The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes

Integrative model for self-perception of well-being in cancer

PURPOSE

Continual illness uncertainty can affect how people perceive and interpret their well-being. Some cognitive and spiritual factors may be involved in the management of disruptive thoughts and emotions that can emerge during the experience of cancer.

MATERIAL AND METHODS

An evidence-based integrative model was developed to evaluate and show the role that mindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life play in the self-perception of well-being in individuals with cancer. This evidence-based integrative model was conducted using relevant and selected studies.

RESULTS

An integrative model for self-perception of well-being has been proposed. This model integrates evidence-based findings and provides clear principles for clinicians and researchers. This integrative model proposes that mindfulness, acceptance, self-efficacy perception, and uncertainty can predict how people with cancer perceive their well-being. The model also posits that meaning and purpose in life can act as mediators or moderators of this prediction.

CONCLUSIONS

This integrative model involves the multidimensionality of human beings and facilitates the understanding of some key factors for the design of therapeutic approaches such as Acceptance & Commitment Therapy or Meaning-Centered Psychotherapy.IMPLICATIONS FOR REHABILITATIONMindfulness, acceptance, self-efficacy, uncertainty, meaning, and purpose in life can be highly relevant for clinical oncology.An integrative model is proposed to understand the combined influence of these factors on patients with cancer.This model may favor a better integration of well-known interventions, such as Mindfulness-based approaches, Acceptance and Commitment Therapy (ACT), and Meaning-Centered Psychotherapy (MCP).

Self-management for sickle cell disease among patients and parents: A qualitative study

OBJECTIVE

This study aimed to explore self-management practices among patients and parents of children with sickle cell disease (SCD).

METHODS

The qualitative descriptive design was employed. The study involved 19 participants comprising adult SCD patients ≥16 years, and nine parents of SCD children ≤ 15 years. Purposive sampling was conducted to select participants from a teaching hospital and SCD association. Data was collected using one-on-one interviews, transcribed verbatim, and analysed using qualitative content analysis.

RESULTS

Self-management was reported through four categories including preventive health, self-monitoring, self-diagnosis, and self-treatment. Hydration, nutrition, activity limitation, avoidance of cold temperatures, and supportive medications were the most common preventive health actions. Regarding self-monitoring and self-diagnosis, the parents emphasized objective indicators such as changes in urine and eye colour compared to the adults who utilize subjective indicators such as feeling unwell and easy fatigue. Pharmacological and non-pharmacological measures were reported by both groups for treating painful episodes, fever, leg ulcers, priapism, and unspecified symptoms.

DISCUSSION

The participants in this study practice several self-management actions with some differences in application between adults and children. Tailored self-management services may be helpful for adults and children when developing services for SCD patients.

Association between health literacy and self-management among middle-aged women: A systematic review

OBJECTIVE

We aimed to review and synthesize the literature on the association between health literacy (HL) and self-management in middle-aged women aged 35-64 years and examine the definitions and measurements of HL.

METHODS

Eleven electronic databases were used for searching specific terms. Experimental and non-experimental studies in English or Korean were included based on the eligibility criteria. Two authors independently conducted study selection, data extraction, and methodological quality assessment.

RESULTS

One experimental and 13 non-experimental studies were included. Of the 11 studies that defined HL, nine conceptualized it as reflecting multidimensional HL. Four studies measured HL capturing all dimensions of the concept (i.e., accessing, understanding, appraising, and applying) and two studies used context-specific HL measurements. Women with greater HL challenges generally had lower self-management context, process, and outcomes across the health continuum.

CONCLUSIONS

Enhancing HL is a critical strategy for improving self-management in middle-aged women. Future research should investigate the effectiveness of HL interventions on self-management considering multidimensional definitions and measures of HL.

PRACTICE IMPLICATIONS

Health professionals should be alert to middle-aged women's HL and implement HL interventions that provide them with opportunities to access, understand, analyze, and utilize health-related information to effectively improve HL and engage in self-management.

Exploring the relationship between illness perception, self-management and quality of life among HIV-positive men who have sex with men

AIMS

This study aimed to explore the mediating effect of self-management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM).

DESIGN

A cross-sectional study.

METHODS

We explored the effect of illness perception and self-management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL.

RESULTS

Among 300 Chinese HIV-positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0-54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = -0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self-management health practices and the chronic nature of the self-management domain played a parallel role in mediating the relationship between illness perception and QOL.

CONCLUSION

Our study demonstrated that SM was a significant factor influencing QOL among HIV-positive MSM. Focusing on daily self-management health practices and the chronic nature of self-management could be the potential key targets for enhancing HIV self-management strategies.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study emphasized the role of SM in the well-being of HIV-positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The importance of self-management for better treatment outcomes for HIV patients in a low-income setting: perspectives of HIV experts and service providers

BACKGROUND

Self-management is the most important strategy to improve quality of life in patients with a chronic disease. Despite the increasing number of people living with HIV (PLWH) in low-income countries, very little research on self-management is conducted in this setting. The aim of this research is to understand the perspectives of service providers and experts on the importance of self-management for PLWH.

METHODS

A systematizing expert interview type of qualitative methodology was used to gain the perspectives of experts and service providers. The study participants had experience in researching, managing, or providing HIV service in east and southern African (ESA) countries. All the interviews were audio recorded, transcribed, and translated to English. The quality of the transcripts was ensured by randomly checking the texts against the audio record. A thematic analysis approach supported by Atlas TI version 9 software.

RESULT

PLWH face a variety of multi-dimensional problems thematized under contextual and process dimensions. The problems identified under the contextual dimension include disease-specific, facility-related, and social environment-related. Problems with individual origin, such as ignorance, outweighing beliefs over scientific issues, low self-esteem, and a lack of social support, were mostly highlighted under the process dimensions. Those problems have a deleterious impact on self-management, treatment outcomes, and the quality of life of PLWH. Low self-management is also a result of professional-centered service delivery in healthcare facilities and health service providers' incapacity to comprehend a patient's need beyond the medical concerns. Participants in the study asserted that patients have a significant stake in enhancing treatment results and quality of life through enhancing self-management.

CONCLUSION AND RECOMMENDATION

HIV patients face multifaceted problems beyond their medical issues. The success of medical treatment for HIV is strongly contingent upon patients' self-management practices and the supportive roles of their family, society, and health service providers. The development and integration of self-management practices into clinical care will benefit patients, their families, and the health system.

Mixed-Methods Study of Disability Self-Management in Mexican Americans With Osteoarthritis

BACKGROUND

Health disparities in osteoarthritis (OA) outcomes exist both in the occurrence and treatment of functional limitation and disability for Mexican Americans. Although the effect of self-management of chronic illness is well established, studies demonstrate little attention to self-management of function or disability, despite the strong potential effect on both and, consequently, on patients' lives.

OBJECTIVE

The purpose of this study pilot was to develop and test key variable relationships for a measure of disability self-management among Mexican Americans.

METHODS

In this sequential, two-phased, mixed-methods, biobehavioral pilot study of Mexican American women and men with OA, a culturally tailored measure of disability self-management was created, and initial relationships among key variables were explored.

RESULTS

First, a qualitative study of 19 adults of Mexican American descent born in Texas (United States) or Mexico was conducted. The Mexican American Disability Self-Management Scale was created using a descriptive content analysis of interview data. The scale was tested and refined, resulting in 18 items and a descriptive frequency of therapeutic management efforts. Second, correlations between study variables were estimated: Disability and function were negatively correlated. Disability correlated positively with social support and activity effort. Disability correlated negatively with disability self-management, pain, and C-reactive protein. Function was positively correlated with age, pain, and depression. Liver enzymes (alanine transaminase) correlated positively with pain and anxiety.

DISCUSSION

This mixed-methods study indicates directions for further testing and interventions for disability outcomes among Mexican Americans.

Theoretical approaches in the development of interventions to promote breastfeeding: A scoping review

PROBLEM AND BACKGROUND

There is a low world rate of exclusive breastfeeding and a short duration of breastfeeding. More studies have constructed interventions to improve breastfeeding behavior, but the actual effect is not significant.

AIM

The purpose of this review is identifying the ways that various theories have an influence on theory-based breastfeeding intervention studies.

METHODS

A scoping review using Arksey and O'Malley's framework explored breastfeeding promotion practices. PubMed, The Cochrane Library, Web of Science, Embase, and CINAHL databases were searched from database creation to March 9, 2024. Building on previous research, key terms were used to search the literature. Data analysis involved descriptive and interpretive summaries of theories used and the proposed interventions.

FINDINGS

An online search yielded 906 articles, with 28 meeting the inclusion criteria for the scoping review, including 5 reviews and 23 articles. Reviews demonstrated that interventions based on theories were more effective. Articles promoting breastfeeding used theories of self-efficacy (n = 9), theory of planned behavior (n = 8), social cognitive theory (n = 5) and individual and family self-management theory (n = 1). These theories were used in developing specific content of the intervention program (n = 20, 86.9%), constructing the framework of the program (n = 10, 43.5%), and evaluating outcomes (n = 19, 82.6%). Most interventions focused on education, professional support, and/or peer support for breastfeeding.

CONCLUSION AND DISCUSSION

Theory can guide decisions and play a role in selecting a methodology or lens. Researchers should make deliberate choices in the use of a theory that relates to aspects of breastfeeding behavior. Future interventions based on theories should be more varied and effective and need to consider families' and social factors.

How Does Anticipated HIV Stigma Affect Medication Adherence? A Longitudinal Path Analysis Model

Prior research has documented that anticipated HIV stigma may play an important predictive role in medication adherence among people living with HIV (PLWH). However, longitudinal data on the mechanisms underlying this linkage are scarce. The current study aimed to explore the longitudinal mediation association among anticipated HIV stigma, medication adherence support, HIV self-management, and medication adherence. A four-wave sample consisting of 1,098 Chinese PLWH (Mage = 38.63, SD = 9.20; 63.9% male) with a six-month interval was used in the current study. Participants were asked to complete self-report questionnaires. A path analysis model was analyzed. Results indicate that anticipated HIV stigma at baseline was positively related to medication adherence at Time 4 (T4). Medication adherence support at Time 2 (T2) and HIV self-management at Time 3 (T3) serially mediated the anticipated HIV stigma at Time 1 (T1) and medication adherence at T4. These findings provide critical insights into the mediating roles of medication adherence support and HIV self-management in the relationship between anticipated HIV stigma and medication adherence over time. Such an understanding has important implications for the development of tailored interventions and public health strategies aimed at improving medication adherence among PLWH in the context of HIV-related stigma.

Trajectories of self-management and independence in youth with spina bifida: Family-related predictors of growth

The purpose of this study was to assess family-related predictors of self-management trajectories in youth with spina bifida (SB). Participants with SB completed the Adolescent/Young Adult Self-Management and Independence Scale (AMIS II) interview across four time points. Family functioning, family-related stress, and perceived family support were assessed by multiple reporters and multiple methods. Growth in AMIS II total self-management and the AMIS II subscales (Condition and Independent Living) were estimated using linear mixed effect models as a function of family factors, after controlling for socio-demographic, condition-related, and neuropsychological variables that had been found to be significant predictors of self-management in prior studies. Model fit and parsimony were assessed using Akaike's information criterion (AIC). This diverse community sample included 99 respondents aged 18-27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and 32.3% were Hispanic/Latino. Observed family cohesion at baseline was associated with all self-management scales at age 18 (all p < 0.05). Growth in self-management was associated with parent-reported number of family stress events. For growth in total self-management, the best model included age, race/ethnicity, family income, shunt status, lesion level, neuropsychological function, observed family cohesion, and an age-by-number of family stress events interaction effect. The study findings suggested that family factors were important predictors of self-management trajectories, even after controlling for socio-demographic, condition-related, and neuropsychological covariates. Risk and protective factors identified in families of youth with SB can inform family-focused interventions for self-management.

The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial

Background

In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues.

Objective

This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels.

Methods

This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention.

Results

Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50%) and control (n=60, 50%) groups. Of the 120 participants, 93 (77.5%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (β=0.617, 95% CI 0.104-1.129; P=.02 and β=1.300, 95% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week (β=1.667, 95% CI -3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week (β=6.287, 95% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43).

Conclusions

Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout.

The effect of a fatigue self-management program based on individual and family self-management theory in cancer patients: A single-blinded randomized controlled trial

PURPOSE

This study was conducted to investigate the effect of the Fatigue Self-Management Program based on the Individual and Family Self-Management Theory on fatigue, daily living activities, and well-being in cancer patients.

METHODS

This randomized controlled single-blind experimental study was carried out between November 2020 and April 2022. A total of 94 patients with advanced cancer, 47 in each group, were included in the study, and 57 participants completed the study. Data were collected using the Brief Fatigue Inventory, Katz Index of Independence in Activities of Daily Living, and Well-Being Questionnaire-22. The Fatigue Self-Management Program based on Individual and Family Self-Management Theory was delivered to the intervention group with two face-to-face and two tele-monitoring sessions. No intervention was applied to the control group, who received only routine care.

RESULTS

The mean score of fatigue in the intervention group compared to the control group decreased, and the difference was statistically significant (p < .05); daily living activities mean scores were higher than the control group, but there was no statistically significant difference (p > .05). The mean scores of depression and anxiety in the intervention group were lower than those in the control group; energy, positive well-being, and general well-being mean scores were found to be higher than those in the control group, and the difference was statistically significant (p < .05).

CONCLUSIONS

The Fatigue Self-Management Program effectively reduces the fatigue experienced by cancer patients and increases their well-being but it does not increase their independence in daily living activities.

CLINICAL TRIAL REGISTRY

NCT04822220.

Development and psychometric evaluation of the Symptom Self-Management Behaviors Tool for adolescents/young adults with cancer

OBJECTIVES

Adolescents and Young Adults (AYAs) with cancer experience symptoms related to disease and treatment. To manage these symptoms, they need to develop self-management behaviors, yet no tool exists to assess these behaviors. The Symptom Self-Management Behaviors Tool (SSMBT) was developed to meet this need.

METHODS

The study consisted of 2 phases. Phase 1 evaluated content validity, and Phase 2 evaluated reliability and validity. The SSMBT initially contained 14 items with 2 dimensions: (1) behaviors used to Manage Symptoms and (2) behaviors used to communicate with providers regarding symptoms. Four oncology professionals and 5 AYAs with cancer assessed the content validity. Evaluation of reliability and validity involved 61 AYAs with cancer. Reliability was evaluated using Cronbach's alpha. Construct validity was assessed with factor analysis. Discriminant validity was assessed using associations with symptom severity and distress.

RESULTS

Content validity evaluation supported the importance of the items. Factor analysis supported a two-factor structure: Manage Symptoms (8 items) and Communicate with Healthcare Providers (4 items) subscales. Internal consistency reliability for the total SSMBT was acceptable with Cronbach's alpha = 0.74. Cronbach's alpha value for the Manage Symptoms subscale was α = 0.69 and for the Communicate with Healthcare Providers subscale was α = 0.78. The SSMBT total and the Manage Symptoms subscale scores were moderately correlated with symptom severity (r = 0.35, p = 0.014; r = 0.44, p = 0.002, respectively), partially supporting discriminant validity.

SIGNIFICANCE OF RESULTS

Systematic assessment of behaviors AYAs use is critical for clinical practice and evaluate interventions to improve self-management. The SSMBT demonstrates initial reliability and validity but requires further evaluation for clinical interpretation and future use.

Positive Affect and Physical Activity Associations in Women and Their Spouses

BACKGROUND

Only 21% of U.S. women meet the recommended physical activity guidelines, placing them at increased risk for long-term conditions such as heart disease and diabetes. Physical activity is influenced by individual and interpersonal factors (e.g., romantic partners). Individual factors, such as positive affect, are associated with lower mortality risk and improved health behaviors.

OBJECTIVES

This secondary data analysis, guided by Fredrickson's Broaden and Build Theory, aims to examine the relationship between positive affect of married women (n = 115 couples) and their physical activity behavior on the same- and next- day, while also considering their spouses' positive affect.

METHODS

Two population average models assessed the relationship of calm and happy (positive affect) to physical activity. Physical activity was assessed as the sum of the minutes of moderate-to-vigorous physical activity (MVPA) over the prior 24 hours. Covariates of age, baseline activity frequency, education, marital quality, and race/ethnicity were also included.

RESULTS

Women's happiness (β = 0.15, p < .005), not calmness (β = -0.03, p = .60), was found to have a significant association with same-day MVPA. Spouses' happiness (β = 0.11, p = .045) was significantly associated with women's next-day MVPA while their calmness (β = -0.04, p = .44) was not.

CONCLUSIONS

The results of this study support that incorporating positive affect could be valuable for improving physical activity behaviors. Spouse reports provide additional context to consider in physical activity promotion research.

Mobile Apps for Common Noncommunicable Disease Management: Systematic Search in App Stores and Evaluation Using the Mobile App Rating Scale

Background

The success of mobile apps in improving the lifestyle of patients with noncommunicable diseases through self-management interventions is contingent upon the emerging growth in this field. While users of mobile health (mHealth) apps continue to grow in number, little is known about the quality of available apps that provide self-management for common noncommunicable diseases such as diabetes, hypertension, and obesity.

Objective

We aimed to investigate the availability, characteristics, and quality of mHealth apps for common noncommunicable disease health management that included dietary aspects (based on the developer's description), as well as their features for promoting health outcomes and self-monitoring.

Methods

A systematic search of English-language apps on the Google Play Store (Google LLC) and Apple App Store (Apple Inc) was conducted between August 7, 2022, and September 13, 2022. The search terms used included weight management, obesity, diabetes, hypertension, cardiovascular diseases, stroke, and diet. The selected mHealth apps' titles and content were screened based on the description that was provided. Apps that were not designed with self-management features were excluded. We analyzed the mHealth apps by category and whether they involved health care professionals, were based on scientific testing, and had self-monitoring features. A validated and multidimensional tool, the Mobile App Rating Scale (MARS), was used to evaluate each mHealth app's quality based on a 5-point Likert scale from 1 (inadequate) to 5 (excellent).

Results

Overall, 42 apps were identified. Diabetes-specific mHealth apps accounted for 7% (n=3) of the market, hypertension apps for 12% (n=5), and general noncommunicable disease management apps for 21% (n=9). About 38% (n=16) of the apps were for managing chronic diseases, while 74% (n=31) were for weight management. Self-management features such as weight tracking, BMI calculators, diet tracking, and fluid intake tracking were seen in 86% (n=36) of the apps. Most mHealth apps (n=37, 88%) did not indicate whether there was involvement of health professionals in app development. Additionally, none of the apps reported scientific evidence demonstrating their efficacy in managing health. The overall mean MARS score was 3.2 of 5, with a range of 2.0 to 4.1. Functionality was the best-rated category (mean score 3.9, SD 0.5), followed by aesthetics (mean score 3.2, SD 0.9), information (mean score 3.1, SD 0.7), and engagement (mean score 2.9, SD 0.6).

Conclusions

The quality of mHealth apps for managing chronic diseases was heterogeneous, with roughly half of them falling short of acceptable standards for both quality and content. The majority of apps contained scant information about scientific evidence and the developer's history. To increase user confidence and accomplish desired health outcomes, mHealth apps should be optimized with the help of health care professionals. Future studies on mHealth content analysis should focus on other diseases as well.

Feasibility of a family-oriented mHealth intervention for Chinese Americans with type 2 diabetes: A pilot randomized control trial

OBJECTIVES

To test the feasibility, acceptability, and potential efficacy of a mHealth intervention tailored for Chinese immigrant families with type 2 diabetes (T2D).

METHODS

We conducted a pilot randomized controlled trial (RCT) with baseline, 3-, and 6-month measurements. Participating dyads, T2D patients and families/friends from NYC, were randomized into the intervention group (n = 11) or the wait-list control group (n = 12). Intervention includes 24 videos covering T2D self-management, behavioral techniques, and family-oriented sessions. Feasibility and acceptability were measured respectively by the retention rate and video watch rate, and a satisfaction survey. Patients' HbA1c, weight, and self-management were also assessed to test potential efficacy.

RESULTS

Most T2D patients (n = 23; mean age 56.2±9.4 years; 52.2% male) and families/friends (n = 23, mean age 54.6±11.2 years; 52.2% female) had high school education or less (69.6% and 69.6%), annual household income < $25,000 (65.2% and 52.2%), and limited English proficiency (95.7% and 95.7%). The retention rates were not significantly different between the intervention and the control groups for both the patients (90.91% vs 83.3%, p = 0.589); and their families/friends (3-month: 90.9% vs 75%, p = 0.313; 6-month: 90.9% vs 83.3%, p = 0.589). The mean video watch rate was 76.8% (7%). T2D patients and families/friends rated satisfaction as 9.4 and 10 out of 10, respectively. Despite no between-group differences, the intervention group had significantly lower HbA1c (p = 0.014) and better self-management (p = 0.009), and lost 12 lbs. on average at 6 months (p = 0.079), compared to their baseline levels.

CONCLUSIONS

A culturally-tailored, family-based mHealth intervention is feasible and acceptable among low-income, limited English-proficient Chinese families with T2D in NYC. Significant changes in HbA1c and self-management within the intervention group indicate this intervention may have potential efficacy. Given the small sample size of this study, a future RCT with adequate power is needed to test efficacy.

Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study

BACKGROUND

The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR.

OBJECTIVE

Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease.

METHODS

One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties.

RESULTS

The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs.

CONCLUSIONS

The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design.

Self-management needs, strategies and support for sickle cell disease in developing countries: a scoping review protocol

INTRODUCTION

Sickle cell disease (SCD) poses a significant global health burden, particularly affecting individuals in developing countries with constrained healthcare resources. While research on self-management in the context of SCD is emerging, it has predominantly focused on primary studies, and there is a notable dearth of evidence synthesis on SCD self-management in developing countries. This scoping review aims to identify and map self-management needs of individuals living with SCD, the strategies they employed to meet those needs, and the support systems available to them.

METHODS AND ANALYSIS

The review will be conducted following the Arksey and O'Malley's (2005) 29 framework to comprehensively examine the landscape of SCD self-management research. Searches will be performed in PubMed, Scopus, Embase and Dimensions AI, with additional searches in other databases and grey literature. Indexed literature published in English from inception to January 2024 will be included. Reference list from included studies will also be searched manually. Two teams will be constituted to independently screen titles, abstracts and full text against the eligible criteria. Data will be extracted from included studies onto a customised data extraction form.

ETHICS AND DISSEMINATION

Ethical approval is not required for this review due to the fact that it synthesises information from available publications. The findings will be disseminated through publication in a peer-reviewed journal. Also, the findings will possibly be presented at relevant international and national conferences. This protocol has already been registered with the Open Science Framework. The study characteristics such as design and setting will be descriptively analysed and presented as graphs, tables and figures. Thematic analysis will also be conducted based on the study objectives and presented as a narrative summary.

Evaluating the Effectiveness of a Self-Management Program on Patients Living with Chronic Diseases

Background

Chronic diseases are a major public health concern globally, and the position in Saudi Arabia is no exception. The Chronic Disease Self-Management Program (CDSMP) is a widely used intervention process to address care of chronic conditions. However, its effectiveness in a Saudi context has not been extensively studied. Therefore, this study aimed at evaluating the post-intervention outcomes of the CDSMP in Saudi Arabia.

Materials and Methods

The study utilized a qualitative design on patients with chronic conditions. Data were collected through two focus group sessions with 15 participants who had completed the CDSMP. A thematic analysis technique was used for data analysis.

Results

Three key themes emerged from analysis of the qualitative data obtained through the focus groups: the perceived benefits from participation in the CDSMP workshop; the impact of the CDSMP workshop on improving health status and quality of life; and, the cultural acceptability of the CDSMP. The study also found that the CDSMP was effective in improving participants' self-management skills and quality of life. Additional benefits included increased motivation for behavioral change, enhanced confidence regarding self-care of chronic conditions, improved communication with healthcare providers, and better coping strategies.

Conclusion

This study provides valuable insights into the effectiveness of the CDSMP in addressing chronic conditions in Saudi Arabia. The program's emphasis on self-management skills and peer support aligns with the cultural values of Saudi Arabia. However, applying the CDSMP across various chronic conditions should be addressed in future interventions.

Software-based interventions for low back pain management: A systematic review and meta-analysis

INTRODUCTION

Using software for self-management interventions can improve health outcomes for individuals with low back pain, but there is a dearth of research to confirm its effectiveness. Additionally, no known research has evaluated the effective elements of software-based interventions for low back pain self-management components. This study aimed to synthesize the effectiveness of software-based interventions to promote self-management health outcomes among individuals with low back pain.

DESIGN

A systematic review and meta-analysis was conducted.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, relevant studies up to July 2022 were searched via four electronic databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science.

RESULTS

4908 adults with low back pain who participated in 23 studies were included. Software-based interventions were effective in reducing fear avoidance (mean difference [MD] = -0.95, 95% CI: -1.45 to -0.44), pain catastrophizing (MD = -1.31, 95% CI: -1.84 to -0.78), disability (MD = -8.21, 95% CI: -13.02 to -3.39), and pain intensity (MD = -0.86, 95% CI: -1.17 to -0.55). Specifically, interventions that included an exercise component were more effective in reducing pain and disability. Additionally, cognitive behavioral therapy (CBT) intervention significantly reduced fear avoidance and pain catastrophizing but had no noticeable impact on disability and pain compared to standard treatment. The certainty of the evidence in this review varied from very low to high across outcomes. The heterogeneity of the study results was significant, suggesting that future studies in this area could optimize the design, time points, measures, and outcomes to strengthen the evidence.

CONCLUSIONS

Low back pain self-management interventions delivered through software-based programs effectively reduce pain intensity, disability, fear avoidance, and pain catastrophizing.

CLINICAL RELEVANCE

Low back pain is among the most common reasons for seeking healthcare visits. Combining exercise and counseling through soft-based programs may effectively address this issue and its associated suffering and disability.

Health-Related Quality of Life of Post-Stroke Patients in a Public Hospital

This study aimed to identify the correlation between influencing factors of activities of daily living (ADLs), mental health, and health-related quality of life (HRQoL) among post-stroke patients who enrolled in a transitional care service in a public hospital. This cross-sectional study involved 67 stroke patients who were enrolled in a transitional care service and visited the outpatient clinic at a public hospital in Seoul between March and December 2022. Their general characteristics, ADLs, mental health, and HRQoL were assessed. The data were analyzed using independent samples t-tests, analysis of variance, and Pearson correlation analysis, and the influencing factors were analyzed using regression analysis. HRQoL showed a statistically significant difference between patients living in different types of arrangements (t = 2.50, p = 0.015), and patients scores on the modified Rankin Scale (t = 7.08, p < 0.001). HRQoL was also significantly correlated with ADLs and mental health in stroke patients (r = -0.59, p < 0.001; r = -0.41, p < 0.001, respectively). Meanwhile, stroke severity (β = -0.30, p = 0.002), living arrangements (β = -0.30, p = 0.009) and ADLs (β = -0.45, p < 0.001) were found to influence HRQoL (F = 6.87, p < 0.001, R2 = 0.47). Reduced dependence for ADLs, improvements in symptoms consequent to stroke, and support related to living arrangements contributed to improved HRQoL and interventions for post-stroke patients in the transitional care service of a public hospital.

A Qualitative Investigation on Chronic Disease Management and Prevention Among Older Adults During the COVID-19 Pandemic

PURPOSE

To qualitatively describe experiences of chronic disease management and prevention in older adults (age ≥65 years) during COVID-19.

APPROACH

Qualitative descriptive approach.

SETTING

Data collected online via telephone and video-conferencing technologies to participants located in various cities in British Columbia, Canada. Data analyzed by researchers in the cities of Vancouver and Kelowna in British Columbia.

PARTICIPANTS

Twenty-four community-living older adults (n = 24) age ≥65 years.

METHODS

Each participant was invited to complete a 30-to-45-minute virtual, semi-structured, one-on-one interview with a trained interviewer. Interview questions focused on experiences managing health prior to COVID-19 and transitioning experiences of practicing health management and prevention strategies during COVID-19. Audio recordings of interviews were transcribed verbatim and analyzed thematically.

RESULTS

The sample's mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (12.5% none, 12.5% one). Three themes described participants' strategies for chronic disease management and prevention: (1) having a purpose to optimize health (i.e., managing health challenges and maintaining independence); (2) internal self-control strategies (i.e., self-accountability and adaptability); and (3) external support strategies (i.e., informational support, motivational support, and emotional support).

CONCLUSION

Helping older adults identify purposes for their own health management, developing internal control strategies, and optimizing social support opportunities may be important person-centred strategies for chronic disease management and prevention during unprecedented times like COVID-19.

Efficacy of BETTER transitional care intervention for diverse patients with traumatic brain injury and their families: Study protocol of a randomized controlled trial

OBJECTIVE

The purpose of this study is to examine the efficacy of BETTER (Brain Injury, Education, Training, and Therapy to Enhance Recovery) vs. usual transitional care management among diverse adults with traumatic brain injury (TBI) discharged home from acute hospital care and families.

METHODS

This will be a single-site, two-arm, randomized controlled trial (N = 436 people, 218 patient/family dyads, 109 dyads per arm) of BETTER, a culturally- and linguistically-tailored, patient- and family-centered, TBI transitional care intervention for adult patients with TBI and families. Skilled clinical interventionists will follow a manualized protocol to address patient/family needs. The interventionists will co-establish goals with participants; coordinate post-hospital care, services, and resources; and provide patient/family education and training on self- and family-management and coping skills for 16 weeks following hospital discharge. English- and Spanish-speaking adult patients with mild-to-severe TBI who are discharged directly home from the hospital without inpatient rehabilitation or transfer to other settings (community discharge) and associated family caregivers are eligible and will be randomized to treatment or usual transitional care management. We will use intention-to-treat analysis to determine if patients receiving BETTER have a higher quality of life (primary outcome, SF-36) at 16-weeks post-hospital discharge than those receiving usual transitional care management. We will conduct a descriptive, qualitative study with 45 dyads randomized to BETTER, using semi-structured interviews, to capture perspectives on barriers and facilitators to participation. Data will be analyzed using conventional content analysis. Finally, we will conduct a cost/budget impact analysis, evaluating differences in intervention costs and healthcare costs by arm.

DISCUSSION

Findings will guide our team in designing a future, multi-site trial to disseminate and implement BETTER into clinical practice to enhance the standard of care for adults with TBI and families. The new knowledge generated will drive advancements in health equity among diverse adults with TBI and families.

TRIAL REGISTRATION

NCT05929833.

Exploring the Experience of Living with Pain after Spinal Cord Injury: A Qualitative Study

A spinal cord injury is a life-changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well-being as well. This study is aimed at exploring the lived experience of living with pain by community-dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In-depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.

Transgender Youth Readiness for Health Care Transition: A Survey of Youth, Parents, and Providers

Purpose

The purpose of this study was to identify health care transition (HCT) readiness and skills among transgender youth transitioning gender-affirming care from pediatric to adult providers.

Methods

A convenience sample of youth, 14-21 years old, their parents, and health care providers recruited from a multidisciplinary transgender youth clinic in 2019 completed a modified version of the Got Transition readiness assessment with elements specific to gender-affirming care. Youth assessed their own readiness, parents assessed their child's readiness, and providers assessed their transgender patients' readiness overall.

Results

Twenty-nine youth (mean age 17.0 years), 26 parents, and 5 health care providers participated. Ratings of the overall importance of preparing for HCT were similar across all participant groups, and there were few disagreements on the importance of individual skills included in the readiness assessment. Ratings of overall HCT readiness were similar for youth regardless of age, while parents of younger youth (<18 years old) reported lower readiness than did parents of older youth. Youth rated their own competence in several skills higher compared with parents or providers, including knowledge of hormone therapy side effects. All groups of participants reported that youth most frequently needed assistance with scheduling appointments and keeping records of health information.

Conclusions

Survey of youth, parents, and providers suggests that youth and parents require additional support to navigate the HCT process, highlighting the importance of ongoing skills assessment and planning.

Experiences of people living with HIV in low- and middle-income countries and their perspectives in self-management: a meta-synthesis

INTRODUCTION

Availability of anti-retroviral treatment has changed HIV in to a manageable chronic disease, making effective self-management essential. However, only a few studies in low- and middle-income countries (LMICs) reported experiences of people living with HIV (PLWH) on self-management.

METHODS

This meta-synthesis of qualitative studies investigated perspectives of PLWH in LMICs on self-management. Various databases, including PubMed, EMBASE, EBSCO, and CINHAL, were searched through June 2022. Relevant additional articles were also included using cross-referencing of the identified papers. We used a thematic synthesis guided by the "Model of the Individual and Family Self-Management Theory" (IFSMT).

RESULT

PLWH in LIMICs experience a variety of challenges that restrict their options for effective self-management and compromises their quality of life. The main ones include: misconceptions about the disease, poor self-efficacy and self-management skills, negative social perceptions, and a non-patient-centered model of care that reduces the role of patients. The experiences that influenced the ability to practice self-management are summarized in context (the condition itself, physical and environmental factors, individual and family factors) and process factors (knowledge and beliefs, relationship with the health care worker, self-regulation skills and abilities, and social facilitation). Context and process greatly impacted quality of life through the self-management practices of the patients.

CONCLUSION AND RECOMMENDATION

PLWH encounter multiple challenges, are not empowered enough to manage their own chronic condition, and their needs beyond medical care are not addressed by service providers. Self-management practice of these patients is poor, and service providers do not follow service delivery approaches that empower patients to be at the center of their own care and to achieve an effective and sustainable outcome from treatment. These findings call for a comprehensive well thought self-management interventions.

Factors affecting patient activation among patients with systemic lupus erythematosus

There are limited published studies on patient activation among patients with systemic lupus erythematosus (SLE) in China. Disease activity can significantly influence a patient's perception of their condition, subsequently impacting patient activation. However, the mechanisms through which disease activity influences patient activation remain poorly understood. This study aimed to investigate patient activation among patients with SLE in China and explore the influencing factors. We conducted a cross-sectional study from June to December 2021 at a rheumatology and immunology department of a tertiary hospital in Chengdu, China. Data were collected by questionnaire, including general information, disease activity, quality of chronic illness care, health literacy, self-efficacy, motivation, social support, and patient activation. A patient activation model was constructed based on the conceptual framework derived from the individual and family self-management theory. To evaluate the moderating effect of disease activity on patient activation model, participants were divided into two subgroups (low disease activity group and high disease activity group). 426 SLE patients were included. The mean score of patient activation among SLE patients was 63.28 ± 11.82, indicating that most SLE patients lacked skills and confidence to stick with health-promoting behaviors. Health literacy, social support, and self-efficacy had the greatest effect on patient activation. In the multi-group analysis, social support and health literacy contributed more to patient activation in SLE patients with high and low disease activity, respectively. Patient activation among SLE patients in China was at the third level. Healthcare professionals should help them adhere to health-promoting behaviors. Health literacy, social support, and self-efficacy are vital factors for patient activation. These factors should be prioritized based on disease activity when developing individually tailored interventions for patient activation.

Grounded Theory Approach to Understand Self-Management of Opioid Recovery Through Pregnancy and Early Parenting

OBJECTIVE

To develop a theory to explain the processes women use to self-manage recovery from opioid use disorder during pregnancy, the postpartum period, and early parenting.

DESIGN

Constructivist grounded theory approach.

PARTICIPANTS

Women (N = 16) who gave birth during the past 12 months and used medication for opioid use disorder for recovery through pregnancy and the postpartum period.

METHODS

We recruited participants through seven medication-assisted treatment clinics in a mid-size Midwestern city and the surrounding suburbs and through online parenting and recovery community groups with national-based memberships. We conducted semistructured, individual audio interviews from November 2020 to July 2021. Interviews continued until we reached theoretical and meaning saturation. We used constant comparative methods during initial and intermediate coding.

RESULTS

Participants described a central process, Growing as a Healthy Dyad, that included six processes they used to self-manage recovery: Maintaining Vigilance, Performing Self-Care, Putting in the Work of Recovery, Advocating, Navigating Social Support, and Acquiring Skills and Knowledge. These processes were affected by personal and social contextual factors.

CONCLUSIONS

The grounded theory, Self-Management of Opioid Recovery Through Pregnancy and Early Parenting, can be used to explain the unique processes of self-management by women in opioid recovery and highlights the need for a strengths-based approach to caring for the maternal-infant dyad.

Enablers and barriers to accessing self-management support services for those living with and beyond cancer: A qualitative study using the theoretical domains framework

BACKGROUND

Supporting those living with and beyond cancer to self-manage their health can optimise health-related quality of life and reduce symptom burden. Self-management support (SMS) programmes have been shown to be effective, but uptake is often low. This qualitative study aimed to identify experienced and perceived enablers and barriers to accessing SMS services among those who had completed primary cancer treatment and were living with and beyond cancer.

METHODS

Participants were recruited through social media and cancer advocacy groups. Semi-structured telephone and online interviews were conducted. Transcripts were coded inductively based on participants' reported experiences. Statements related to factors that enable or inhibit access to SMS were then mapped to the Theoretical Domains Framework (TDF).

RESULTS

Twenty-six people participated. Six themes explain the factors that act as barriers and enablers which mapped to 11 TDF domains. Lack of knowledge of available SMS was a prominent barrier, as well as inaccessible services due to timing and place of delivery. Lack of confidence and emotional factors including fear were barriers to seeking SMS. Social influences shaped knowledge, attitudes and readiness to access SMS. Perceptions of SMS service goals and if in alignment with self-identity, intentions and goals also shaped decisions around accessing support.

CONCLUSIONS

While lack of knowledge and provider signposting were common barriers, findings suggest that other psychosocial and emotional factors may be barriers, even if SMS services are accessible. Findings are relevant for oncology healthcare services developing strategies to increase reach of SMS for those living with and beyond cancer.

Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study

Objective

There are currently an increasing number of mobile health (mHealth) programs offered to patients with breast cancer undergoing chemotherapy, but their rate of adherence to app usage has remained low. This study aimed to examine the feasibility of an mHealth app-based program such as the adherence rate of app usage and determine the preliminary effects on self-efficacy, quality of life, symptom burden and healthcare utilization in these patients.

Methods

We conducted a randomized controlled pilot trial. Ninety-six participants were randomly allocated into either an intervention group or a control group (routine care plus a placebo app). The intervention group engaged in a 6-week self-regulation activity and received nurse-led social support via the app. The intention-to-treat principle was adopted. The generalized estimating equation was utilized to analyze the between-group, within-group and interaction effectiveness of this program.

Results

Totally 96 participants were enrolled from 16 May to 23 August 2022. The average rate of adherence to app usage increased from 4.8% at week 3 to 51.2% at week 6. There was a statistically significant reduction in the physiological efficacy scores of the intervention (p < .001) and control groups (p < .001) at week 6, compared with the baseline. At week 6, the intervention group reported a significantly lower symptom burden (p = .042) and significantly better physical well-being than the control group (p = .024).

Conclusions

It is feasible to perform an mHealth app-based self-management program for patients with breast cancer receiving chemotherapy. Nurses can utilize this program to facilitate patient self-management of symptoms during chemotherapy.

Registration

Clinicaltrials.gov, https://clinicaltrials.gov, (NCT05192525).

The needs of patients with diabetes for the prevention and treatment of foot complications in Thailand: A qualitative descriptive study

Background

Inadequate diabetes self-management leads to foot infections and lower extremity amputations. Effective self-care, supported by nurse-provided information, is crucial, particularly in foot care. However, the current approach in Thailand focuses more on what nurses want patients to know rather than addressing patients' actual needs. Consequently, nurses might misunderstand their patients' perspectives. Hence, nurses need to grasp patients' needs for successful foot care behavior.

Objective

This study aimed to explore the needs of patients with diabetes regarding the prevention and treatment of foot complications.

Methods

The study employed a qualitative descriptive design. Thirty participants classified as high risk for foot ulcers were purposively selected from Thailand's university hospitals. Focus group discussions were used for data collection between June and July 2021. Verbatim transcription and content analysis were carried out for data analysis.

Results

Four emergent themes highlighted patients' needs: 1) information-giving, 2) proactive foot screening with foot-care affirmation, 3) foot care services, and 4) relieving foot burdens and limb loss.

Conclusion

Nurses should change their mindset to care for and continually understand patients' needs. This involves adapting educational strategies like the teach-back method and coaching while providing skill training. Offering diverse service platforms, both online and onsite education programs and counseling, is essential. Additionally, ensuring accessibility and affordability, such as establishing after-hours clinics and supplying foot care toolkits, remains crucial.

Methodologies Used in Studies of Self-Management Interventions for Urinary Incontinence in Adult Women: An Integrative Review

BACKGROUND

Urinary incontinence (UI) affects approximately 60% of women in the United States and negatively impacts self-esteem, sexual function, participation in social activities, and quality of life (QOL). Self-management interventions show promise for improving UI symptoms and QOL. Previous reviews of UI self-management studies have focused on outcomes for older women. However, the literature lacks a synthesis of methodologies of these studies.

PURPOSE

The purpose of this integrative review was to synthesize and evaluate methodologies used in studies of self-management interventions for UI in adult women.

METHODS

Using an integrative review approach, a search of PubMed, CINAHL, and Embase was conducted yielding 1404 results, 23 of which met inclusion criteria. Data abstracted from each article included author(s), year of publication, study design and purpose, sample, country and setting, measures of UI symptoms, and intervention description.

RESULTS

Findings showed methodological differences, particularly in design, assessment of UI subtypes, measures of UI symptoms, and intervention components. Multicomponent self-management interventions were used in 18 studies and 1 component used in 5 studies. Education, pelvic floor muscle exercises, and bladder training were the intervention components most frequently used, either alone or in combination; however, intervention components were not consistently aligned with the UI subtypes. Analysis of ethical matters revealed areas for improvement, specifically in reporting privacy and confidentiality and in methods to obtain informed consent.

CONCLUSIONS

Results highlight opportunities to improve the rigor of methodologies used in studies of self-management interventions for UI in adult women.

"The constant worry": Urinary incontinence self-management in rural women: A qualitative study

Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field.

Heart failure self-management: a scoping review of interventions implemented by allied health professionals

BACKGROUND

Heart failure (HF) is typically managed using both medical and patient self-management interventions. Individuals with HF often have frequent readmissions to hospital for medical management. Effective self-management can help to reduce the exacerbation of HF symptoms and the frequency of readmissions.

METHODS

A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) guidelines was conducted to identify literature on the interventions used by allied health professionals to promote HF self-management. A search strategy was implemented, and articles were reviewed by two independent reviewers.

RESULTS

Twenty articles met the inclusion criteria. Articles included interventions from physical therapy, nutrition, social work, and occupational therapy, as well as other health professions in team-based programs. The most common interventions were verbal education, textual information, monitoring resources, and skills practice. Interventions addressed diet/fluid control, exercise and activity, symptom monitoring, medication management, cardiovascular disease knowledge, and mental health. Many interventions were theory informed.

CONCLUSION

There is nascent evidence that interventions promoting HF self-management positively impact health and quality of life outcomes. HF self-management is multi-faceted and requires interprofessional collaboration. Further work is warranted exploring the impact of theory-informed interventions, and the effectiveness of interventions on self-management competence and desired health outcomes.

Perspectives Regarding Engagement in Physical Activity in Women: Traditional Gender Role-Based Themes

BACKGROUND

There has not been a significant improvement in cardiovascular disease (CVD) statistics among women; 44.4% of women older than 20 years have a diagnoses of CVD. Only 24.3% of adults meet physical activity (PA) guidelines, women have significantly lower levels of PA significantly lower levels than men. There is a call to action from the American Heart Association to delineate reasons for related genderized, socially determined factors.

OBJECTIVE

The purpose of this study was to use the individual and family self-management theory to explore and describe interacting sociodemographic, family, cultural, health/access-related, and personal factors contributing to PA engagement in women living in areas of reduced socioeconomic resources.

METHODS

This study used a community-engaged, qualitative descriptive focus group design to explore PA engagement in women between 18 and 64 years old living in an area of reduced socioeconomic resources and high racial and ethnic diversity.

RESULTS

Context-related factors included cost/access, transportation, safety, and setting and interacted with family structure and functioning. Process-level factors affecting PA engagement included outcome expectancy, goal incongruence, lack of self-efficacy, self-regulation, and provider support/collaboration. Facilitators included family/friend social support.

CONCLUSIONS

The current community-engaged study reveals socially constructed gender role elements related to family dynamics, self-perception, and self-regulation that potentially impact engagement in self-management behavior. Programs to increase awareness and self-management of CVD in women exist, but there is a lack of direct effects, speaking to unknown factors. Given perpetually high rates of CVD, low levels of PA, and declining knowledge levels among women, further investigation is imperative.

The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study

Background

Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system.

Objective

This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus.

Methods

A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis.

Results

Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01).

Conclusion

The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions.

Clinical trial registration number

NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100).

Health locus of control and self-management behaviours among individuals with ischaemic heart disease: protocol for a scoping review

INTRODUCTION

Ischaemic heart disease is a significant cause of morbidity and mortality worldwide. Self-management is a way to reduce the risk associated with ischaemic heart disease; however, some individuals may not have the ability or willingness to engage in self-management behaviours. One approach to identify an individual's readiness and capacity to engage in self-management behaviours is to assess their health locus of control. Based on the Individual and Family Self-Management Theory, this review's objectives are to describe: (1) how health locus of control affects the process of engaging in self-management behaviours, (2) impacts of health locus of control on outcomes associated with self-management behaviours and (3) potential contextual variations in the relationship between health locus of control and self-management behaviours.

METHODS AND ANALYSIS

The scoping review will be guided by the Joanna Briggs Institute methodological framework. A comprehensive search will encompass seven electronic databases (Ovid Medline, CINAHL, EMBASE, APA PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus) and grey literature sources (ProQuest Dissertations, ClinicalTrials.gov). Collaborative efforts with library experts will inform our search strategies, building on insights from previous reviews centred on self-management and ischaemic heart disease. Two review authors will independently conduct the screening and data extraction processes; discrepancies will be resolved through consensus or discussion with a third review author. The review will include English studies from database inception, focusing on the health locus of control among adults with ischaemic heart disease. Findings will be presented graphically and tabularly, together with a narrative description.

ETHICS AND DISSEMINATION

We will collect data from published and grey literature, meaning ethical approval is not necessary. Findings will be published in peer-reviewed journals and presented at academic conferences.

REGISTRATION DETAILS

Open Science Framework (https://doi.org/10.17605/OSF.IO/B4A6F).

Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study

BACKGROUND

Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia.

METHODS

An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities.

RESULT

In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity.

CONCLUSION

The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs.

Implementing Digital Cognitive-Behavioral Therapy for Major Depressive Disorder in Routine Psychiatric Appointments: A Pilot Project in a Rural Population

Psychotherapy is well-established as an effective treatment for major depressive disorder (MDD). However, many individuals with MDD in rural areas of the United States do not have access to psychotherapy. Self-management (SM) strategies are now the standard of care for chronic medical conditions and may be a viable alternative for individuals without access to psychotherapy. The current article describes the implementation of a 13-week pilot project to integrate digital cognitive-behavioral therapy (dCBT) SM programs into routine psychiatric advanced practice nurse (APN) telehealth appointments in the rural United States. Eight participants completed the project. The project did not meet the benchmark of 20 participants to improve access to treatment; however, one half (n = 4) of participants reported clinically significant improvement in MDD symptoms over 6 weeks. For clients without access to psychotherapy, dCBT SM programs can be effective in improving individual client outcomes when implemented by APNs in routine telehealth appointments. [Journal of Psychosocial Nursing and Mental Health Services, 61(10), 44-51.].

Health perceptions and attitudes on mobile health apps in China

Since the COVID-19 pandemic, the use of mobile health apps has been increasing significantly. Many have started using mobile health apps to manage their health and well-being. People need to develop healthy habits that will increase their job productivity, life expectancy and improve their social relationships. This study tests the Health Belief Model with adults in China in influencing health motivation and in turn improving their health behavior. A mobile and online survey was developed, and 120 usable responses were collected. A structural equation modeling was used to test the relationships between perceived benefits, perceived susceptibility, perceived barriers, health motivation, and health behavior. We found perceived self-efficacy, perceived benefits, and perceived susceptibility predicts health motivation, and health motivation predicts health behavior. We did not find that perceived barrier is a predictor for health motivation. We conclude that to encourage behavioral change, it is important to enhance self-efficacy and address the benefits; in the meantime, educating people on susceptibility is also important.

Experiences of and preferences for self-management among low grade non-Hodgkin's lymphoma survivors: A qualitative interview study

PURPOSE

Supporting self-management is one strategy to help cancer survivors optimise their quality of life. Low grade non-Hodgkin's lymphoma is often incurable with a chronic disease trajectory requiring lifelong self-management. This study explored the views on self-management and preferences for self-management support among survivors of low grade non-Hodgkin's lymphoma and their informal caregivers more than 6 months after completion of systemic anti-cancer therapy.

METHOD

In-depth semi-structured telephone interviews were conducted. Key themes and subthemes were determined using inductive and deductive thematic analysis.

RESULTS

The sample included eight survivors of low grade non-Hodgkin's lymphoma and two family caregivers. There were four themes. 1) The chronic nature of low grade non-Hodgkin's lymphoma shapes perceptions of self-management; participants described their cancer as a chronic condition and self-management strategies reflected this. 2) Social networks enable self-management; participants emphasised the importance of making low grade non-Hodgkin's lymphoma survivors aware of social networks. 3) Support and monitoring are needed immediately after the initial treatment phase ends. 4) Preferred components of self-management support; this included regular review with monitoring, advice on diet, and strategies to manage the psychosocial consequences of low grade non-Hodgkin's lymphoma.

CONCLUSIONS

Providing self-management support to those diagnosed with low grade non-Hodgkin's lymphoma is relevant given the chronic trajectory of the disease. Findings suggest that necessary components of a self-management support programme for those with low grade non-Hodgkin's lymphoma should include regular review with monitoring and practical support around facilitating engagement with social networks.

The BETTER Traumatic Brain Injury Transitional Care Intervention: A Feasibility Study

This study aimed to investigate the feasibility, acceptability, and clinical outcome measures of BETTER (Brain Injury Education, Training, and Therapy to Enhance Recovery), a culturally tailored traumatic brain injury (TBI) transitional care intervention, among diverse younger adult patients with TBI (age 18-64) and their caregivers. Trained clinical interventionists addressed patient/family needs; established goals; coordinated post-hospital care and resources; and provided patient/family training on self- and family-management coping skills. Fifteen dyads enrolled (N = 31, 15 patients, 16 caregivers). All completed baseline data; 74.2% (n = 23; 10 patients, 13 caregivers) completed 8-week data; 83.8% (n = 26; 13 each) completed 16-week data. Approximately 38% (n = 12, 3 patients, 9 caregivers) completed acceptability data, showing positive experiences (mean = 9.25, range 0-10; SD = 2.01). Overall and mental quality of life (QOL) scores did not differ over time but physical QOL scores did improve over time (baseline: 30.3, 8 weeks: 46.5, 16 weeks: 61.6; p = 0.0056), which was considered to be a suitable outcome measure for a future trial. BETTER is a promising intervention with implications to improve TBI care standards. Research is needed to determine efficacy in a randomized trial.

Best practice guidelines for professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection: A scoping review

BACKGROUND

Adults with tuberculosis-human immunodeficiency virus coinfection require professional nurses' support to manage their illness, treatment and its effect on their daily lives. This scoping review maps recommendations in clinical or best practice guidelines that guide professional nurses to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings.

METHODS

We conducted a scoping review by searching for guidelines in six online databases, guideline clearing houses and search engines from 16th April 2022 to 25th May 2022. The title, abstract and full-text screening of guidelines were conducted independently and in duplicate by two reviewers based on predetermined eligibility criteria. The guidelines were critically appraised with the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Relevant data regarding the characteristics of the guideline, recommendations and underlying evidence were extracted, analysed and reported.

RESULTS

The six guidelines on self-management support found were developed in four high-income countries. Five of the guidelines recorded <60% across all six domains of the AGREE II instrument. One high-quality guideline scored >60% in all AGREE II domains but was informed by outdated evidence produced between 1977 to 2010. Twenty-five practice, education and organisational/policy recommendations were extracted from the high-quality guideline. The guidelines did not report evidence-to-decision frameworks and the strength of the recommendations. The guidelines also lacked direct underlying evidence on the effectiveness and cost of self-management support. Lastly, the review found a paucity of contextual (equity, acceptability and feasibility) evidence on self-management support among adults with tuberculosis-human immunodeficiency virus in the guidelines.

CONCLUSION

There is a dearth of updated and relevant high-quality guidelines that guide healthcare professionals to provide self-management support to adults with tuberculosis-human immunodeficiency virus coinfection in primary healthcare settings. Systematic reviews of effectiveness, economic and contextual evidence related to self-management support interventions are required for guideline production.

The concept of treatment beliefs in children and adolescents with chronic health conditions: a scoping review

Children and adolescents with chronic health conditions are faced with ongoing challenges, making self-regulation crucial. As children grow up, they gradually develop differentiated beliefs about illness and treatment. While research indicates treatment beliefs as relevant factor on outcomes like adherence, the specific contents and dimensions of children's and adolescents' treatment beliefs remained unclear. This scoping review therefore aimed at the identification of treatment beliefs dimensions in children and adolescents with chronic health conditions, the underlying theoretical frameworks, and methodological operationalisation. Published literature was examined by applying systematic searches in electronic databases (Medline, PsycINFO, CINAHL) and comprehensive selection criteria, resulting in 49 included studies. The predominant treatment beliefs dimensions were necessity, concerns, perceived benefits and costs/barriers, and expectations. The latter can be differentiated into outcome, social, process, and structural expectations, and expectations of one's own role in the treatment process. In addition, dimensions that cover emotions and reasons for treatment were identified. The results are related to the methods and theoretical models applied, which were often adapted from adult research. However, additional and possibly more child-specific dimensions such as social expectations and emotions were found. This scoping review indicates several research gaps and discusses practical implications.

Effect of Health Literacy Intervention on Glycemic Control and Renal Function Among Thai Older Adults at Risk of Type 2 Diabetes Mellitus

Purpose

Diabetes patients with low health literacy often have poor health and clinical outcomes. The study aimed to assess the effectiveness of a health literacy intervention on glycemic control and renal function among Thai older adults at risk of type 2 diabetes mellitus (T2DM).

Methods

A quasi-experimental study was carried out in rural areas of Phayao Province in northern Thailand. The participants were older adults with T2DM who recorded blood glucose levels ranging from 140 to 180 mg/dL and who were not receiving prescribed medication. The intervention lasted 12 weeks, and data were collected at three points: baseline, post-intervention, and at 3 months' follow-up. The study outcomes included the measurement of fasting blood sugar (FBS), hemoglobin A1C (HbA1c), and glomerular filtration rate (eGFR) levels after the intervention. A linear mixed model and generalized estimating equations model were used to assess the intervention effect for continuous and binary outcomes, respectively.

Results

From baseline to post-intervention, FBS and HbA1c decreased more in the intervention group than in the control group by 8.2 mg/dL (p < 0.001) and 0.1% (p = 0.029), respectively, whereas eGFR increased by 8.0 mL/min/1.73m2 (p < 0.001). The absolute effect of the intervention at follow-up was -9.8 units for FBS, -0.4 units for HbA1c, and 14.0 units for eGFR. Abnormal HbA1c level (≥6.5%) of the intervention group was reported as 70.3% at baseline, 31.3% at post-intervention, and 9.4% at follow-up. Compared to baseline levels, the T2DM patients who received the intervention were 0.31 times less likely to have abnormal HbA1c levels than the control subjects at follow-up (p = 0.003) who received no intervention.

Conclusion

Our findings suggest that this intervention may potentially improve diabetes self-management and prevention behaviors, thereby reducing the diabetes burden in rural communities in northern Thailand.

Analysis of action planning, achievement and life purpose statements in an intervention to support caregivers of persons with heart failure

BACKGROUND

Caregivers of persons living with heart failure (HF) experience uncertainty related to heart failure trajectory and caregiving demands. Caregiver Support is a nurse-led intervention consisting of a well-being assessment, development of a life purpose statement, and action planning related to self-care and support for caregivers.

OBJECTIVES

The goal of this study was to describe the caregivers' action plans, action plan achievement and life purpose statements.

METHODS

We used inductive content analysis to code life purpose statements and action plans by 2 coders. Descriptive statistics were used to describe the average number of action plans set per caregiver, the average number of themes coded per action plan and life purpose statement, and the status of goal achievement (i.e., by thematic domain, subdomains). Goal achievement was defined categorically: Achieved, not achieved, and not assessed. The achievement rate was calculated as the proportion of achieved action plans out of the total number of assessed action plans.

RESULTS

The sample (n = 22) was predominantly women, spousal caregivers, and an average age of 62±14.2 years. Thirty-six percent of caregivers were Black and 41% reported financial strain. Action plans comprised five categories: personal health and well-being, social support, home environment, instrumental support and other. The most common topics of life purpose statements were faith and self-care/actualization. Of 85 action plans, 69 were assessed and 66.7% were achieved.

CONCLUSIONS

These findings highlight the diversity of values and needs of caregivers and provides insights for additional person-centered support.

Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease

PURPOSE

Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD.

DESIGN AND METHODS

The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app.

RESULTS

Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use.

CONCLUSION

We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app.

PRACTICE IMPLICATIONS

The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.

Are exposure to health information and media health literacy associated with fruit and vegetable consumption?

BACKGROUND

Health information promotes a healthy lifestyle; however, media health literacy (MHL) is essential to personal intake, especially fruit and vegetables (F&V). This study aimed to determine how exposure to health information and MHL affect F&V consumption among Thai youth aged 10-14 years. Health behavior at this age can be an important determinant of consumption habits when transitioning into adulthood.

METHODS

A stratified two-stage sample survey was conducted to recruit 1,871 youth across regions to be nationally representative. Qualtrics offline survey application was used for data collection face-to-face with all respondents. Multiple linear regression was used to analyze the explanatory variables on fruit consumption and vegetable consumption.

RESULTS

This study found that almost 70% of Thai youth were exposed to health-related content via the Internet, and had low analytical skills to process that information. Grade Point Average (GPA), exposure to health information, various media types, frequency of exposure to health information, and MHL influenced the frequency of F&V intake. Health status related to fruit intake, age, place of residence, amount of pocket money, and body mass index (BMI) were associated with F&V consumption.

CONCLUSION

Exposure to health information and MHL are associated with F&V intake. Therefore, exposure to health information and MHL should be addressed for policy formulation in Thai schools and the health system.

Emotional Intelligence: A Novel Factor Influencing Hypertension Self-Management

The purpose of this study was to examine associations among emotional intelligence, quality of patient-provider interaction, and hypertension (HTN) self-management behaviors. A convenience sample of 90 adults (predominately African American women) with primary HTN were recruited from an urban ambulatory internal medicine clinic. Multivariate linear regression models were used to determine the predictive associations among the study variables. Emotional intelligence was associated with the quality of the patient-provider interaction (r = 0.34; p < .001), patient activation (r = 0.56; p < .001), and medication use (r = 0.26; p = .006). The patient-provider interaction was associated with higher states of patient activation (r = 0.42; p < .001) and medication use behavior (r = 0.29; p = .002). Also, the quality of patient-provider interaction partially mediated the relationship between emotional intelligence and self-management behaviors. Emotional intelligence is a promising patient factor that influences quality of patient-provider interaction and self-management behaviors.

Pain self-management plus activity tracking and nurse-led support in adults with chronic low back pain: feasibility and acceptability of the problem-solving pain to enhance living well (PROPEL) intervention

BACKGROUND

Chronic low back pain can lead to individual suffering, high medical expenditures, and impaired social well-being. Although the role of physical activity in pain management is well established, the underlying mechanisms of biological and clinical outcomes are unknown. This study aimed to assess the feasibility and acceptability of a pain self-management intervention, Problem-Solving Pain to Enhance Living Well, which employs wearable activity tracking technology and nurse consultations for people with chronic low back pain.

METHODS

This one-arm longitudinal study recruited 40 adults aged 18-60 years with chronic low back pain. Over 12 weeks, participants watched 10 short video modules, wore activity trackers, and participated in nurse consultations every 2 weeks. At baseline and the 12-week follow-up, they completed study questionnaires, quantitative sensory testing, and blood sample collection.

RESULTS

Forty participants were recruited, and their mean age was 29.8. Thirty-two participants completed the survey questionnaire, quantitative sensory testing, Fitbit activity tracker, and bi-weekly nurse consultation, and 25 completed the evaluation of biological markers. The overall satisfaction with the Problem-Solving Pain to Enhance Living Well video modules, nurse consultations, and Fitbit in pain management was rated as excellent. No adverse events were reported. Between the baseline and 12-week follow-up, there was a significant decrease in pain intensity and interference and an increase in the warm detection threshold at the pain site.

CONCLUSIONS

Despite concerns about the participant burden due to multidimensional assessment and intensive education, the feasibility of the Problem-Solving Pain to Enhance Living Well intervention was favorable. Technology-based self-management interventions can offer personalized strategies by integrating pain phenotypes, genetic markers, and physical activity types affecting pain conditions.

TRIAL REGISTRATION

This pilot study was registered with ClinicalTrials.gov [NCT03637998, August 20, 2018]. The first participant was enrolled on September 21, 2018.

Medication self-management behaviors of adolescents and young adults with cancer

PURPOSE

Adolescents and young adults (AYAs) with cancer are challenged to manage complex medication regimens during treatment. The aims of the study are to (1) describe the medication self-management behaviors of AYAs with cancer and (2) examine the barriers and facilitators to AYAs' optimal use of medications, including their self-efficacy to manage medications.

METHODS

This cross-sectional study enrolled 30 AYAs (18-29 years) with cancer who were receiving chemotherapy. Participants electronically completed a demographic form, a health literacy screen, and the PROMIS Self-efficacy for Medication Management instrument. They completed a semi-structured interview to answer questions about their medication self-management behaviors.

RESULTS

Participants (53% female, mean age = 21.9 y) had a variety of AYA cancer diagnoses. Over half (63%) had limited health literacy. Most AYAs had accurate knowledge about their medications and average self-efficacy for managing medications. These AYAs were managing an average of 6 scheduled and 3 unscheduled medications. Oral chemotherapy was prescribed for 13 AYAs; other medications were for prevention of complications and symptom management. Many AYAs relied on a parent for obtaining and paying for medications, used multiple reminders to take medications, and used a variety of strategies to store and organize medications.

CONCLUSION

AYAs with cancer were knowledgeable and confident about managing complex medication regimens but needed support and reminders. Providers should review medication-taking strategies with AYAs and ensure a support person is available.