Patient Perspectives on a Tailored Self-Management Education and Support Intervention for Low-Income Seniors With Chronic Health Conditions

Background

The Assessing Outcomes of Enhanced Chronic Disease Care Through Patient Education and a Value-based Formulary Study (ACCESS) was a 2 x 2 factorial randomized trial that tested the impact of a tailored self-management education support (SMES) program, which demonstrated a 22% reduction in adverse clinical events. We sought to qualitatively explore participants' perspectives on the SMES intervention, and the ways in which it may have improved self-management skills.

Methods

We used a qualitative descriptive approach and conducted individual semistructured interviews. We conducted inductive and deductive thematic analysis using NVivo 12 (QSR International, Burlington, MA).

Results

We interviewed 20 participants who had recently completed the 3-year SMES intervention. The following 3 main themes emerged from the data: (i) empowerment; (ii) intervention acceptability; and (iii) suggestions for improvement. Regarding empowerment, we identified subthemes of health literacy, self-efficacy, self-management, and active role in health. Several participants reported that empowerment promoted health behaviour change or improved confidence in self-management. Regarding acceptability, we identified subthemes of ease of use and presentation style. Most participants expressed positive feelings toward the intervention and felt that it was easy to understand. Finally, we identified subthemes of learning style, content, and engagement strategies, within the theme of suggestions for improvement. Some participants said that the messages were too general and did not fully address the complex health concerns they had.

Conclusions

Our results highlighted key strategies to promote patient engagement and self-management behaviours and demonstrated how they may have been used to improve clinical endpoints. Additionally, we demonstrated the novel use of marketing principles in SMES interventions.

Managing 'sick days' in patients with chronic conditions: An exploration of patient and healthcare provider experiences

INTRODUCTION

People with chronic medical conditions often take medications that improve long-term outcomes but which can be harmful during acute illness. Guidelines recommend that healthcare providers offer instructions to temporarily stop these medications when patients are sick (i.e., sick days). We describe the experiences of patients managing sick days and of healthcare providers providing sick day guidance to their patients.

METHODS

We undertook a qualitative descriptive study. We purposively sampled patients and healthcare providers from across Canada. Adult patients were eligible if they took at least two medications for diabetes, heart disease, high blood pressure and/or kidney disease. Healthcare providers were eligible if they were practising in a community setting with at least 1 year of experience. Data were collected using virtual focus groups and individual phone interviews conducted in English. Team members analyzed transcripts using conventional content analysis.

RESULTS

We interviewed 48 participants (20 patients and 28 healthcare providers). Most patients were between 50 and 64 years of age and identified their health status as 'good'. Most healthcare providers were between 45 and 54 years of age and the majority practised as pharmacists in urban areas. We identified three overarching themes that summarize the experiences of patients and healthcare providers, largely suggesting a broad spectrum in approaches to managing sick days: Individualized Communication, Tailored Sick Day Practices, and Variation in Knowledge of Sick Day Practices and Relevant Resources.

CONCLUSION

It is important to understand the perspectives of both patients and healthcare providers with respect to the management of sick days. This understanding can be used to improve care and outcomes for people living with chronic conditions during sick days.

PATIENT OR PUBLIC CONTRIBUTION

Two patient partners were involved from proposal development to the dissemination of our findings, including manuscript development. Both patient partners took part in team meetings and contributed to team decision-making. Patient partners also participated in data analysis by reviewing codes and theme development. Furthermore, patients living with various chronic conditions and healthcare providers participated in focus groups and individual interviews.

Diabetes in the context of incarceration: A scoping review

Background

The burden of chronic conditions, like diabetes, is disproportionately carried by people facing social disadvantages (e.g., those with experiences of incarceration). A dearth of knowledge remains about this topic. We conducted a scoping review to determine the extent of literature about diabetes management and/or self-management in relation to incarceration.

Methods

We used the Arksey and O'Malley five stage process, recommendations by Levac et al., and the PRISMA Extension for Scoping Reviews Checklist. Core search terms for diabetes were combined using the Boolean operator AND with terms relevant to incarceration. We initially searched the following electronic academic databases on January 5, 2021, and then updated these searches on September 7, 2022: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX. There were no restrictions on language, study design, quality, location, time, and sex or gender differences. We searched for research articles, conference proceedings, dissertations and theses, government documents, and organization documents. We then searched for other forms of literature using an electronic database (ProQuest Dissertations and Theses - Global), the internet search engine Google, and various corrections and diabetes websites in August 2021 and then updated these searches in September 2022. We also reviewed the reference lists of the final selected documents to identify additional literature.

Findings

The search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review. The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most commonly investigated. Clinical outcomes were often reported. Most guidelines were targeted at healthcare providers. Much of the literature originated from high-income countries, which may not be fully applicable for different contexts like low-income countries. Many interventions were associated with improved outcomes.

Interpretation

Administrators can use our findings to develop appropriate policies for this population. Tailored diabetes education for this population and healthcare providers may improve management practices. Our findings offer key insights for improving diabetes care and outcomes for this underserved population. Addressing the diabetes-specific health needs of these people may improve overall public health.

Funding

KD has received the O'Brien Institute for Public Health Postdoctoral Scholarship (University of Calgary), Cumming School of Medicine Postdoctoral Scholarship (University of Calgary), and the Libin Cardiovascular Institute's 2021 Person to Population Seed Grant (University of Calgary).

The implementation of correctional nursing practice-Caring behind bars: A grounded theory study

AIM

To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health).

DESIGN

Straussian grounded theory.

METHODS

Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed.

RESULTS

The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements.

CONCLUSION

Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements.

IMPACT

The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

South Asians' experience of managing hypertension: a grounded theory study

OBJECTIVE

We examined the process that South Asians undergo when managing their hypertension (HTN).

METHOD

Using grounded theory methods, 27 community-dwelling English-, Punjabi-, or Hindi-speaking South Asian participants (12 men and 15 women), who self-identified as having HTN were interviewed. Transcripts were analyzed using constant comparison.

RESULTS

The core category was "fitting it in". First, the participants assessed their diagnosis and treatment primarily in the context of their current family/social environment. Participants who paid attention to their diagnosis either fully or partly embraced activities and attitudes associated with successful management of hypertension. However, those who did not attend to their diagnosis, identified other familial/social factors, stress of immigration, and not having symptoms of their disease as barriers. The longer the time since diagnosis of HTN, the more participants came to appropriately manage their HTN.

CONCLUSION

Healthcare providers may use this information to enhance their cultural understanding of how and why South Asians manage their HTN.

Correctional nursing and transformational leadership

Transformational leadership (TL) is a highly discussed approach in the literature for many professions. Likewise, the TL approach continues to be explored in a myriad of nursing contexts to demonstrate its advantages for practice and client health. The tension between custody and care is particular to correctional nursing practice, such as the correctional priorities of safety and security that often override caring-focused nursing practice. Presented herein, is information relating to correctional nursing leadership as found in the minimal, available literature; and hypothetical examples of how correctional nursing leaders can use TL are provided. Measuring the influence of TL on practice and offender health can assist in determining if this approach is an appropriate "fit" for the correctional nursing context. The dearth of literature regarding correctional nursing leadership must be addressed to advance this subspecialty of nursing and promote offender health. The intent is not to argue that TL is the only applicable leadership approach for this subspecialty of nursing. Rather, introductory insight is offered regarding the suitability of TL in correctional nursing practice.

Use of Mixed Methods Research in Research on Coronary Artery Disease, Diabetes Mellitus, and Hypertension: A Scoping Review

BACKGROUND

Mixed methods research, the use of both qualitative and quantitative methods within 1 program of study, is becoming increasingly popular to allow investigators to explore patient experiences (qualitative) and also measure outcomes (quantitative). Coronary artery disease and its risk factors are some of the most studied conditions; however, the extent to which mixed methods studies are being conducted in these content areas is unknown. We sought to comprehensively describe the characteristics of published mixed methods studies on coronary artery disease and major risk factors (diabetes mellitus and hypertension).

METHODS AND RESULTS

We conducted a scoping review of the literature indexed in PubMed, Medline, EMBASE, and CINAHL. We identified 811 abstracts for screening, of which 254 articles underwent full-text review and 97 reports of 81 studies met criteria for inclusion. The majority of studies in this area were conducted in the past 10 years by nurse researchers from the United States and United Kingdom. Diabetes mellitus was the most common content area for mixed methods investigation (compared with coronary artery disease and hypertension). Most authors described their rationale for using mixed methods as complementarity and did not describe study priority or how they reconciled differences in methodological paradigms. Some mixed methods study designs were more commonly used than others, including concurrent timing and integration at the interpretation stage. Qualitative strands were most commonly descriptive studies using interviews for data collection. Quantitative strands were most commonly cross-sectional observational studies, which relied heavily on self-report data such as surveys and scales.

CONCLUSIONS

Although mixed methods research is becoming increasingly popular in the area of coronary artery disease and its risk factors, many of the more advanced mixed methods, qualitative, and quantitative techniques have not been commonly used in these areas.

Exploring the impact of financial barriers on secondary prevention of heart disease

BACKGROUND

Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease.

METHODS

We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking.

RESULTS

The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems.

CONCLUSION

Financial barriers impacted patients' ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients' self-advocacy and navigation skills may assist in improving patient health outcomes.