use and preferences for information and communication technologies in patients with sleep apnea: a multicenter, multinational, observational cross-sectional survey study. Int J Med Inform 2022; 162:104760. [DOI: 10.1016/j.ijmedinf.2022.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
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van Beest W, Boon WPC, Andriessen D, Moors EHM, van der Veen G, Pol H. Successful implementation of self-management health innovations. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01330-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Background
Literature on self-management innovations has studied their characteristics and position in healthcare systems. However, less attention has been paid to factors that contribute to successful implementation. This paper aims to answer the question: which factors play a role in a successful implementation of self-management health innovations?
Methods
We conducted a narrative review of academic literature to explore factors related to successful implementation of self-management health innovations. We further investigated the factors in a qualitative multiple case study to analyse their role in implementation success. Data were collected from nine self-management health projects in the Netherlands.
Results
Nine factors were found in the literature that foster the implementation of self-management health innovations: 1) involvement of end-users, 2) involvement of local and business partners, 3) involvement of stakeholders within the larger system, 4) tailoring of the innovation, 5) utilisation of multiple disciplines, 6) feedback on effectiveness, 7) availability of a feasible business model, 8) adaption to organisational changes, and 9) anticipation of changes required in the healthcare system. In the case studies, on average six of these factors could be identified. Three projects achieved a successful implementation of a self-management health innovation, but only in one case were all factors present.
Conclusions
For successful implementation of self-management health innovation projects, the factors identified in the literature are neither necessary nor sufficient. Therefore, it might be insightful to study how successful implementation works instead of solely focusing on the factors that could be helpful in this process.
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Kwakkenbos L, Østbø N, Carrier ME, Nielson WR, Fedoruk C, Levis B, Henry RS, Pope J, Frech T, Gholizadeh S, Johnson SR, Piotrowski P, Jewett LR, Gordon J, Chung L, Bilsker D, Tao L, Turner KA, Cumin J, Welling J, Fortuné C, Leite C, Gottesman K, Sauvé M, Reyna TSR, Hudson M, Larche M, van Breda W, Suarez-Almazor ME, Bartlett SJ, Malcarne VL, Mayes MD, Boutron I, Mouthon L, Benedetti A, Thombs BD. Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program. Pilot Feasibility Stud 2022; 8:45. [PMID: 35219340 PMCID: PMC8881754 DOI: 10.1186/s40814-022-00994-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/27/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Scleroderma Patient-centered Intervention Network (SPIN) developed an online self-management program (SPIN-SELF) designed to improve disease-management self-efficacy in people with systemic sclerosis (SSc, or scleroderma). The aim of this study was to evaluate feasibility aspects for conducting a full-scale randomized controlled trial (RCT) of the SPIN-SELF Program. METHODS This feasibility trial was embedded in the SPIN Cohort and utilized the cohort multiple RCT design. In this design, at the time of cohort enrollment, cohort participants consent to be assessed for trial eligibility and randomized prior to being informed about the trial. Participants in the intervention arm are informed and provide consent, but not the control group. Forty English-speaking SPIN Cohort participants from Canada, the USA, or the UK with low disease-management self-efficacy (Self-Efficacy for Managing Chronic Disease Scale [SEMCD] score ≤ 7) who were interested in using an online self-management program were randomized (3:2 ratio) to be offered the SPIN-SELF Program or usual care for 3 months. Program usage was examined via automated usage logs. User satisfaction was assessed with semi-structured interviews. Trial personnel time requirements and implementation challenges were logged. RESULTS Of 40 SPIN Cohort participants randomized, 26 were allocated to SPIN-SELF and 14 to usual care. Automated eligibility and randomization procedures via the SPIN Cohort platform functioned properly, except that two participants with SEMCD scores > 7 (scores of 7.2 and 7.3, respectively) were included, which was caused by a system programming error that rounded SEMCD scores. Of 26 SPIN Cohort participants offered the SPIN-SELF Program, only 9 (35%) consented to use the program. Usage logs showed that use of the SPIN-SELF Program was low: 2 of 9 users (22%) logged into the program only once (median = 3), and 4 of 9 (44%) accessed none or only 1 of the 9 program's modules (median = 2). CONCLUSIONS The results of this study will lead to substantial changes for the planned full-scale RCT of the SPIN-SELF Program that we will incorporate into a planned additional feasibility trial with progression to a full-scale trial. These changes include transitioning to a conventional RCT design with pre-randomization consent and supplementing the online self-help with peer-facilitated videoconference-based groups to enhance engagement. TRIAL REGISTRATION clinicaltrials.gov , NCT03914781 . Registered 16 April 2019.
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Affiliation(s)
- Linda Kwakkenbos
- Department of Clinical Psychology, Radboud University, Montessorilaan 3, 6525, HR, Nijmegen, The Netherlands.
| | - Nora Østbø
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Claire Fedoruk
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Brooke Levis
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Richard S Henry
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Janet Pope
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Tracy Frech
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Shadi Gholizadeh
- California School of Professional Psychology/Alliant, Los Angeles, CA, USA
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital & Toronto Western Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Lisa R Jewett
- Department of Psychology, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada
| | - Jessica Gordon
- Department of Medicine, Hospital for Special Surgery, New York City, NY, USA
| | - Lorinda Chung
- Department of Medicine, Stanford University, Palo Alto, CA, USA.,Department of Medicine Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Dan Bilsker
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lydia Tao
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Kimberly A Turner
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Joep Welling
- NVLE Dutch patient organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | | | | | | | - Maureen Sauvé
- Scleroderma Canada, Hamilton, Ontario, Canada.,Scleroderma Society of Ontario, Hamilton, Ontario, Canada
| | | | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maggie Larche
- Department of Medicine, McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Ward van Breda
- Faculty of Behavioural and Movement Sciences, Vrije University, Amsterdam, The Netherlands
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University, San Diego, CA, USA.,Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Maureen D Mayes
- Department of Internal Medicine, University of Texas McGovern School of Medicine, Houston, TX, USA
| | - Isabelle Boutron
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Paris, France.,Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,APHP-CUP, Hôpital Cochin, Université de Paris, F-75014, Paris, France
| | - Andrea Benedetti
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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Roberge P, Houle J, Provost JR, Coulombe S, Beaudin A, Bower P, Lemyre FC, Drapeau M, Drouin MS, Hudon C, Provencher MD, Vasiliadis HM. A pragmatic randomized controlled trial of a group self-management support program versus treatment-as-usual for anxiety disorders: study protocol. BMC Psychiatry 2022; 22:135. [PMID: 35189848 PMCID: PMC8862538 DOI: 10.1186/s12888-021-03675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The integration of a personal recovery-oriented practice in mental health services is an emerging principle in policy planning. Self-management support (SMS) is an intervention promoting recovery that aims at educating patients on the nature of their mental disorder, improving their strategies to manage their day-to-day symptoms, fostering self-efficacy and empowerment, preventing relapse, and promoting well-being. While SMS is well established for chronic physical conditions, there is a lack of evidence to support the implementation of structured SMS programs for common mental disorders, and particularly for anxiety disorders. This study aims to examine the effectiveness of a group-based self-management support program for anxiety disorders as an add-on to treatment-as-usual in community-based care settings. METHODS/DESIGN We will conduct a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months. TREATMENT AND CONTROL GROUPS: a) group self-management support (10 weekly 2.5-h group web-based sessions with 10-15 patients with two trained facilitators); b) treatment-as-usual. Participants will include adults meeting DSM-5 criteria for Panic Disorder, Agoraphobia, Social Anxiety Disorder, and/or Generalized Anxiety Disorder. The primary outcome measure will be the Beck Anxiety Inventory; secondary outcome measures will comprise self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation. STATISTICAL ANALYSIS Data will be analysed based on intention-to-treat with a mixed effects regression model accounting for between and within-subject variations in the effects of the intervention. DISCUSSION This study will contribute to the limited knowledge base regarding the effectiveness of structured group self-management support for anxiety disorders. It is expected that changes in patients' self-management behaviour will lead to better anxiety management and, consequently, to improved patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov: NCT05124639 . Prospectively registered 18 November 2021.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
| | - Janie Houle
- Department of Psychology, Faculty of Social Sciences, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal (Quebec), H3C 3P8 Canada
| | - Jean-Rémy Provost
- Relief, 418, rue Sherbrooke Est, bur. 300, Montréal (Québec), H2L 1J6 Canada
| | - Simon Coulombe
- Département des Relations Industrielles, Université Laval, Pavillon J.-A.-DeSève, 1025, avenue des Sciences-Humaines, Québec, G1V 0A6 Canada
- VITAM – Centre de recherche en santé durable, Québec, Canada
| | - Annie Beaudin
- Relief, 418, rue Sherbrooke Est, bur. 300, Montréal (Québec), H2L 1J6 Canada
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, The University of Manchester, Manchester, M13 9PL UK
| | - Félix Camirand Lemyre
- Department of Mathematics, Faculty of Sciences, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 2500, boul. de l’Université, Sherbrooke (Quebec), J1K 2R1 Canada
| | - Martin Drapeau
- Departments of counselling psychology and psychiatry, McGill University, 3700 McTavish, Montreal, Quebec, H3A 1Y2 UK
| | - Marc-Simon Drouin
- Department of Psychology, Faculty of Social Sciences, Université du Québec à Montréal, C.P. 8888, succ. Centre-ville, Montréal (Quebec), H3C 3P8 Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
| | - Martin D. Provencher
- VITAM – Centre de recherche en santé durable, Québec, Canada
- School of Psychology, Faculty of Social Sciences, Université Laval, 2325, rue des Bibliothèques, Québec, G1V 0A6 Canada
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne, Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke (Quebec), J1H 5N4 Canada
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Cross-sectional study of the effects of self-efficacy on fatigue and pain interference in black women with systemic lupus erythematosus: the role of depression, age and education. Lupus Sci Med 2022; 9:9/1/e000566. [PMID: 35149578 PMCID: PMC8845307 DOI: 10.1136/lupus-2021-000566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
Abstract
Objective While fatigue and pain are pervasive symptoms in SLE, self-efficacy can mitigate their intensity and impact on patients’ daily activity. We examined the relationships of these domains and their interactions with demographics and depression in black women with SLE. Methods This is a cross-sectional analysis of data collected among 699 black women with SLE. We used validated, self-reported measures of fatigue, pain interference, symptom self-efficacy, treatment self-efficacy and depression. Linear regression analyses were conducted to examine the relationships between each outcome (fatigue and pain interference) and each predictor (symptom self-efficacy and treatment self-efficacy), and the interaction of demographics and depression. Results We found inverse associations between fatigue and each of symptom self-efficacy (slope −0.556, p<0.001) and treatment self-efficacy (slope −0.282, p<0.001), as well as between pain interference and each of symptom self-efficacy (slope −0.394, p<0.001) and treatment self-efficacy (slope −0.152, p<0.001). After adjusting for confounders, symptom self-efficacy remained significantly associated with each outcome (adjusted slope −0.241 (p<0.001) and −0.103 (p=0.008) for fatigue and pain, respectively). The amount of decrease in fatigue and pain interference differed by depression severity (p<0.05 for the interaction of symptom self-efficacy and depression). The difference in fatigue by depression widened as symptom self-efficacy increased; the adjusted fatigue scores for moderate/severe depression compared with no depression were 6.8 and 8.7 points higher at mean and high symptom self-efficacy, respectively (p<0.001). Age and education significantly changed the relationship between outcomes and self-efficacy. Conclusions Symptom self-efficacy and treatment self-efficacy were inversely related to fatigue and pain interference in black women with SLE. Depression disproportionately increased the intensity of these outcomes. While older women with low symptom self-efficacy reported disproportionately higher pain interference, those with higher education and mean or high levels of symptom self-efficacy reported lower pain interference. These findings may help predict who might benefit most from self-efficacy-enhancing interventions.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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Johnson LJ, Schopp LH, Waggie F, Frantz JM. Challenges experienced by community health workers and their motivation to attend a self-management programme. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144456 PMCID: PMC8831930 DOI: 10.4102/phcfm.v14i1.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022] Open
Abstract
Background: Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.Aim: This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.Setting: The study was conducted in a low socio-economic urban area of the Western Cape, South Africa.Methods: This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.Results: Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.Conclusion: The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.
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Affiliation(s)
- Levona J Johnson
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Bellville.
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Raunsbæk Knudsen L, Lomborg K, Ndosi M, Hauge EM, de Thurah A. The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study-protocol for a pragmatic randomised controlled trial. BMC Rheumatol 2021; 5:57. [PMID: 34924034 PMCID: PMC8686289 DOI: 10.1186/s41927-021-00226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis.
Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00226-y.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,University Hospitals Bristol, Bristol, England
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Zora S, Custodero C, Pers YM, Valsecchi V, Cella A, Ferri A, Pisano-González MM, Peñacoba Maestre D, Vazquez Alvarez R, Raat H, Baker G, Pilotto A. Impact of the chronic disease self-management program (CDSMP) on self-perceived frailty condition: the EU-EFFICHRONIC project. Ther Adv Chronic Dis 2021; 12:20406223211056722. [PMID: 34820081 PMCID: PMC8606718 DOI: 10.1177/20406223211056722] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The Chronic Disease Self-Management Program (CDSMP) improves self-efficacy and health outcomes in people with chronic diseases. In the context of the EFFICHRONIC project, we evaluated the efficacy of CDSMP in relieving frailty, as assessed by the self-administered version of Multidimensional Prognostic Index (SELFY-MPI), identifying also potential predictors of better response over 6-month follow-up. Methods: The SELFY-MPI explores mobility, basal and instrumental activities of daily living (Barthel mobility, ADL, IADL), cognition (Test Your Memory-TYM Test), nutrition (Mini Nutritional Assessment-Short Form-MNA-SF), comorbidities, medications, and socio-economic conditions (social-familiar evaluation scale-SFES). Participants were stratified in three groups according to the 6-month change of SELFY-MPI: those who improved after CDSMP (Δ SELFY-MPI < 0), those who remained unchanged (Δ SELFY-MPI = 0), and those who worsened (Δ SELFY-MPI > 0). Multivariable logistic regression was modeled to identify predictors of SELFY-MPI improvement. Results: Among 270 participants (mean age = 61.45 years, range = 26–93 years; females = 78.1%) a benefit from CDSMP intervention, in terms of decrease in the SELFY-MPI score, was observed in 32.6% of subjects. SELFY-MPI improvement was found in participants with higher number of comorbidities (1–2 chronic diseases: adjusted odd ratio (aOR)=2.38, 95% confidence interval (CI) =1.01, 5.58; ⩾ 3 chronic diseases: aOR = 3.34, 95% CI = 1.25, 8.90 vs no chronic disease), poorer cognitive performance (TYM ⩽ 42: aOR = 2.41, 95% CI = 1.12, 5.19 vs TYM > 42) or higher risk of malnutrition (MNA-SF ⩽ 11: aOR = 6.11, 95% CI = 3.15, 11.83 vs MNA-SF > 11). Conclusion: These findings suggest that the CDSMP intervention contributes to decreasing the self-perceived severity of frailty (SELFY-MPI score) in more vulnerable participants with several chronic diseases and lower cognitive performance and nutritional status.
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Affiliation(s)
- Sabrina Zora
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, Clinica Medica e Geriatria “Cesare Frugoni,” University of Bari Aldo Moro, Bari, Italy
| | - Yves-Marie Pers
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Alberto Cella
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Alberto Ferri
- Geriatrics Unit, Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy
| | - Marta M. Pisano-González
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Delia Peñacoba Maestre
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Raquel Vazquez Alvarez
- SESPA, Health Service of the Principality of Asturias, Research Group “Community Health and Active Aging” of the Research Institute of Asturias (IPSA), Oviedo, Spain
| | - Hein Raat
- Erasmus University Medical Center, Rotterdam, The Netherlands
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Pal T, Hull PC, Koyama T, Lammers P, Martinez D, McArthy J, Schremp E, Tezak A, Washburn A, Whisenant JG, Friedman DL. Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer 2021; 21:1262. [PMID: 34814868 PMCID: PMC8609269 DOI: 10.1186/s12885-021-08949-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. METHODS Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. DISCUSSION The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. TRIAL REGISTRATION Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 - Retrospectively registered, http://www.clinicaltrials.gov/.
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Affiliation(s)
- Tuya Pal
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Pamela C Hull
- University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY, 40536, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Rural and Underserved Health Research Center, Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Tatsuki Koyama
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN, 37203, USA
| | - Phillip Lammers
- Baptist Cancer Center, 80 Humphreys Center Suite 330, Memphis, TN, 38120, USA
| | - Denise Martinez
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jacob McArthy
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Emma Schremp
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Anne Washburn
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jennifer G Whisenant
- Division of Hematology & Oncology, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
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Duca LM, Helmick CG, Barbour KE, Guglielmo D, Murphy LB, Boring MA, Theis KA, Odom EL, Liu Y, Croft JB. Self-Management Education Class Attendance and Health Care Provider Counseling for Physical Activity Among Adults with Arthritis - United States, 2019. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1466-1471. [PMID: 34673750 PMCID: PMC9361837 DOI: 10.15585/mmwr.mm7042a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Arthritis is a highly prevalent and disabling condition among U.S. adults (1); arthritis-attributable functional limitations and severe joint pain affect many aspects of health and quality of life (2). Self-management education (self-management) and physical activity can reduce pain and improve the health status and quality of life of adults with arthritis; however, in 2014, only 11.4% and 61.0% of arthritis patients reported engaging in each, respectively. To assess self-reported self-management class attendance and health care provider physical activity counseling among adults with doctor-diagnosed arthritis, CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. In 2019, an age-standardized state median of one in six (16.2%) adults with arthritis reported ever attending a self-management class, and 69.3% reported ever receiving health care provider counselling to be physically active. Prevalences of both differed by state and sociodemographic characteristics; decreased with lower educational attainment, joint pain severity, and urbanicity; and were lower in men than in women. Health care providers can play an important role in promoting self-management class attendance and physical activity by counseling arthritis patients about their benefits and referring patients to evidence-based programs (3).
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Theis KA, Murphy LB, Guglielmo D, Boring MA, Okoro CA, Duca LM, Helmick CG. Prevalence of Arthritis and Arthritis-Attributable Activity Limitation - United States, 2016-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1401-1407. [PMID: 34618800 PMCID: PMC8519273 DOI: 10.15585/mmwr.mm7040a2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Arthritis has been the most frequently reported main cause of disability among U.S. adults for >15 years (1), was responsible for >$300 billion in arthritis-attributable direct and indirect annual costs in the U.S. during 2013 (2), is linked to disproportionately high levels of anxiety and depression (3), and is projected to increase 49% in prevalence from 2010-2012 to 2040 (4). To update national prevalence estimates for arthritis and arthritis-attributable activity limitation (AAAL) among U.S. adults, CDC analyzed combined National Health Interview Survey (NHIS) data from 2016-2018. An estimated 58.5 million adults aged ≥18 years (23.7%) reported arthritis; 25.7 million (10.4% overall; 43.9% among those with arthritis) reported AAAL. Prevalence of both arthritis and AAAL was highest among adults with physical limitations, few economic opportunities, and poor overall health. Arthritis was reported by more than one half of respondents aged ≥65 years (50.4%), adults who were unable to work or disabled* (52.3%), or adults with fair/poor self-rated health (51.2%), joint symptoms in the past 30 days (52.2%), activities of daily living (ADL)† disability (54.8%), or instrumental activities of daily living (IADL)§ disability (55.9%). More widespread dissemination of existing, evidence-based, community-delivered interventions, along with clinical coordination and attention to social determinants of health (e.g., improved social, economic, and mental health opportunities), can help reduce widespread arthritis prevalence and its adverse effects.
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Sobers NP, Hambleton IR, Hassan S, Anderson SG, Brathwaite-Graham L, Lewis K, Ferguson TS. Assessing the effectiveness and implementation of a chronic disease self-management programme in faith-based organisations in Barbados: protocol for a cluster randomised parallel trial. BMJ Open 2021; 11:e050548. [PMID: 34607863 PMCID: PMC8491298 DOI: 10.1136/bmjopen-2021-050548] [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] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the COVID-19 environment of reduced patient interaction with the healthcare system, evidenced-based self-care of chronic disease is vital. We will evaluate the effect of an online chronic disease self-management programme (CDSMP) plus medication adherence tools on systolic blood pressure (SBP) (primary aim) and, seek to understand the barriers and facilitators to implementation of this modified CDSMP in faith-based organisations (FBOs) (secondary aim). METHODS We will conduct an unblinded cluster randomised trial in FBOs throughout Barbados. Eligibility: Persons ages 35-70 years; a previous diagnosis of hypertension or currently on antihypertensive therapy and the occurrence of two or more blood pressure readings above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on the day of recruitment. Persons not known to have hypertension but who have two or more blood pressure readings at or above 130 mm Hg (systolic) or 80 mm Hg (diastolic) on two recruitment days at least 1 week apart will also be eligible. The unit of randomisation is a church cluster which consists of 7-9 churches. We will perform block randomisation to assign 24 clusters to intervention or control. The intervention has three components: modified CDSMP workshops, distribution of medication pill boxes and use of social media (WhatsApp V.2.0) to encourage medication adherence. Controls will receive one didactic lecture only. We will determine the mean changes in SBP levels for the intervention group versus controls and compare differences in outcomes 6 months' post intervention using mixed effects regression models. ETHICS AND DISSEMINATION This project has received ethical approval from the Institutional Review Board of the University of the West Indies in Barbados. Dissemination will use peer-reviewed publications, policy briefs to government and guidelines to leaders of FBOs. We aim to increase the proportion of patients with controlled hypertension and inform implementation of self-management programmes in small populations. TRAIL REGISTRATION NUMBER NCT04437966.
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Affiliation(s)
- Natasha P Sobers
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Ian Richard Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Saria Hassan
- Centre for Humanitarian Emergencies, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Simon George Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Lisa Brathwaite-Graham
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Kia Lewis
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
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Abstract
Chronic care management is a multidimensional phenomenon involving multilayered interaction, reaction, and adaptation responses to feedback within chronic care micro/macro- systems. Complex adaptive systems (CASs) consider interconnected dynamic relationships between discrete components of systems' internal and external environments. CAS is an applicable framework to examine components and networks within chronic care models. This article considers CAS as a framework for an alternate integrated patient-centered model that incorporates a holistic approach to chronic care. Recognizing relationships, behavioral patterns, and adaptive mechanisms informs health systems and health policy to influence service excellence improvements and quality of care and life within chronic disease populations.
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Murphy LB, Theis KA, Brady TJ, Sacks JJ. Supporting self-management education for arthritis: Evidence from the Arthritis Conditions and Health Effects Survey on the influential role of health care providers. Chronic Illn 2021; 17:217-231. [PMID: 31475576 PMCID: PMC10878350 DOI: 10.1177/1742395319869431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Self-management education programs are recommended for many chronic conditions. We studied which adults with arthritis received a health care provider's recommendation to take a self-management education class and who attended. METHODS We analyzed data from a 2005--2006 national telephone survey of US adults with arthritis ≥45 years (n = 1793). We used multivariable-adjusted prevalence ratios (PR) from logistic regression models to estimate associations with: (1) receiving a health care provider recommendation to take a self-management education class; and (2) attending a self-management education class. RESULTS Among all adults with arthritis: 9.9% received a health care provider recommendation to take an self-management education class; 9.7% attended a self-management education class. Of those receiving a recommendation, 52.0% attended a self-management education class. The strongest association with self-management education class attendance was an health care provider recommendation to take one (PR = 8.9; 95% CI = 6.6-12.1). CONCLUSIONS For adults with arthritis, a health care provider recommendation to take a self-management education class was strongly associated with self-management education class attendance. Approximately 50% of adults with arthritis have ≥1 other chronic conditions; by recommending self-management education program attendance, health care providers may activate patients' self-management behaviors. If generalizable to other chronic conditions, this health care provider recommendation could be a key influencer in improving outcomes for a range of chronic conditions and patients' quality of life.
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Affiliation(s)
- Louise B Murphy
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina A Theis
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Teresa J Brady
- Arthritis Program, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Retired
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Hussein WF, Bennett PN, Abra G, Watson E, Schiller B. Integrating Patient Activation Into Dialysis Care. Am J Kidney Dis 2021; 79:105-112. [PMID: 34461165 DOI: 10.1053/j.ajkd.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/17/2021] [Indexed: 11/11/2022]
Abstract
Patient activation, the measure of patients' readiness and willingness to manage their own health care, is low among people receiving in-center hemodialysis, which is exacerbated because such centers are commonly set up for patients to passively receive care. In our pursuit of person-centered care and value-based medicine, enabling patients to take a more active role in their care can lead to healthy behaviors, with subsequent reductions in individual burden and costs to the health care system. To improve patient activation, we need to embrace a patient-first approach and combine it with ways to equip patients to thrive with self-management. This requires changes in the training of the health care team as well as changes in care delivery models, promoting interventions such as health coaching and peer mentoring, while leveraging technology to enable self-access to records, self-monitoring, and communication with providers. We also need health care policies that encourage a focus on patient-identified goals, including more attention to patient-reported outcomes. In this article, we review the current status of patient activation in dialysis patients, outline some of the available interventions, and propose steps to change the dynamics of the current system to move toward a more active role for patients in their care.
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Affiliation(s)
- Wael F Hussein
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
| | - Paul N Bennett
- Satellite Healthcare, San Jose, California; Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Graham Abra
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | | | - Brigitte Schiller
- Satellite Healthcare, San Jose, California; Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
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Trends in Meeting the Aerobic Physical Activity Guideline Among Adults With and Without Select Chronic Health Conditions, United States, 1998-2018. J Phys Act Health 2021; 18:S53-S63. [PMID: 34465653 DOI: 10.1123/jpah.2021-0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Physical activity is central to the management and control of many chronic health conditions. The authors examined trends during the past 2 decades in the prevalence of US adults with and without select chronic health conditions who met the minimal aerobic physical activity guideline. METHODS The 1998-2018 National Health Interview Survey data were analyzed. Prevalence of meeting the minimal aerobic physical activity guideline among adults with and without 6 chronic health conditions was estimated across 3-year intervals. Linear and higher-order trends were assessed overall and by age group. RESULTS During the past 2 decades, prevalence of meeting the aerobic guideline increased among adults with diabetes, hypertension, coronary heart disease, stroke, cancer, and arthritis. However, the absolute increase in prevalence was lower among adults with hypertension, coronary heart disease, and arthritis compared to counterparts without each condition, respectively. Prevalence was persistently lower among those with most chronic health conditions, except cancer, and among older adults compared to their counterparts. CONCLUSIONS Although rising trends in physical activity levels among adults with chronic health conditions are encouraging for improving chronic disease management, current prevalence remains low, particularly among older adults. Increasing physical activity should remain a priority for chronic disease management and control.
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Kim S, Park M, Song R. Effects of self-management programs on behavioral modification among individuals with chronic disease: A systematic review and meta-analysis of randomized trials. PLoS One 2021; 16:e0254995. [PMID: 34297741 PMCID: PMC8301623 DOI: 10.1371/journal.pone.0254995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/07/2021] [Indexed: 11/18/2022] Open
Abstract
The prevalence of chronic disease associated with unhealthy lifestyles has been increasing worldwide. Health professionals have recognized that self-management programs (SMPs) can provide health benefits by promoting health behaviors, especially when applied to individuals with lifestyle-related chronic disease. This review performed a meta-analysis of the features of SMPs using randomized studies and analyzed the magnitude of the combined effects of self-management on behavioral modification. We searched the PubMed, CINAHL, ScienceDirect, SCOPUS, Web of Science, Embase, Cochrane Library, DBpia, and KISS to identify randomized trials that evaluated the behavioral outcomes of SMPs. Subgroup analyses were performed for program duration, providers, type of comparisons, and program settings. We selected 25 studies (N = 5,681) to perform analyses with random-effects models. The effect sizes of SMPs were small but significant for physical activity (standardized difference in means [SDM] = 0.25), dietary habits (SDM = 0.28), and health responsibility (SDM = 0.18), and not significant for stress management and smoking behaviors. A short-term SMPs (less than 12 weeks) was indicated as being effective in modifying physical activity, dietary habits, and health responsibility, while the program effects on dietary habits were significant only with expert-delivered education and when compared with inactive controls. The findings of this study indicate that SMPs can effectively improve physical activity, dietary habits, and health responsibility in individuals with chronic disease, with a small but significant effect size. Future studies should explore the effects of SMPs on stress management and smoking cessation and assess the long-term maintenance of healthy lifestyles in individuals with lifestyle-related chronic disease.
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Affiliation(s)
- Sunju Kim
- Sejong Chungnam National University Hospital, Daejeon, Korea
| | - Moonkyoung Park
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Rhayun Song
- College of Nursing, Chungnam National University, Daejeon, Korea
- * E-mail:
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Brunes A, Hansen MB, Heir T. General self-efficacy in individuals with visual impairment compared with the general population. PLoS One 2021; 16:e0254043. [PMID: 34214108 PMCID: PMC8253439 DOI: 10.1371/journal.pone.0254043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction. METHODS A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril's Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females). RESULTS People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population. CONCLUSIONS People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life.
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Affiliation(s)
- Audun Brunes
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- * E-mail:
| | - Marianne B. Hansen
- Division of Mental Health and Addiction, Norwegian National Unit for Hearing Impairment and Mental Health, Oslo University Hospital, Oslo, Norway
| | - Trond Heir
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Lambert S, Schaffler JL, Ould Brahim L, Belzile E, Laizner AM, Folch N, Rosenberg E, Maheu C, Ciofani L, Dubois S, Gélinas-Phaneuf E, Drouin S, Leung K, Tremblay S, Clayberg K, Ciampi A. The effect of culturally-adapted health education interventions among culturally and linguistically diverse (CALD) patients with a chronic illness: A meta-analysis and descriptive systematic review. PATIENT EDUCATION AND COUNSELING 2021; 104:1608-1635. [PMID: 33573916 DOI: 10.1016/j.pec.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To review the effectiveness of health education interventions adapted for culturally and linguistically diverse (CALD) populations with a chronic illness. METHODS A systematic review and meta-analysis were conducted. Eligible studies were identified across six databases. Data were extracted and intervention effect was summarized using standardized mean difference. If there were insufficient data for meta-analysis, a descriptive summary was included. Modifying effects of intervention format, length, intensity, provider, self-management skills taught, and behavioral change techniques (BCTs) utilized were examined. RESULTS 58 studies were reviewed and data were extracted for 36 outcomes. Most interventions used multiple modes of delivery and were facilitated by bilingual health care professionals (HCPs). On average, interventions included 5.19 self-management skills and 4.82 BCTs. Interventions were effective in reducing BMI, cholesterol, triglycerides, blood glucose, HbA1C, and depression, and in increasing knowledge. Effectiveness was influenced partly by provider, with HCPs favored over lay providers or paraprofessionals in increasing knowledge; however, the opposite was noted for HbA1c. CONCLUSIONS Health education interventions are effective among CALD populations, particularly at improving objective, distal outcomes (e.g., anthropometric measures). These interventions may be equally effective in improving proximal patient-reported outcomes (PROs); however, diversity in PROs limited analyses. PRACTICE IMPLICATIONS Core outcome sets (COS) are needed to further investigate and compare health education intervention effectiveness on PROs.
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Affiliation(s)
- Sylvie Lambert
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada.
| | | | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
| | | | | | - Nathalie Folch
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Christine Maheu
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Luisa Ciofani
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Sylvie Dubois
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | | | - Susan Drouin
- The Research Institute of the McGill University Health Centre, Montréal, Canada
| | - Katerina Leung
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Sarah Tremblay
- Ingram School of Nursing, McGill University, Montréal, Canada
| | | | - Antonio Ciampi
- Ingram School of Nursing, McGill University, Montréal, Canada; St. Mary's Research Centre, Montréal, Canada
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Johnson LE, Lee MJ, Turner-Moore R, Grinsted Tate LR, Brooks AJ, Tattersall RS, Jones GL, Lobo AJ. Systematic Review of Factors Affecting Transition Readiness Skills in Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:1049-1059. [PMID: 33252669 DOI: 10.1093/ecco-jcc/jjaa245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS The incidence of inflammatory bowel disease [IBD] diagnosed before adulthood is increasing worldwide. Transition from paediatric to adult health care requires certain skills. The aim of this study was to identify factors affecting these skills. METHODS This review was registered on the PROSPERO database [CRD42019152272]. Inclusion criteria were: 1] studies of factors affecting transition readiness skills in patients with IBD; 2] written in English; 3] published since 1999. MEDLINE, CINAHL, and PsychINFO databases were searched between 1999 and 2019. Quality was assessed using the Joanna Briggs Institute critical appraisal tools. RESULTS Searches identified 822 papers. Sixteen papers were included. Age was positively associated with skills including disease knowledge and performing self-management behaviours [14 studies]. Improvement often occurs at 18; however, skill deficiency may still remain. Increased self-efficacy [confidence] was associated with greater disease knowledge and performing self-management behaviours [three studies]. Self-efficacy was positively correlated with transition duration [two studies] and health-related quality of life [r = 0.57, p <0.001] [one study], negatively correlated with depression [r = -0.57, p <0.001] and anxiety [r = -0.23, p = 0.03] [one study], and was associated with higher education level [two studies] and a family history of IBD [one study]. Females had higher self-management scores [three studies], and greater health care satisfaction was significantly associated with higher knowledge [one study]. Greater transition communication improved knowledge, self-management, and overall transition readiness [two studies]. CONCLUSIONS Potentially modifiable factors have been identified that could be supported in the transitioning IBD population, to improve transition readiness. Identification of those with non-modifiable characteristics associated with poor readiness may aid targeted support.
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Affiliation(s)
| | - Matthew J Lee
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rhys Turner-Moore
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | | | - Alenka J Brooks
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield Children's Hospitals, Sheffield, UK
| | - Georgina L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Alan J Lobo
- Academic Department of Gastroenterology, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Chinman M, Goldberg R, Daniels K, Muralidharan A, Smith J, McCarthy S, Medoff D, Peeples A, Kuykendall L, Vineyard N, Li L. Implementation of peer specialist services in VA primary care: a cluster randomized trial on the impact of external facilitation. Implement Sci 2021; 16:60. [PMID: 34099004 PMCID: PMC8183089 DOI: 10.1186/s13012-021-01130-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over 1100 veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs)—those with formal training who support other veterans with similar diagnoses. A White House Executive Action mandated the pilot reassignment of VHA PSs from their usual placement in mental health to 25 primary care Patient Aligned Care Teams (PACTs) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PSs in PACTs, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in new settings. Methods This study was a cluster-randomized hybrid II effectiveness-implementation trial to test the impact of minimal implementation support vs. facilitated implementation on the deployment of VHA PSs in PACT over 2 years. Twenty-five Veterans Affairs Medical Centers (VAMCs) were recruited to reassign mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n = 7, 10, 8) over 6-month blocks were matched and randomized to each study condition. In facilitated implementation, an outside expert worked with site stakeholders through a site visit and regular calls, and provided performance data to guide the planning and address challenges. Minimal implementation sites received a webinar and access to the VHA Office of Mental Health Services work group. The two conditions were compared on PS workload data and veteran measures of activation, satisfaction, and functioning. Qualitative interviews collected information on perceived usefulness of the PS services. Results In the first year, sites that received facilitation had higher numbers of unique veterans served and a higher number of PS visits, although the groups did not differ after the second year. Also, sites receiving external facilitation started delivering PS services more quickly than minimal support sites. All sites in the external facilitation condition continued in the pilot into the second year, whereas two of the sites in the minimal assistance condition dropped out after the first year. There were no differences between groups on veterans’ outcomes—activation, satisfaction, and functioning. Most veterans were very positive about the help they received as evidenced in the qualitative interviews. Discussion These findings demonstrate that external facilitation can be effective in supporting the implementation of PSs in primary care settings. The lack of significant differences across conditions after the second year highlights the positive outcomes associated with active facilitation, while also raising the important question of whether longer-term success may require some level of ongoing facilitation and implementation support. Trial registration This project is registered at ClinicalTrials.gov with number NCT02732600 (URL: https://clinicaltrials.gov/ct2/show/NCT02732600).
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Affiliation(s)
- Matthew Chinman
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA. .,RAND Corporation, Pittsburgh, PA, USA.
| | - Richard Goldberg
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research-Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Karin Daniels
- Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Anjana Muralidharan
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Jeffrey Smith
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Sharon McCarthy
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Deborah Medoff
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research-Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Amanda Peeples
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Lorrianne Kuykendall
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Natalie Vineyard
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Lan Li
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research-Department of Psychiatry, School of Medicine, University of Maryland, Baltimore, MD, USA
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Drenkard C, Easley K, Bao G, Dunlop-Thomas C, Lim SS, Brady T. Overcoming barriers to recruitment and retention of African-American women with SLE in behavioural interventions: lessons learnt from the WELL study. Lupus Sci Med 2021; 7:7/1/e000391. [PMID: 32532797 PMCID: PMC7295441 DOI: 10.1136/lupus-2020-000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/27/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
Background African–Americans are historically under-represented in SLE studies and engaging them in behavioural interventions is challenging. The Women Empowered to Live with Lupus (WELL) study is a trial conducted to examine the effectiveness of the Chronic Disease Self-Management Program (CDSMP) among African–American women with SLE. We describe enrolment and retention challenges and successful strategies of the WELL study. Methods The Georgians Organized Against Lupus (GOAL) cohort, a population-based cohort established in Atlanta, Georgia, was used to enrol a sample of 168 African–American women with SLE into the CDSMP. The CDSMP is a 6-week, group-based programme led by peers to enhance self-management skills in people with chronic conditions. Study performance standards were predefined and close monitoring of recruitment and retention progress was conducted by culturally competent staff members. Continuous contact with participants, research coordinators’ notes and regular research team meetings served to assess barriers and define strategies needed to meet the desired recruitment and retention outcomes. Results While no substantial barriers were identified to enrol GOAL participants into the WELL study, WELL participants faced difficulties registering for and/or completing (attending ≥4 sessions) a CDSMP workshop. Major barriers were unpredicted personal and health-related issues, misunderstanding of the scope and benefits of the intervention, and transportation problems. Early implementation of tailored strategies (eg, CDSMP scheduled on Saturdays, CDSMP delivered at convenient/familiar facilities, transportation services) helped to reduce participant barriers and achieve a CDSMP registration of 168 participants, with 126 (75%) completers. Frequent contact with participants and compensation helped to reach 92.3% retention for the 6-month survey. Conclusions Predefined standards and monitoring of participant barriers by a culturally competent research team and proactive solutions were critical to implementing successful strategies and achieving the desired recruitment and retention outcomes of a behavioural trial involving African–American women with SLE. Trial registration number NCT02988661.
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Affiliation(s)
- Cristina Drenkard
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Gaobin Bao
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charmayne Dunlop-Thomas
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Teresa Brady
- Clarity Consulting and Communications, Atlanta, Georgia, USA
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Wang F, Boros S. Aerobic Walking Exercise and Lifestyle Habits Interact with Sleep Quality, Stress, and Life Satisfaction: Results from a Randomized Crossover Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1877219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Muralidharan A, Peeples A, Lucksted A. Health Behavior Change Processes Among Adults With Serious Mental Illness Engaged in Illness Self-Management. QUALITATIVE HEALTH RESEARCH 2021; 31:1155-1168. [PMID: 33588639 PMCID: PMC8106668 DOI: 10.1177/1049732321992049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Self-management interventions promote illness management among adults with chronic health conditions. Little is known regarding the processes by which these interventions have their effects. The present study examined how Living Well, an effective self-management intervention for adults with serious mental illness, led to health behavior change in a randomized controlled trial. A convenience subset (N = 15) of participants completed qualitative interviews regarding the feasibility/acceptability of Living Well. An inductive secondary qualitative analysis, using a combination of interpretive phenomenological and social constructivist approaches, was conducted to examine processes of change. Results indicate that Living Well provided information and knowledge, opportunities for learning from others and real-world practice, and an interpersonally supportive environment. These active ingredients led to enhanced self-awareness, confidence, sense of control, and behavior and health status changes among participants. These findings are considered in the context of prominent behavior change theories such as social cognitive theory and self-regulation.
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Affiliation(s)
- Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amanda Peeples
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alicia Lucksted
- VA Capitol Healthcare Network (VISN 5), Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
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50
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Campbell D, Wilson O'Raghallaigh J, O'Doherty V, Lunt V, Lowry D, Mulhern S, Lonergan K, McSharry K, Lynnott J, Forry M, Evans D, Pardoe P, Ward H, Hevey D. Investigating the impact of a chronic disease self-management programme on depression and quality of life scores in an Irish sample. PSYCHOL HEALTH MED 2021; 27:1609-1617. [PMID: 33902360 DOI: 10.1080/13548506.2021.1916953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Depression is more common among people with chronic conditions than in the general population and can negatively influence both health behaviours and outcomes. The Chronic Disease Self-Management Programme (CDSMP) is a six-week psycho-educational programme designed to promote self-efficacy and to teach patients skills for managing their chronic conditions. A longitudinal design evaluated the effect of the CDSMP on depression in an Irish cohort. Self-report data on psychological wellbeing were collected at baseline (n = 263), immediately post-program (n = 102), and six months (n = 81) after enrolment. CDSMP participation was associated with a significant decrease in the mean depression score of the whole sample, across the three time points. Significant improvements in quality of life and health interference in social activities were also observed among those who met criteria for depression on the PHQ-8 at baseline, but not their peers with sub-threshold depression scores. Quality of life continued to improve between the end of the programme and 6-month follow-up. These findings support the efficacy of the CDSMP in the treatment of chronic conditions, as well as its role in promoting sustainable changes to quality of life.
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Affiliation(s)
- Dónal Campbell
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Victoria Lunt
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Katie Lonergan
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Mary Forry
- CDSMP Ireland Research Group, Dublin, Ireland
| | - David Evans
- CDSMP Ireland Research Group, Dublin, Ireland
| | | | - Harry Ward
- CDSMP Ireland Research Group, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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