1
|
Pack AP, Zuleta A, Daugerdas E, Huang W, Batio S, Svoboda S, Zeitler EP, Kumar N, Watt S, Fernandez-Arias MI, Bader M, Assaf AR, Bailey SC. Developing, optimizing, and evaluating patient infographics for diagnosing cardiac amyloidosis. PEC INNOVATION 2023; 3:100212. [PMID: 37743956 PMCID: PMC10514075 DOI: 10.1016/j.pecinn.2023.100212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
Objective Advancements in diagnostics and treatment options for cardiac amyloidosis have improved patient outcomes, yet few patient education materials exist to help patients understand the disease and diagnosis process. We sought to develop and evaluate a set of plain language, patient-centered infographics describing the condition and common diagnostic tests. Methods Using health literacy best practices, we developed 7 infographics which were further revised based on multilevel stakeholder feedback. To evaluate the materials, we recruited 100 patients from healthcare settings in Chicago, IL; participants completed a web-assisted interview during which they were randomized 1:1 to first view either our infographics or a standard material. Participants completed a knowledge assessment on their assigned material and subsequently reported impressions of both materials. Results No differences were found between study arms in knowledge. The infographics took significantly less time to read and were more highly rated by participants in terms of appearance and understandability. Over two-thirds of participants preferred the infographics to the standard. Conclusions The infographics created may improve the learning process about a complex condition and diagnosis process unknown to most adults. Innovation These infographics are the first of their kind for cardiac amyloidosis and were created using health literacy best practices.
Collapse
Affiliation(s)
- Allison P. Pack
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Andrea Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Eleanor Daugerdas
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Wei Huang
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Stephanie Batio
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Sophia Svoboda
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| | - Emily P. Zeitler
- Dartmouth Hitchcock Medical Center, Heart and Vascular Center, Cardiovascular Section, The Dartmouth Institute, Geisel School of Medicine at Dartmouth, United States of America
| | | | | | | | | | - Annlouise R. Assaf
- Pfizer, Inc, United States of America
- Brown University School of Public Health, United States of America
| | - Stacy Cooper Bailey
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, United States of America
| |
Collapse
|
2
|
Almutairi N, Gopaldasani V, Hosseinzadeh H. The Effect of a Patient Activation Tailored Intervention on Type 2 Diabetes Self-Management and Clinical Outcomes: A Study from Saudi Arabian Primary Care Settings. J Diabetes Res 2023; 2023:2074560. [PMID: 38059208 PMCID: PMC10696472 DOI: 10.1155/2023/2074560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/23/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a global public health challenge. T2DM self-management, including diet, physical activity, blood glucose self-monitoring, foot care, and adherence to medication, is considered a primary tool for managing diabetes. Patient activation, an individual's knowledge, skill, and confidence in managing their health and healthcare, was recognized to be associated with better T2DM self-management and clinical outcomes. Patient activation intervention has been described as a potential approach for enhancing chronic disease self-management. This study is aimed at examining the effect of a patient activation-tailored intervention on T2DM self-management and clinical outcomes in primary care settings in Saudi Arabia. Method A pre- and postintervention study was conducted among ≥18 years old T2DM patients attending primary healthcare centers in Saudi Arabia. Collected data included demographics, clinical data, the Patient Activation Measure (PAM), the Summary of Diabetes Self-Care Activities (SDSCA), the diabetes knowledge test (DKT2), the problem area in diabetes test (PAID-5), and the diabetes quality of life test (DQOL). The intervention was tailored based on the participants' patient activation level. The intervention consisted of monthly face-to-face sessions for three months and a telephone follow-up per month for three months postintervention. Descriptive statistics, a paired sample t-test for scale variables, and Wilcoxon's signed-rank test for categorical variables were used for data analysis. Results A total of 82 patients, mostly female (61%) with a mean age of 51.3 ± 9.9 years old, completed baseline and postintervention surveys. After six months of intervention, there was a significant change in patient activation score from 54.74 to 61.58 (p < 0.001), hemoglobin A1c (HbA1c) from 8.38 to 7.55 (p < 0.001), and body mass index (BMI) from 30.90 to 29.16 (p < 0.001). Also, there was a significant change in SDSCA scores (diet from 3.12 to 3.67, exercise from 2.54 to 3.49, and blood glucose self-testing from 2.37 to 3.24) (p < 0.001) and DKT from 6.29 to 7.22 (p = 0.01). Conclusion Our findings suggested that tailoring interventions based on patients' activation levels is more likely to yield promising T2DM self-management and clinical outcomes.
Collapse
Affiliation(s)
- Nasser Almutairi
- School of Health & Society, University of Wollongong, NSW, Australia
- Public Health Sector, Ministry of Health, Riyadh, Saudi Arabia
| | - Vinod Gopaldasani
- School of Health & Society, University of Wollongong, NSW, Australia
| | | |
Collapse
|
3
|
Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
Collapse
|
4
|
Lambert K. Designing Dietary Education Materials for People With Chronic Kidney Disease: Recommendations for Improving the Quality of Resources. J Ren Nutr 2023; 33:208-213. [PMID: 35792257 DOI: 10.1053/j.jrn.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The aim of this study is to quantify the readability, actionability, understandability, and overall quality of dietary education resources designed for patients and published in the Journal of Renal Nutrition. DESIGN AND METHODS All patient education materials published in the "Patient Education" section of the journal from 2011 to 2021 were included. The readability, health literacy demand, and quality were evaluated using the Hemingway editor, Patient Education Materials Assessment Tool, and the Centers for Disease Control and Prevention Clear Communication Index (CDC CCI) respectively. Good quality materials were those with a reading grade level of ≤8; a Patient Education Materials Assessment Tool score of >70% (indicating materials were understandable and actionable), and a CDC CCI score >90%. RESULTS A total of 42 resources were evaluated. Most materials (92%) were written at an appropriate level of readability (median grade 5, interquartile range [IQR: 5-7). The median understandability score was 71% (IQR: 60-81); however, only half (52%) of the materials met the 70% benchmark. Materials published performed poorly for actionability with the median actionability score of 37% (IQR: 20-83), and only 29% met the benchmark score. Overall quality was scored as low, with a median CDC CCI score of 65%, and only 10% of materials met the benchmark score. Areas for improvement were identified including providing a clear purpose, and summary of important points, explaining numbers and how to perform calculations, and including at least one action to take. Future efforts to improve actionability need to use the active voice, directly address readers, explain how to act, and describe the steps required. CONCLUSION Patient education materials that are attentive to health literacy principles beyond readability may enhance patient engagement, confidence, and empowerment, and improve adherence to the kidney diet.
Collapse
Affiliation(s)
- Kelly Lambert
- Adv APD, Senior Lecturer, School of Medical, Indigenous, and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia.
| |
Collapse
|
5
|
Dietz CJ, Sherrill WW, Stancil M, Rennert L, Parisi M, McFall D. Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults' Activation. Diabetes Spectr 2023; 36:59-68. [PMID: 36818413 PMCID: PMC9935283 DOI: 10.2337/ds21-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goals of this study were to determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM score in individuals participating in the DSMS. METHODS The Health Extension for Diabetes (HED) is a 4-month program delivered via a paraprofessional extension agent in partnership with an established diabetes self-management education and support program. The study population included 148 adults (median age 69 years; interquartile range 60-74 years) with diabetes recruited from local community organizations. Data for the analysis were collected before and after participation in the intervention as part of a longitudinal study, using the PAM and Self-Efficacy for Diabetes instruments. Descriptive statistics were gathered, and hypothesis tests and simple and multivariable regression analyses were conducted. RESULTS The mean PAM score increased by 6.58 points, with a 5-point change considered clinically significant. From pre- to post-intervention, PAM scores significantly decreased for 23 participants, decreased for 6, did not change for 14, increased for 21, and significantly increased for 84. Higher pre-intervention PAM scores, younger age, greater educational attainment, and higher baseline self-efficacy scores were associated with increased post-intervention PAM scores when not controlling for potential covariates. Age was no longer associated with higher PAM scores after controlling for covariates. CONCLUSION Community-based DSMS interventions can be effective in generating positive change in individuals' activation. HED provides a feasible and accessible DSMS option that addresses key diabetes self-management components while effectively improving individuals' activation. It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.
Collapse
Affiliation(s)
- Christina J. Dietz
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Corresponding author: Christina J. Dietz,
| | | | - Michelle Stancil
- Diabetes Self-Management Program, Prisma Health–Upstate, Greenville, SC
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | | | | |
Collapse
|
6
|
Standage-Beier CS, Ziller SG, Bakhshi B, Parra OD, Mandarino LJ, Kohler LN, Coletta DK. Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12551. [PMID: 36231846 PMCID: PMC9566768 DOI: 10.3390/ijerph191912551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.
Collapse
Affiliation(s)
| | - Shelby G. Ziller
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85721, USA
| | - Bahar Bakhshi
- School of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ 85721, USA
| | - Oscar D. Parra
- UA Center for Disparities in Diabetes, Obesity and Metabolism, University of Arizona, Tucson, AZ 85724, USA
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Lawrence J. Mandarino
- UA Center for Disparities in Diabetes, Obesity and Metabolism, University of Arizona, Tucson, AZ 85724, USA
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
| | - Lindsay N. Kohler
- UA Center for Disparities in Diabetes, Obesity and Metabolism, University of Arizona, Tucson, AZ 85724, USA
| | - Dawn K. Coletta
- UA Center for Disparities in Diabetes, Obesity and Metabolism, University of Arizona, Tucson, AZ 85724, USA
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ 85724, USA
- Department of Physiology, University of Arizona, Tucson, AZ 85724, USA
| |
Collapse
|
7
|
Yıldırım Ayaz E, Dincer B, Oğuz A. The Effect of Foot Care Education for Patients with Diabetes on Knowledge, Self-Efficacy and Behavior: Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022; 21:234-253. [PMID: 35711163 DOI: 10.1177/15347346221109047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This systematic review and meta-analysis aimed to synthesize randomized controlled trials on the impact of foot care education on knowledge, self-efficacy and behavior in patients with diabetes. A search was made using PubMed, Web of Science, Science Direct, Google Scholar, YOK National Thesis Center and Google Scholar electronic databases for studies published between March 2003-January 2022. The search medical subject headings (MeSH) terms were diabetic foot, knowledge, self-efficacy, and behavior. Studies suitable for the systematic review and the meta-analysis met the following criteria (PICOS): target participants would be diagnosed with diabetes (population), diabetic foot education (intervention), comparison of the group receiving diabetic foot care education and routine care education, and the control group receiving only routine care education (comparison), studies evaluating the levels of knowledge, self-efficacy and behavior (outcome), randomized controlled trials (study design). Twenty-six studies were included in systematic review. Three studies for knowledge, 5 studies for behavior, 8 studies for self-efficacy were included in the meta-analysis (total sample: 2534, experiment: 1464, control: 1071). All of the studies had low reporting bias. The mean duration of educations for knowledge was 5.2 months. This duration was 4.8 months for behavior and 4.5 months for self-efficacy. In the random effect (since the homogeneity test: P < .001, this model was used), there were significantly difference in terms of knowledge (standardized mean difference (SMD): 1.656, 95% [CI]: 1.014-2.299, P < .001), and behavior (SMD: 1.045, 95% CI: 0.849-1.242, P < .001). But no difference was observed in terms of self-efficacy (SMD: 0.557, 95%CI: -0.402-1.517, P > .05). The results of a systematic review of twenty-six studies and a meta-analysis of 9 studies showed that diabetic foot education improved the level of knowledge and behavior of patients with diabetes, while not affecting their self-efficacy. Educational interventions with long-term follow-up are needed to address the growing health care needs of patients with diabetes.
Collapse
Affiliation(s)
- Elif Yıldırım Ayaz
- University of Health Sciences, 506079Sultan Abdülhamid Han Training and Research Hospital, Internal Medicine Clinic, İstanbul, Turkey
| | - Berna Dincer
- Faculty of Health Sciences, Department of Medical Nursing, Istanbul 226842Medeniyet University, İstanbul, Turkey
| | - Aytekin Oğuz
- 64071Istanbul Medeniyet University Göztepe Prof. Dr Süleyman Yalçın City Hospital, Internal Medicine Clinic, İstanbul, Turkey
| |
Collapse
|
8
|
Azadbakht M, Fadayevatan R, Tanjani PT, Foroughan M, Zanjari N. Prevalence and Determinant Factors of Diabetes Distress in Community-Dwelling Elderly in Qom, Iran. Int J Prev Med 2021; 12:145. [PMID: 34912521 PMCID: PMC8631124 DOI: 10.4103/ijpvm.ijpvm_372_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/23/2020] [Indexed: 11/05/2022] Open
Abstract
Background: Diabetes distress (DD) is common among the patients with type 2 diabetes (T2D), but few studies investigated this problem and its related factors in the elderly population. This study has focused on the prevalence rate of DD and its determinants in community-dwelling elderly in Qom, Iran. Methods: This study was cross-sectional. A total of 519 subjects community-dwelling with T2D participated in the study. Collected data contained sociodemographic information, some clinical variables (body mass index and duration of diabetes) knowledge, attitude, and self-efficacy. Participants' distress was measured via diabetes distress scale (DDS). The cut of 3 (≥3) was considered as the presence of distress. Also, the attitude, self-efficacy, and knowledge about diabetes were measured by questioner. Multiple logistic regression analysis was applied to detect predictors of DD. Results: The mean age of the participants was 68.38 ± 6.78 and 53.6% were female. Among the participants, 48.6% were identified with positive DD. According to the results of logistic regression analysis, being female (odds ration [OR] = 1.688, P = 0.009), being widowed or divorced (OR = 1.629, P = 0.027), being over-weight or obese (OR = 1.627, P = 0.027), and having less than 10 years in disease duration (OR = 1.721, P = 0.029), attitude (OR = 0.590, P < 0.001), and self-efficacy (OR = 0.658, P = 0.009) were identified as the independent predictors of DD. No significant association was found between DD and age, occupational status, education level, and knowledge (P > 0.05). Conclusions: The prevalence of DD is considerable among the elderly in Qom. It seems that more attention should be paid to the mental aspects of the patients with T2D specially in high risk groups.
Collapse
Affiliation(s)
- Mojtaba Azadbakht
- Department of Aging, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Public Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Reza Fadayevatan
- Department of Aging, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parisa Taheri Tanjani
- Department of Internal Medicine, Ayatollah Taleghani Hospital, Research Development Unit, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Foroughan
- Department of Aging, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nasibeh Zanjari
- Department of Aging, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
9
|
Maternal knowledge of the child's heart defect over a 1-year time span, its development and associated factors. Cardiol Young 2021; 31:1943-1952. [PMID: 33858555 DOI: 10.1017/s1047951121001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mothers are the link between patients, physicians, and other caregivers. Therefore, they should be well informed about the child's heart defect and accompanying issues. This study aimed to assess the mothers' understanding of their child's heart defect at hospitalisation and one year later and to analyse the individual development and associated factors. MATERIAL AND METHODS Mothers of children with CHD (aged ≤2 years) were interviewed at time of hospitalisation and after one year. Development was calculated using the Wilcoxon signed-rank test. Knowledge was assessed using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease that consists of eight subscales. Associated factors were self-assessed knowledge at hospitalisation, educational level, cardiac diagnosis, self-assessed severity of CHD, and source of information at follow-up. RESULTS Mothers showed mixed understanding at hospitalisation, but their knowledge improved over a 1-year time span. This was especially true for the subscales "management of CHD" and "surveillance of deterioration", which resulted in an overall good knowledge at follow-up, whereas knowledge on infective endocarditis was still poor. Mothers with lowest and highest education had the most notable improvements. The same holds for caregivers with children with more severe CHD and who rated their knowledge as less than good. CONCLUSION Overall, mothers showed significant improvement especially for topics that are important to provide adequate care, but still revealed knowledge gaps one year after hospitalisation. Consequently, clinicians should evaluate the individual knowledge level at all times and inform mothers accordingly.
Collapse
|
10
|
Zhao X, Hilton A, Watson R, Chen Y. Development and Validity Testing of a Type 1 Diabetes Resource for 10-19-Years Old Adolescents in China. J Pediatr Nurs 2021; 60:e96-e103. [PMID: 33836937 DOI: 10.1016/j.pedn.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This phase 1 study aimed to develop a Type 1 diabetes (T1DM) educational resource for adolescents (10-19 years) in China, and to test its validity for improving diabetes knowledge, self-efficacy and adherence. DESIGN AND METHODS This phase 1 study was carried out in four phases: preliminary development of the Type 1 diabetes educational resource in English based on the health belief model (HBM) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines 2014; translation of the resource into Chinese; readability testing of the resource; and face and content validity testing for scientific and clinical accuracy. RESULTS Type 1 diabetes educational resource with 17 "topics" in four sections was developed for 10-19-years old adolescents in China. Cartoon story, images, stories, questions & answers, and quizzes were used to attract adolescents' interest. Furthermore, the educational resource was confirmed to be understandable among adolescents, clinically accurate, and consistent with its purpose. CONCLUSIONS This resource with good readability and content validity is a potential facilitator for diabetes education and self-management in adolescents with T1DM in China. PRACTICAL IMPLICATIONS This type 1 diabetes resource can be used to educate adolescents with T1DM as a validated resource after further testing in an effectiveness study.
Collapse
Affiliation(s)
- Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, China.
| | | | | | - Yanhua Chen
- The Affiliated Hospital of Southwest Medical University, China.
| |
Collapse
|
11
|
Savarese M, Sapienza M, Acquati GM, Nurchis MC, Riccardi MT, Mastrilli V, D’Elia R, Graps EA, Graffigna G, Damiani G. Educational Interventions for Promoting Food Literacy and Patient Engagement in Preventing Complications of Type 2 Diabetes: A Systematic Review. J Pers Med 2021; 11:jpm11080795. [PMID: 34442439 PMCID: PMC8399193 DOI: 10.3390/jpm11080795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023] Open
Abstract
The present review aims to map the current literature on educational interventions to promote food literacy in type 2 diabetes, with a particular focus on the concept of patient engagement. The systematic review was implemented on five databases with no restrictions on the publication year. The studies selected for the review were focused on patients with type 2 diabetes, ranging from 2003 to 2021 and published in 13 countries (44% USA). Thirty-three articles were analyzed. Twenty-seven articles targeted singular patients; fifteen articles conceptualized patient engagement as self-management. In seven articles, the provider is a multidisciplinary team. Twenty articles did not report a theoretical framework in the intervention development, and eleven did not use an intervention material. Twenty-six articles did not use a technology proxy. Outcome categories were narratively mapped into four areas: clinical, psychological, behavioral, and literacy. To date, most of the interventions are heterogeneous in the adopted methodology, measures, and outcomes considered. More attention should be given to the psychosocial characterization of patient engagement as well as the technological support. High-quality, randomized controlled trials and longitudinal studies are lacking and need to be conducted to verify the efficacy of these insights.
Collapse
Affiliation(s)
- M. Savarese
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - M. Sapienza
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
| | - G. M. Acquati
- Faculty of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy;
| | - M. C. Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
| | - M. T. Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Correspondence: ; Tel.: +39-06-3015-4396
| | - V. Mastrilli
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - R. D’Elia
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - E. A. Graps
- A.Re.S.S. Puglia-Agenzia Regionale Strategica per la Salute ed il Sociale Area Valutazione e Ricerca, 20123 Milano, Italy;
| | - G. Graffigna
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy
| | - G. Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
| |
Collapse
|
12
|
Hierarchy of customer goals: conceptual framework and new insights. JOURNAL OF SERVICE MANAGEMENT 2021. [DOI: 10.1108/josm-03-2020-0087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to: (1) better understand the structure (hierarchy) of customer goals providing conceptual clarity; and (2) propose a hierarchy of customer goals conceptual framework that explicates how healthcare customer goals are linked to drivers and outcomes, thus building theory and informing practice.Design/methodology/approachThe research draws on 21 in-depth interviews of patients with a chronic disease. Drawing principally on construal-level theory and using manual thematic analysis and Leximancer, this article provides new insights into customer goals.FindingsIn a first, the authors identify a two-dimensional structure for each of the three main goal types, which previously had been viewed as unidimensional. The authors develop a conceptual framework linking drivers of goal setting (promotion/prevention focus world view and perceived role) with goal type (life goals, focal goals and action plan goals and their respective subgoals) and outcomes (four forms of subjective well-being). Visual concept maps illustrate the relative importance of certain health-related goals over others.Research limitations/implicationsThe usefulness of the authors’ conceptual framework is demonstrated through the application of their framework to goal setting among healthcare customers, showing links between the structure of goals (life goals, focal goals and action plan goals) to drivers (promotion/prevention focus world view and perceived role) and outcomes (subjective well-being) and the framework's potential application to other service settings.Originality/valueThis study contributes to healthcare marketing and service management literature by providing new insights into goal setting and proposing a novel hierarchy of customer goals conceptual framework linking drivers, goal types and outcomes.
Collapse
|
13
|
Huang LY, Lin YP, Glass GF, Chan EY. Health literacy and patient activation among adults with chronic diseases in Singapore: A cross-sectional study. Nurs Open 2021; 8:2857-2865. [PMID: 33942559 PMCID: PMC8363362 DOI: 10.1002/nop2.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Increased patient activation levels can improve health outcomes. Hence, this study aims to examine the relationships between sociodemographic variables and domain-specific health literacies with patient activation. DESIGN A cross-sectional design. METHODS 200 outpatient adults with chronic diseases completed a survey that assessed their domain-specific health literacy and patient activation levels. Univariate and multivariate analysis of the variables were conducted on patient activation with 95% confidence interval (CI). RESULTS Multiple linear regression analyses observed a positive linear relationship between the following domain-specific health literacy variables-"actively manage my health" (p < .0001, 95% CI: 0.89-2.29), "understanding health information" (p = .008, 95% CI: 0.28-1.85), and "finding good health information" (p = .02, 95% CI 0.13-1.51) with patient activation. The other sociodemographic and clinical variables were not statistically significant. Increased focus from healthcare professionals is needed on helping patients better find and understand health information and encouraging them to actively manage their health; elements which would raise their activation levels.
Collapse
Affiliation(s)
- Laura Yuqi Huang
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Yongxing Patrick Lin
- Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ee-Yuee Chan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore.,Nursing Research Unit, Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore
| |
Collapse
|
14
|
Felix CMDM, Ghisi GLDM, Seixas MB, Batalha APDB, Ezequiel DGA, Trevizan PF, Pereira DAG, Silva LPD. Translation, cross-cultural adaptation, and psychometric properties of the Brazilian Portuguese version of the DiAbeTes Education Questionnaire (DATE-Q). Braz J Phys Ther 2021; 25:583-592. [PMID: 33824060 DOI: 10.1016/j.bjpt.2021.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 01/08/2021] [Accepted: 03/13/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The DiAbeTes Education Questionnaire (DATE-Q) is a self-administered tool developed to evaluate disease-related knowledge and to assess knowledge of five core components of rehabilitation programs: physical exercise, diet, psychosocial well-being, disease self-management, and complications. OBJECTIVE To translate and cross-culturally adapt into Brazilian Portuguese, and to test the psychometric properties of the DATE-Q for its use in Brazil. METHODS The process of translation and cross-cultural adaptation consisted of five steps: translation into Brazilian Portuguese, synthesis of translation, back translation, expert committee, and pilot test of pre-final version. The pre-final version was applied to a sample of 30 patients with diabetes. Psychometric properties (internal consistency, reliability, construct validity, and ceiling and floor effects) of the final version of the Brazilian Portuguese version of the DATE-Q were tested in a sample of 200 adults with diabetes. RESULTS There was no conceptual divergence between the original and the translated versions. Ten (50%) items of the DATE-Q were culturally adapted. Internal consistency (Cronbach's alpha coefficient = 0.6), reliability (intraclass correlation coefficient = 0.5), and construct validity (correlation between Diabetes Knowledge Scales and DATE-Q total scores: ρ = 0.7; P < 0.001) were confirmed. Ceiling or floor effects were not identified. The highest scoring item was about healthy eating. The average time for completion of the DATE-Q was 5 min and 51 s, and the completion rate was 100% for all items. CONCLUSION The Brazilian Portuguese version of the DATE-Q showed adequate psychometric properties, and results suggested that the tool can be used to assess disease-related knowledge in adults with diabetes in Brazil.
Collapse
Affiliation(s)
| | - Gabriela Lima de Melo Ghisi
- Cardiac Rehabilitation and Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mariana Balbi Seixas
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | | | - Patrícia Fernandes Trevizan
- Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | | | - Lilian Pinto da Silva
- Faculty of Physical Therapy, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil; Cardiovascular Research Unit and Exercise Physiology, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
| |
Collapse
|
15
|
Anderson D, Sturt J, McDonald N, Sapkota D, Porter-Steele J, Rogers R, Temple A, Seib C, McGuire A, Tjondronegoro D, Walker R, Al-Khudairy L, White C. Women's Wellness with Type 2 Diabetes Program (WWDP): Qualitative findings from the UK and Australian feasibility study. Diabetes Res Clin Pract 2021; 172:108654. [PMID: 33422587 DOI: 10.1016/j.diabres.2021.108654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
AIMS To undertake a qualitative study of a multimodal behavioural intervention and research protocol developed to improve wellness in women with type 2 diabetes mellitus (T2DM), the Women's Wellness with Type 2 Diabetes program (WWDP). METHODS Semi-structured interviews were conducted with 15 participants who completed the WWDP. The interviews were transcribed verbatim and analysed thematically in an iterative process. RESULTS Themes developing from interviews were broadly grouped into three domains, 1) Hope for a better everyday life; 2) Reflection of the program and its contents; and 3) Impacts on health and wellbeing. Participants viewed the WWDP as a necessary and valuable approach that was crucial in helping them adopt strategies to improve their wellbeing and prevent complications associated with T2DM. Some participants expressed ambivalence towards their adherence to the program due to day-to-day life commitments. The most appreciated feature of the program were the individualised approach adopted by the consultation nurse via skype, convenient appointments, the provision of credible and factual information and the accessible website. CONCLUSIONS This study critically evaluated perceptions of participants towards the WWDP and provided important recommendations for improving the delivery and sustainability of the program in future. Participants perceived the program as an effective means of supporting their T2DM self-management and improving wellbeing.
Collapse
Affiliation(s)
- Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Faculty of Health, University of Technology Sydney, New South Wales, Australia.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Nicole McDonald
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Diksha Sapkota
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | | | - Rebecca Rogers
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Amanda McGuire
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Dian Tjondronegoro
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rosie Walker
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom; Successful Diabetes, Ipswich, United Kingdom
| | | | - Codi White
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
16
|
Abdullah A, Ng CJ, Liew SM, Ambigapathy S, V P, Chinna K. Prevalence of limited health literacy and its associated factors in patients with type 2 diabetes mellitus in Perak, Malaysia: a cross-sectional study. BMJ Open 2020; 10:e039864. [PMID: 33191262 PMCID: PMC7668359 DOI: 10.1136/bmjopen-2020-039864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/02/2020] [Accepted: 10/13/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Limited health literacy in patients with type 2 diabetes mellitus (T2DM) led to poorer diabetes knowledge, less medication adherence and increased healthcare cost. The purpose of this paper was to report the prevalence of limited health literacy in patients with T2DM and to identify factors that are associated with it. DESIGN A cross-sectional study was conducted from January to March 2018; data on patients' sociodemographic characteristics, diabetes knowledge, perceived social support and health literacy level were collected. Health literacy level was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q47). SETTING Patients were recruited from four primary care clinics in Perak, Malaysia. PARTICIPANTS Adult patients diagnosed with T2DM who attended the study clinics during the study period. PRIMARY OUTCOME VARIABLE Patients with HLS-EU-Q47 General Index of ≤33 points were classified as having limited health literacy. RESULTS The prevalence of limited health literacy was 65.3% (n=279). In bivariate analysis, patients' ethnicity (p=0.04), highest education level (p<0.001), monthly income (p=0.003), having health insurance (p=0.007), English language fluency (p<0.001), Malay language fluency (p=0.021), attending diabetes education sessions (p<0.001), perceived social support (p<0.001) and diabetes knowledge (p=0.019) were factors associated with limited health literacy. In logistic regression, not being fluent in English was associated with limited health literacy (OR=2.36, 95% CI 1.30 to 4.30) whereas having high perceived social support (OR=0.52, 95% CI 0.40 to 0.69) and having attended diabetes education sessions (OR=0.42, 95% CI 0.27 to 0.68) were associated with adequate health literacy. CONCLUSION The prevalence of limited health literacy is high among patients with T2DM in Perak, Malaysia. Strategies to improve health literacy in these patients must consider the influences of English fluency, attendance at diabetes education sessions and social support, and may need to adopt a universal approach to addressing limited health literacy.
Collapse
Affiliation(s)
- Adina Abdullah
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Paranthaman V
- Health Clinic Greentown, Ministry of Health Malaysia, Ipoh, Malaysia
| | - Karuthan Chinna
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Kuala Lumpur, Malaysia
| |
Collapse
|
17
|
Durand MA, Yen RW, O’Malley J, Elwyn G, Mancini J. Graph literacy matters: Examining the association between graph literacy, health literacy, and numeracy in a Medicaid eligible population. PLoS One 2020; 15:e0241844. [PMID: 33175891 PMCID: PMC7657552 DOI: 10.1371/journal.pone.0241844] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Graphic display formats are often used to enhance health information. Yet limited attention has been paid to graph literacy in people of lower education and lower socioeconomic status (SES). This study aimed to: 1) examine the relationship between graph literacy, numeracy, health literacy and sociodemographic characteristics in a Medicaid-eligible population 2) determine the impact of graph literacy on comprehension and preference for different visual formats. METHODS We conducted a cross-sectional online survey among people in the US on Medicaid, and of presumed lower education and SES. RESULTS The mean graph literacy score among 436 participants was 1.47 (SD 1.05, range: 0 to 4). Only graph literacy was significantly associated with overall comprehension (p < .001). Mean comprehension scores were highest for the table format (1.91), closely followed by bar graph (1.85) and icon array (1.80). Information comprehension was aligned with preference scores. CONCLUSIONS Graph literacy in a Medicaid-eligible population was lower than previous estimates in the US. Tables were better understood, with icon arrays yielding the lowest score. Preferences aligned with comprehension. PRACTICE IMPLICATIONS It may be necessary to reconsider the use of graphic display formats when designing information for people with lower educational levels. Further research is needed.
Collapse
Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
- UMR 1027, Université Toulouse III Paul Sabatier, Toulouse, France
- * E-mail:
| | - Renata W. Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, SESSTIM, “Cancer, Biomedicine & Society” Group, Hop Timone, Marseille, France
| |
Collapse
|
18
|
Ghisi GLDM, Aultman C, Konidis R, Foster E, Tahsinul A, Sandison N, Sarin M, Oh P. Effectiveness of an education intervention associated with an exercise program in improving disease-related knowledge and health behaviours among diabetes patients. PATIENT EDUCATION AND COUNSELING 2020; 103:1790-1797. [PMID: 32362522 DOI: 10.1016/j.pec.2020.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE to assess the effectiveness of an education intervention associated with an exercise program in improving knowledge and health behaviours among diabetes patients. METHODS Diabetes and prediabetes patients were exposed to an evidence- and theoretically-based comprehensive education intervention over 24 weeks. Patients completed surveys assessing knowledge, physical activity, food intake, self-efficacy, and health literacy. Functional capacity was measured by oxygen uptake. All outcomes were assessed pre- and post-CR. Satisfaction about the education provided was assessed at post-CR. Paired t-tests, Pearson correlation coefficients, and linear regression models were computed to investigate the effectiveness of this intervention. RESULTS 84 patients consented to participate, of which 47(56.0%) completed post-CR assessments. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in physical activity, food intake, self-efficacy, and health literacy (p < 0.05). Peak VO2 has clinically significant improved. Results showed a low significant positive correlation was between post-CR knowledge and food intake(r = 0.297;p = 0.04). Linear regression analysis revealed that age(B=-0.051; p = 0.01) was influential in changing post-CR knowledge. CONCLUSION The benefits of an education intervention designed for diabetes and prediabetes patients associated with an exercise program have been supported. PRACTICE IMPLICATIONS This work shows one effective education strategy taken in place that can be replicated in different settings.
Collapse
Affiliation(s)
- Gabriela Lima de Melo Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada.
| | - Crystal Aultman
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Renee Konidis
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Evelyn Foster
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Anam Tahsinul
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Nicole Sandison
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Michael Sarin
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| | - Paul Oh
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute (TRI), University Health Network (UHN), Toronto, Canada
| |
Collapse
|
19
|
Bailey SC, Andrews EN, Halton CC, Wolf MS. Evaluation of a Discussion Guide to Promote Patient Understanding of Menopause and Informed Treatment Decision-Making. J Womens Health (Larchmt) 2020; 30:445-451. [PMID: 32857643 DOI: 10.1089/jwh.2020.8436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patient-provider communication surrounding menopause symptoms and treatment is often limited. We developed and evaluated a health literacy-appropriate discussion guide to support patient education. Materials and Methods: A cross-sectional randomized study was conducted among 100 English-speaking women, aged 45-60 years, in Chicago, IL, and Durham, NC. Participants were randomly assigned to review either the discussion guide or a standard education material (n = 50 per arm) and to complete an open book knowledge questionnaire; they then rated the appearance and quality of both materials. Bivariate analyses examined knowledge and satisfaction by study arm and across sociodemographic characteristics. Multivariable models tested the effectiveness of the discussion guide to improve knowledge compared with the standard material. Results: Women receiving the discussion guide demonstrated significantly higher knowledge scores compared with those who reviewed the standard material (mean [M] = 20.0, standard deviation [SD] = 2.7, vs. M = 18.1, SD = 2.6; p < 0.001); 82.0% of those exposed to the discussion guide correctly answered ≥85% of knowledge items compared with only 48.0% of those reviewing the standard material (p < 0.001). In multivariable analyses, participants receiving the discussion guide displayed significantly greater knowledge in comparison with those receiving the standard material regardless of whether knowledge was examined as a score (∝ = 1.9, 95% confidence interval [CI]: 0.9-2.9, p < 0.001) or 85% threshold (odds ratio: 5.7, 95% CI: 2.0-16.2, p < 0.001). More than two-thirds of women (68%) preferred the discussion guide; it was rated highly in terms of appearance and content. Conclusions: The discussion guide improved understanding of menopause symptoms and treatment options in comparison with a current standard and was well received by a diverse audience.
Collapse
Affiliation(s)
- Stacy Cooper Bailey
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emma N Andrews
- U.S./Global Medical Affairs, Pfizer, Inc., New York, New York, USA
| | - Candida C Halton
- School of Social Sciences, University of Westminster, London, United Kingdom.,Consultant at Studio Health, London, United Kingdom
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
20
|
Rodríguez LA, Barquera S, Aguilar-Salinas CA, Sepúlveda-Amor J, Sánchez-Romero LM, Denova-Gutiérrez E, Balderas N, Moreno-Loaeza L, Handley MA, Basu S, López-Arellano O, Gallardo-Hernández A, Schillinger D. Design of a cluster-randomized trial of the effectiveness and cost-effectiveness of metformin on prevention of type 2 diabetes among prediabetic Mexican adults (the PRuDENTE initiative of Mexico City). Contemp Clin Trials 2020; 95:106067. [PMID: 32580032 PMCID: PMC7484103 DOI: 10.1016/j.cct.2020.106067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a global epidemic, and nations are struggling to implement effective healthcare strategies to reduce the burden. While efficacy studies demonstrate that metformin can reduce incident T2D by half among younger, obese adults with prediabetes, its real-world effectiveness are understudied, and its use for T2D prevention in primary care is low. We describe the design of a pragmatic trial to evaluate the incremental effectiveness of metformin, as an adjunct to a simple lifestyle counseling. METHODS The "Prevención de la Diabetes con Ejercicio, Nutrición y Tratamiento" [Diabetes Prevention with Exercise, Nutrition and Treatment; PRuDENTE, (Spanish acronym)] is a cluster-randomized trial in Mexico City's public primary healthcare system. The study randomly assigns 51 clinics to deliver one of two interventions for 36 months: 1) lifestyle only; 2) lifestyle plus metformin, to 3060 patients ages 30-65 with impaired fasting glucose and obesity. The primary endpoint is incident T2D (fasting glucose ≥126 mg/dL, or HbA1c ≥6.5%). We will also measure a range of implementation-related process outcomes at the clinic-, clinician- and patient-levels to inform interpretations of effectiveness and enable efforts to refine, adapt, adopt and disseminate the model. We will also estimate the cost-effectiveness of metformin as an adjunct to lifestyle counseling in Mexico. DISCUSSION Findings from this pragmatic trial will generate new translational knowledge in Mexico and beyond, both with respect to metformin's real-world effectiveness among an 'at-risk' population, and uncovering facilitators and barriers to the reach, adoption and implementation of metformin preventive therapy in public primary care settings. TRIAL REGISTRATION This trial is registered at Clinicaltrials.gov (NCT03194009).
Collapse
Affiliation(s)
- Luis A Rodríguez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Simón Barquera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Carlos A Aguilar-Salinas
- Division of Nutrition, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Jaime Sepúlveda-Amor
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Nydia Balderas
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
| | - Lizbeth Moreno-Loaeza
- Research Unit on Metabolic Diseases, Salvador Zubiran National Institute of Medical Sciences and Nutrition, Mexico City, Mexico; Medical, Dental and Health Sciences, National Autonomous University of Mexico, Mexico City, Mexico
| | - Margaret A Handley
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA; Division of General Internal Medicine at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | | | | | - Dean Schillinger
- Division of General Internal Medicine at San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA, USA
| |
Collapse
|
21
|
Dang YH, Patel-Shori NM, Barros M, Yu D. Good Literacy to Enhance Response in Diabetes Mellitus (GLITTER-DM). Innov Pharm 2020; 11. [PMID: 34007632 PMCID: PMC8075145 DOI: 10.24926/iip.v11i3.2406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: The purpose of this study is to determine the effectiveness of individualized communication strategies and self-management action plans to improve A1c control at 3 months in patients with low health literacy. Methods: A prospective, open-labeled, pilot study was conducted on 23 patients with diabetes mellitus in a pharmacist-led ambulatory care clinic. Patients who had a Rapid Estimate of Adult Literacy in Medicine- Revised (REALM-R) score of 6 or less and an A1c greater than 7% upon study entry were included. The first group received the teach-back method, personalized actions, and follow-up phone calls to assess comprehension (N = 12). The second group was assigned to usual care (N = 11). Results: Patients receiving literacy-appropriate interventions had greater A1c percent reduction (A1c difference of -2.0 ± 1.3 vs -1.0 ± 2.2; P = 0.02) and less hyperglycemic events per week (0.1 vs. 2.1; P = 0.04). There were no differences in the number of hypoglycemic events, testing frequency, medication-adherence rates, or hospitalizations and emergency room visits related to diabetes. Conclusion: Literacy-appropriate methods such as the teach-back method, personalized action plans, and telephone follow-ups may improve glycemic control in low health literate patients with diabetes. Practice Implications and Innovations: The findings from this study suggest that pharmacists may improve diabetes outcomes when managing patients who possess low health literacy using simplified teaching methods.
Collapse
Affiliation(s)
- Yen H Dang
- University of Maryland Eastern Shore, School of Pharmacy and Health Professions, Department of Pharmacy Practice
| | | | - Michael Barros
- Temple University, School of Pharmacy, Department of Pharmacy Practice
| | - Daohai Yu
- Temple University, School of Medicine, Department of Clinical Sciences
| |
Collapse
|
22
|
White RO, Chakkalakal RJ, Wallston KA, Wolff K, Gregory B, Davis D, Schlundt D, Trochez KM, Barto S, Harris LA, Bian A, Schildcrout JS, Kripalani S, Rothman RL. The Partnership to Improve Diabetes Education Trial: a Cluster Randomized Trial Addressing Health Communication in Diabetes Care. J Gen Intern Med 2020; 35:1052-1059. [PMID: 31919724 PMCID: PMC7174470 DOI: 10.1007/s11606-019-05617-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings. OBJECTIVE The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients. DESIGN Cluster randomized controlled trial. PATIENTS Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN. INTERVENTIONS A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics). MAIN MEASURES Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care. KEY RESULTS Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (- 0.76 [95% CI, - 1.08 to - 0.44]; P < .001 vs - 0.54 [95% CI, - 0.86 to - 0.21]; P = .001), odds of poor eating (0.53 [95% CI, 0.33-0.83]; P = .01 vs 0.42 [95% CI, 0.26-0.68]; P < .001), treatment satisfaction (3.93 [95% CI, 2.48-6.21]; P < .001 vs 3.04 [95% CI, 1.93-4.77]; P < .001), and self-efficacy (2.97 [95% CI, 1.89-4.67]; P < .001 vs 1.81 [95% CI, 1.1-2.84]; P = .01). No significant difference was observed between study arms in adjusted analyses. CONCLUSIONS Both interventions improved the participant's A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.
Collapse
Affiliation(s)
- Richard O White
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
| | - Rosette James Chakkalakal
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth A Wallston
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathleen Wolff
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Becky Gregory
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dianne Davis
- Vanderbilt Diabetes Research and Training Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Karen M Trochez
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shari Barto
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura A Harris
- Mid-Cumberland Regional Office, Tennessee Department of Health , Nashville, TN, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | | | - Sunil Kripalani
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Russell L Rothman
- Department of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
23
|
Mediators of Socioeconomic Inequity in Living-donor Kidney Transplantation: Results From a UK Multicenter Case-Control Study. Transplant Direct 2020; 6:e540. [PMID: 32309626 PMCID: PMC7145004 DOI: 10.1097/txd.0000000000000986] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/13/2019] [Accepted: 01/01/2020] [Indexed: 01/12/2023] Open
Abstract
Supplemental Digital Content is available in the text. There is evidence of socioeconomic inequity in access to living-donor kidney transplantation, but limited evidence as to why. We investigated possible mediators of the inequity.
Collapse
|
24
|
Prioritizing a sequence of short-duration groups as the standardized pathway for chronic noncancer pain at an Australian tertiary multidisciplinary pain service: preliminary outcomes. Pain Rep 2019; 4:e780. [PMID: 31875185 PMCID: PMC6882570 DOI: 10.1097/pr9.0000000000000780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Objective: To describe implementation and report preliminary outcomes of a resource-efficient, standardized group pathway for chronic noncancer pain. Design: Descriptive cross-sectional study of a group-based pain management pathway in comparison with an Australasian benchmarking data set. Setting: An Australian tertiary multidisciplinary pain service. Subjects: Patients with chronic noncancer pain actively participating in the group pathway in 2016. Methods: Referred patients were prioritized to a short-duration group–based standardized pain management pathway linking education, assessment, and treatment groups. Measures of pain, mood, self-efficacy, and catastrophizing and reduction in daily opioid use were collated from the Australasian data set. Results: In 2016, 928 patients were actively engaged with the pain service. More patients were prioritized to receive treatment in a group format in comparison with other Australasian services (68.4% vs 22%). A greater percentage of patients attended their first clinical contact within 3 months of referral (81.4%) compared with the Australasian average (68.6%). Comparable improvements in average pain intensity, pain interference, depression, anxiety, stress, pain catastrophizing, and self-efficacy were observed. There was significantly greater reduction in opioid use, including for those taking more than 40 mg of oral morphine equivalent daily dose. Conclusion: Implementation of a sequence of short-duration groups as the default clinical pathway resulted in shorter waiting times and noninferior outcomes in key areas for patients completing the program, compared with Australasian averages. Given the resource efficiencies of the group process, this finding has implications for service design.
Collapse
|
25
|
Ueno H, Ishikawa H, Suzuki R, Izumida Y, Ohashi Y, Yamauchi T, Kadowaki T, Kiuchi T. The association between health literacy levels and patient-reported outcomes in Japanese type 2 diabetic patients. SAGE Open Med 2019; 7:2050312119865647. [PMID: 31384463 PMCID: PMC6651654 DOI: 10.1177/2050312119865647] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/01/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of this study is to empirically examine a full pathway model of health literacy, and health and well-being outcomes among patients with type 2 diabetes. METHODS A three-wave longitudinal survey was administered to 148 patients with diabetes. Covariance structure analysis was conducted to create a path diagram, with health literacy and burden of medical expenses included as independent variables and with psychosocial factors, behaviors, and health and well-being outcomes included as dependent variables. RESULTS The model fit indices showed a comparative fit index of 0.985 at baseline, 0.959 after 3 months, and 0.948 after 6 months, with a root mean square error of approximation of 0.040 at baseline, 0.079 after 3 months, and 0.085 after 6 months. There were 14 significant paths across the three time points between health literacy and understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. CONCLUSION The model fitness index showed an adequate result. Health literacy was significantly positively associated with understanding of diabetes care, self-efficacy, communication with doctors, and medication adherence. Health literacy had a direct positive influence on medication adherence and possibly an indirect positive influence on exercise/diet via self-efficacy. The results were generally consistent across the three time points, suggesting good reliability of the models. Improving health literacy may lead to better self-management of diabetes and favorable health outcomes.
Collapse
Affiliation(s)
- Haruka Ueno
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirono Ishikawa
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of Public Health, Teikyo University, Tokyo, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Diabetes, Metabolism, Endocrinology, Rheumatology and Collagen Diseases Tokyo Medical University, Tokyo, Japan
| | - Yoshihiko Izumida
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yumiko Ohashi
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Prevention of Diabetes and Life-style Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Metabolism and Nutrition, Mizonokuchi Hospital, Teikyo University, Kawasaki, Kanagawa, Japan
| | - Takahiro Kiuchi
- Department of Health Communication, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
26
|
Saltaouras G, Lightowler H, Coe S, Brett J, Watson EK. Availability and quality assessment of online nutrition information materials for pelvic cancer patients in the UK. Eur J Cancer Care (Engl) 2019; 28:e13039. [DOI: 10.1111/ecc.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 12/07/2018] [Accepted: 03/20/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Georgios Saltaouras
- Department of Sport, Health Sciences and Social Work Oxford Brookes University Oxford UK
- School of Nursing and Midwifery Oxford Brookes University Oxford UK
| | - Helen Lightowler
- Department of Sport, Health Sciences and Social Work Oxford Brookes University Oxford UK
| | - Shelly Coe
- Department of Sport, Health Sciences and Social Work Oxford Brookes University Oxford UK
| | - Jo Brett
- School of Nursing and Midwifery Oxford Brookes University Oxford UK
| | - Eila K. Watson
- School of Nursing and Midwifery Oxford Brookes University Oxford UK
| |
Collapse
|
27
|
Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med 2019; 34:1007-1017. [PMID: 30877457 PMCID: PMC6544696 DOI: 10.1007/s11606-019-04832-y] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/25/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Empirical evidence on how health literacy affects diabetes outcomes is inconsistent. The purpose of this meta-analysis was to quantitatively summarize the findings on the associations between health literacy and diabetes knowledge, self-care activities, and glycemic control as disease-related outcomes, with specific focus on the type of health literacy assessment. DATA SOURCES Nine databases (MEDLINE, CINAHL, Communication and Mass Media Complete, PsychInfo, PsychArticles, Psychology and Behavioral Sciences Collection, ERIC, Sociology, Embase) were searched for peer-reviewed original research articles published until 31 March 2018. METHODS Studies with type 1 and/or type 2 diabetes patients aged 18 or older, providing a calculable baseline effect size for functional health literacy and diabetes knowledge, self-care activities, or HbA1C were included. RESULTS The meta-analysis includes 61 studies with a total of 18,905 patients. The majority were conducted in the USA, on type 2 diabetes patients, and used the S-TOFHLA as a performance-based or the BHLS as a perception-based measure of functional health literacy. Meta-analytic results show that all three outcomes are related to health literacy. Diabetes knowledge was best predicted by performance-based health literacy measures, self-care by self-report measures, and glycemic control equally by both types of health literacy assessment. DISCUSSION Health literacy plays a substantial role in diabetes knowledge. Findings for the role of health literacy in self-care and glycemic control remain heterogeneous, partly due to the type of health literacy assessment (performance- vs. perception-based). This has implications for the use of health literacy measures in clinical settings and original research. This meta-analysis was limited to functional health literacy and, due to the paucity of studies, did not investigate the role of other dimensions including communicative and critical health literacy.
Collapse
Affiliation(s)
- Laura Marciano
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland.
| | - Anne-Linda Camerini
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
| | - Peter J Schulz
- Faculty of Communication Sciences, Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904, Lugano, Switzerland
| |
Collapse
|
28
|
Heisler M, Choi H, Mase R, Long JA, Reeves PJ. Effectiveness of Technologically Enhanced Peer Support in Improving Glycemic Management Among Predominantly African American, Low-Income Adults With Diabetes. DIABETES EDUCATOR 2019; 45:260-271. [PMID: 31027477 DOI: 10.1177/0145721719844547] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-health educational tools than peer coaching alone. METHODS The effectiveness of peer coaches who used an individually tailored, interactive, web-based tool (iDecide) was compared with peer coaches with no access to the tool. Two hundred and ninety Veterans Affairs patients with A1C ≥8.0% received a 6-month intervention with an initial session with a fellow patient trained to be a peer coach, followed by weekly phone calls to discuss behavioral goals. Participants were randomized to coaches who used iDecide or coaches who used nontailored educational materials at the initial session. Outcomes were A1C (primary), blood pressure, and diabetes social support (secondary) at 6 and 12 months. RESULTS Two hundred and fifty-five participants (88%) completed 6-month and 237 (82%) 12-month follow-up. Ninety-eight percent were men, and 63% were African American. Participants in both groups improved A1C values (>-0.6%, P < .001) at 6 months and maintained these gains at 12-month follow-up ( >-0.5%, P < .005). Diabetes social support was improved at both 6 and 12 months ( P < .01). There were no changes in blood pressure. CONCLUSIONS Clinical gains achieved through a volunteer peer coach program were not increased by the addition of a tailored e-health educational tool.
Collapse
Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, and Michigan Center for Diabetes Translation Research (MCDTR), University of Michigan, Ann Arbor VA, Ann Arbor, Michigan.,VA Corporal Michael J. Crescenz Medical Center and Center for Health Equity Research and Promotion and University of Pennsylvania Department of Internal Medicine, Philadelphia, Pennsylvania
| | - Hwajung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Rebecca Mase
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Judith A Long
- VA Corporal Michael J. Crescenz Medical Center and Center for Health Equity Research and Promotion and University of Pennsylvania Department of Internal Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
29
|
Gómez-Velasco DV, Almeda-Valdes P, Martagón AJ, Galán-Ramírez GA, Aguilar-Salinas CA. Empowerment of patients with type 2 diabetes: current perspectives. Diabetes Metab Syndr Obes 2019; 12:1311-1321. [PMID: 31496769 PMCID: PMC6689555 DOI: 10.2147/dmso.s174910] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/25/2019] [Indexed: 01/18/2023] Open
Abstract
Patient empowerment is a continuous process in which knowledge, motivation, and capacity to take control of their disease are built within a person. This concept is not always well understood and applied. This review describes the strategies to induce empowerment in patients with diabetes. In addition, the most common scales used to evaluate empowerment in diabetes is described. Furthermore, the effectiveness of the empowerment-based interventions for improving metabolic control and diabetes knowledge are described. Finally, we discuss opportunities for empowerment implementation in clinical practice and current needs on research that can be translated into public policies.
Collapse
Affiliation(s)
- Donají V Gómez-Velasco
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alexandro J Martagón
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Gabriela A Galán-Ramírez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
- Correspondence: Carlos A Aguilar-SalinasUnidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15 Colonia Belisario Domínguez Sección XVI. Delegación Tlalpan, Mexico City14080, MexicoTel +52 555 487 0900 ext 6319 Email
| |
Collapse
|
30
|
Hadden KB, Arnold CL, Curtis LM, Gan JM, Hur SI, Kwasny MJ, McSweeney JC, Prince LY, Wolf MS, Davis TC. Rationale and development of a randomized pragmatic trial to improve diabetes outcomes in patient-centered medical homes serving rural patients. Contemp Clin Trials 2018; 73:152-157. [PMID: 30243812 PMCID: PMC6179446 DOI: 10.1016/j.cct.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/10/2018] [Accepted: 09/18/2018] [Indexed: 12/20/2022]
Abstract
Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that can be readily implemented and sustained in rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on our team developed an evidence-based, patient-centered, low literacy intervention promoting diabetes self-care that includes: 1) the American College of Physicians (ACP) Diabetes Guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2) a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change ('action plans'); and 3) a training module for health coaches that prepares them to assume educator/counselor roles with the Diabetes Guide as a teaching tool. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, its optimal implementation is not known. This project took advantage of a unique opportunity to modify and disseminate the ACP health literacy intervention among patients with type 2 diabetes cared for at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices all had health coaches that could be leveraged to provide chronic disease self-management mostly via phone, but also at the point-of-care. Hence we conducted a patient-randomized, pragmatic clinical trial in 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes.
Collapse
Affiliation(s)
- Kristie B Hadden
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA.
| | - Connie L Arnold
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
| | - Laura M Curtis
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Jennifer M Gan
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Scott I Hur
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Mary J Kwasny
- Northwestern University, Department of Preventive Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Jean C McSweeney
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Latrina Y Prince
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205-7199, USA
| | - Michael S Wolf
- Northwestern University, Division of General Internal Medicine and Geriatrics, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA
| | - Terry C Davis
- Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
| |
Collapse
|
31
|
Inadequate Health Literacy in Patients with Arterial Vascular Disease. Eur J Vasc Endovasc Surg 2018; 56:239-245. [DOI: 10.1016/j.ejvs.2018.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 04/22/2018] [Indexed: 11/20/2022]
|
32
|
Vicente A, Candila J, Thomas JJ, Gomez Aguilar P, Oliva Aviles C. Living With Type 2 Diabetes in San Jose Tecoh, Yucatan, Mexico: A Phenomenological Study. J Transcult Nurs 2018; 30:214-221. [PMID: 30033827 DOI: 10.1177/1043659618790090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Understanding the psychosocial aspects that accompany and influence type 2 diabetes mellitus (T2DM) has become increasingly important for culturally appropriate health care in Mexico. The purpose of this study was to understand the lived experience of individuals' with T2DM in Merida, Yucatan. METHOD A phenomenological method guided data collection and analysis. Patients in San Jose Tecoh, diagnosed with T2DM for at least 5 years, were interviewed. RESULTS Eight (six female, two male) patients described their lived experience. Individuals discussed knowledge of the disease (e.g., care, beliefs about origin, consequences, type, symptoms) and changes arising from diagnosis (e.g., emotional, dietary, physiological, lifestyle and self-care, economic). DISCUSSION The Mayan-Yucatecan cultural perceptions of factors that influence physical health are unique to this region. Nurses can facilitate improvement in T2DM health outcomes through providing information and encouraging self-care. Our results emphasize the importance of considering T2DM in terms of differences between and within culture.
Collapse
Affiliation(s)
| | - Julia Candila
- 1 Autonomous University of Yucatan, Merida, Yucatan, Mexico
| | | | | | | |
Collapse
|
33
|
Burgette JM, Preisser JS, Weinberger M, King RS, Lee JY, Rozier RG. Absence of a moderating effect of parent health literacy on Early Head Start enrollment and dental use. J Public Health Dent 2018; 78:257-265. [PMID: 29659021 DOI: 10.1111/jphd.12269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 03/06/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the moderating effect of parents' health literacy (HL) on the effectiveness of North Carolina Early Head Start (EHS) in improving children's dental use. METHODS Parents of 479 children enrolled in EHS and 699 Medicaid-matched parent-child dyads were interviewed at baseline when children were approximately 10 months old and 24 months later. We used in-person computer-assisted, structured interviews to collect information on sociodemographic characteristics, dental use, and administer the Short Assessment of Health Literacy - Spanish and English (SAHL-S&E). This quasi-experimental study tested whether the interaction effect between EHS and parents' HL was associated with dental use. Logit (any use) and marginalized zero-inflated negative binomial count models (number of dental visits) included random effects to account for clustering and controlled for baseline dental use, dental need, survey language, and a propensity score covariate. RESULTS Nineteen percent of parents in EHS had low literacy compared to 12 percent of parents in the non-EHS group (P < 0.01). The interaction term between EHS and parent's HL was not significant in the adjusted logit model (ratio of aORs 0.98, 95 percent CI: 0.43-2.20) or the adjusted count model (ratio of aRRs 0.88, 95 percent CI: 0.72-1.09). CONCLUSIONS Parents in EHS had a higher prevalence of low HL compared to non-EHS parents. Parents' HL did not moderate the relationship between EHS and child dental use, suggesting that EHS results in similar improvements in dental use regardless of parent's HL levels.
Collapse
Affiliation(s)
- Jacqueline M Burgette
- Department of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Research Fellow, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - John S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca S King
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica Y Lee
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - R Gary Rozier
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
34
|
Davis TC. Diabetes status is linked to low health literacy: Implications for health system. J Diabetes Complications 2018; 32:355-356. [PMID: 29467095 DOI: 10.1016/j.jdiacomp.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 11/29/2022]
|
35
|
Smith-Miller CA, Berry DC, DeWalt D, Miller CT. Type 2 Diabetes Self-management Among Spanish-Speaking Hispanic Immigrants. J Immigr Minor Health 2018; 18:1392-1403. [PMID: 26547695 DOI: 10.1007/s10903-015-0271-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This article describes the quantitative findings of a mixed-methods study that examined the relationship among knowledge, self-efficacy, health promoting behaviors, and type 2 diabetes self-management among recent Spanish-speaking, limited English proficient immigrants to the US. This population is at risk for both a higher incidence of disease and increased barriers to successful disease management compared to the general US population. Distinguishing aspects of this study compared to the available literature are the comprehensive nature of the data collected, the theoretical component, and the analysis and modeling approach. Social cognitive theory provides the framework for the study design and analysis. An innovative community-based recruiting strategy was used, a broad range of physiological measures related to health were observed, and instruments related to knowledge, self-efficacy, and healthy lifestyle behaviors were administered orally in Spanish to 30 participants. A broad range of statistical analysis methods was applied to the data, including a set of three structural equation models. The study results are consistent with the importance of education, health knowledge, and healthy lifestyle practices for type 2 diabetes self-management. With the usual cautions associated with applying structural equation modeling to modest sample sizes, multiple elements of the posited theoretical model were consistent with the data collected. The results of the investigation of this under-studied population indicate that, on average, participants were not effectively managing their disease. The results suggest that clinical interventions focused on improving knowledge, nutrition, and physical activity, reducing stress, and leveraging the importance of interpersonal relations could be effective intervention strategies to improve self-management among this population.
Collapse
Affiliation(s)
- Cheryl A Smith-Miller
- Nursing Quality and Research, University of North Carolina Hospital, Chapel Hill, NC, USA. .,School of Nursing, UNC-CH, Chapel Hill, NC, USA.
| | | | | | - Cass T Miller
- UNC Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
| |
Collapse
|
36
|
Riemenschneider H, Saha S, van den Broucke S, Maindal HT, Doyle G, Levin-Zamir D, Muller I, Ganahl K, Sørensen K, Chang P, Schillinger D, Schwarz PEH, Müller G. State of Diabetes Self-Management Education in the European Union Member States and Non-EU Countries: The Diabetes Literacy Project. J Diabetes Res 2018; 2018:1467171. [PMID: 29850598 PMCID: PMC5932431 DOI: 10.1155/2018/1467171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/21/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diabetes self-management education (DSME) is considered essential for improving the prevention and care of diabetes through empowering patients to increase agency in their own health and care processes. However, existing evidence regarding DSME in the EU Member States (EU MS) is insufficient to develop an EU-wide strategy. OBJECTIVES This study presents the state of DSME in the 28 EU MS and contrasts it with 3 non-EU countries with comparable Human Development Index score: Israel, Taiwan, and the USA (ITU). Because type 2 diabetes mellitus (T2DM) disproportionately affects minority and low-income groups, we paid particular attention to health literacy aspects of DSME for vulnerable populations. METHODS Data from multiple stakeholders involved in diabetes care were collected from Feb 2014 to Jan 2015 using an online Diabetes Literacy Survey (DLS). Of the 379 respondents (249 from EU MS and 130 from ITU), most were people with diabetes (33% in the EU MS, 15% in ITU) and care providers (47% and 72%). These data were supplemented by an expert survey (ES) administered to 30 key informants. RESULTS Access to DSME varies greatly in the EU MS: an average of 29% (range 21% to 50%) of respondents report DSME programs are tailored for people with limited literacy, educational attainment, and language skills versus 63% in ITU. More than half of adult T2DM patients and children/adolescents participate in DSME in EU MS; in ITU, participation of T1DM patients and older people is lower. Prioritization of DSME (6.1 ± 2.8 out of 10) and the level of satisfaction with the current state of DSME (5.0 ± 2.4 out of 10) in the EU MS were comparable with ITU. CONCLUSION Variation in availability and organization of DSME in the EU MS presents a clear rationale for developing an EU-wide diabetes strategy to improve treatment and care for people with diabetes.
Collapse
Affiliation(s)
- Henna Riemenschneider
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarama Saha
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stephan van den Broucke
- Institut de Recherche en Sciences Psychologiques, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Gerardine Doyle
- College of Business, University College Dublin, Dublin, Ireland
| | | | - Ingrid Muller
- Department of Psychology, University of Southampton, Southampton, UK
| | - Kristin Ganahl
- Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria
| | - Kristine Sørensen
- Department of International Health, Maastricht University, Maastricht, Netherlands
| | - Peter Chang
- Ministry of Health & Welfare, National Taipei Hospital, New Taipei City, Taiwan
| | - Dean Schillinger
- Center for Vulnerable Populations, Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Peter E. H. Schwarz
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
37
|
Strait A, Velasquez A, Handley MA, Leong K, Najmabadi A, Powe NR, Tuot DS. Acceptability of a multilevel intervention to improve blood pressure control among patients with chronic kidney disease in a public health care delivery system. Clin Kidney J 2017; 11:540-548. [PMID: 30094019 PMCID: PMC6070069 DOI: 10.1093/ckj/sfx141] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/09/2017] [Indexed: 12/19/2022] Open
Abstract
Background The Kidney Awareness Registry and Education (KARE) trial examined the impact of a multilevel intervention on blood pressure control among patients with chronic kidney disease (CKD) in a public health care delivery system. KARE consisted of a clinic-based intervention (a primary care CKD registry with point-of-care provider notifications and quarterly feedback related to CKD management) and a patient-directed intervention [a CKD self-management support (CKD-SMS) program that included low literacy educational materials, automated telephone-administered self-management modules and telephone health coaching]. We explored the acceptability of these interventions among end users. Methods At trial conclusion, we surveyed 39 primary care providers (PCPs) to identify preferences about components of the clinic intervention, conducted two focus groups among non-PCP staff to elicit in-depth attitudes and experiences with operationalizing the team-based CKD registry, and conducted eight focus groups with English- and Spanish-speaking patients to hear about their experiences with the CKD-SMS program. Focus group transcripts were analyzed using thematic analysis. Self-reported participation and data from the automated telephone program were used to evaluate patient engagement. Results Most PCPs (94%) believed that the point-of-care notifications benefited clinic workflow and agreed that quarterly feedback enhanced their ability to identify (89.5%) and manage (73.7%) CKD. Staff confirmed usefulness of point-of-care notifications. Patients suggested the automated telephone system was impersonal, though easy to use; that frequent automated calls were helpful to reinforce self-management behaviors; and that telephone health coaching was convenient. Nearly 40% of patients completed >80% of automated phone calls, 95% participated in calls with their health coach and 77% created at least one action plan. Conclusions A CKD registry is acceptable to primary care health care teams and has potential to enhance identification and management of CKD in primary care. Low-income patients appreciated and engaged with a telephone-based CKD-SMS program, demonstrating its potential for increasing awareness and health engagement among populations with CKD within a public health care delivery system.
Collapse
Affiliation(s)
- Adrienne Strait
- Division of Nephrology, University of California, San Francisco, CA, USA
| | | | - Margaret A Handley
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Karen Leong
- Division of Nephrology, University of California, San Francisco, CA, USA
| | - Adriana Najmabadi
- Division of Nephrology, University of California, San Francisco, CA, USA
| | - Neil R Powe
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Delphine S Tuot
- Division of Nephrology, University of California, San Francisco, CA, USA
| |
Collapse
|
38
|
Abstract
Collaborative goal setting (CGS) is a cornerstone of diabetes self-management support, but little is known about its feasibility and effectiveness during routine care. The aim of this study was to evaluate the implementation of an existing CGS intervention when integrated by primary care staff. Using a mixed-methods approach guided by the RE-AIM framework, intervention adoption, implementation, reach, and effectiveness were evaluated over 12 months. Three of four sites adopted the CGS intervention, in which 521 patients with type 2 diabetes (9-29 % of those targeted) received CGS. For those with suboptimal glycemic control (A1C ≥ 7.5 %), %A1C decreased by 1.1 for those receiving CGS (n = 204, p < 0.001) compared to 0.4 for a group who did not (n = 41, p = 0.23). Practice characteristics influenced adoption and implementation, while isolation of CGS from the remainder of clinical care likely influenced reach and effectiveness. CGS may benefit patients with diabetes, but a lack of integration by practice staff is a key barrier to overcome during implementation.
Collapse
|
39
|
Lee SJ, Song M, Im EO. Effect of a Health Literacy-Considered Diabetes Self-Management Program for Older Adults in South Korea. Res Gerontol Nurs 2017; 10:215-225. [PMID: 28926669 DOI: 10.3928/19404921-20170831-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/18/2017] [Indexed: 11/20/2022]
Abstract
The current randomized controlled study evaluated the effects of a health literacy-considered diabetes self-management program on diabetes-related parameters: diabetes self-management knowledge (DSK), diabetes health beliefs (DHB), diabetes self-efficacy (DSE), diabetes self-management behavior (DSMB), and diabetes biomarkers. Fifty-one Korean older adults with diabetes completed 12 weekly sessions that were developed based on their health literacy and health-related characteristics. The results indicate significant posttest differences between groups in DSK (p = 0.046), DSE (p = 0.046), DSMB (p = 0.012), and the DSMB self-monitored blood glucose subscale (p = 0.002). Significant pre-post changes between groups were observed in the DHB benefit subscale (p = 0.043), DSE (p = 0.006), DSMB (p = 0.008), DSMB diet (p = 0.029), and the self-monitored blood glucose subscale (p < 0.001). A significant pre-post difference was observed in the intervention group's HbA1c levels (p = 0.008). The program effectively improved participants' DSK, DHB, DSE, and DSMB values, which may be helpful for improving HbA1c levels. [Res Gerontol Nurs. 2017; 10(5):215-225.].
Collapse
|
40
|
Schumacher JR, Lutz BJ, Hall AG, Pines JM, Jones AL, Hendry P, Kalynych C, Carden DL. Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation. West J Emerg Med 2017; 18:743-751. [PMID: 28611897 PMCID: PMC5468082 DOI: 10.5811/westjem.2017.2.32570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions. METHODS We conducted a mixed-methods study including a randomized controlled trial and in-depth interviews in two EDs in northern Florida. Participants were chronically ill older ED patients with limited health literacy and Medicare as a payer source. Patients were assigned to an evidence-based coaching intervention (n= 35) or usual post-ED care (n= 34). Qualitative interviews (n=9) explored patients' reasons for ED use. We assessed average between-group differences in patient engagement over time with the Patient Activation Measure (PAM) tool, using logistic regression and a difference-in-difference approach. Between-group differences in follow-up doctor visits were determined. We analyzed qualitative data using open coding and thematic analysis. RESULTS PAM scores fell in both groups after the ED visit but fell significantly more in "usual care" (average decline -4.64) than "intervention" participants (average decline -2.77) (β=1.87, p=0.043). There were no between-group differences in doctor visits. Patients described well-informed reasons for ED visits including onset and severity of symptoms, lack of timely provider access, and immediate and comprehensive ED care. CONCLUSION The coaching intervention significantly reduced declines in patient engagement observed after usual post-ED care. Patients reported well-informed reasons for ED use and will likely continue to make ED visits unless strategies, such as ED-initiated coaching, are implemented to help vulnerable patients better manage their health and healthcare.
Collapse
Affiliation(s)
| | - Barbara J. Lutz
- University of North Carolina-Wilmington, College of Health and Human Services, School of Nursing, Wilmington, North Carolina
| | - Allyson G. Hall
- University of Alabama at Birmingham, Department of Health Services Administration, Birmingham, Alabama
| | - Jesse M. Pines
- The George Washington University School of Medicine, Department of Emergency Medicine and Health Policy & Management, Washington, DC
| | - Andrea L. Jones
- University of North Carolina-Wilmington, College of Health and Human Services, School of Social Work, Wilmington, North Carolina
| | - Phyllis Hendry
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Colleen Kalynych
- University of Florida, College of Medicine, Department of Emergency Medicine, Jacksonville, Florida
| | - Donna L. Carden
- University of Florida, Department of Emergency Medicine, Gainesville, Florida
| |
Collapse
|
41
|
Chew BH, Vos RC, Shariff Ghazali S, Shamsuddin NH, Fernandez A, Mukhtar F, Ismail M, Mohd Ahad A, Sundram NN, Ali SZM, Rutten GEHM. The effectiveness of a value-based EMOtion-cognition-Focused educatIonal programme to reduce diabetes-related distress in Malay adults with Type 2 diabetes (VEMOFIT): study protocol for a cluster randomised controlled trial. BMC Endocr Disord 2017; 17:22. [PMID: 28376921 PMCID: PMC5379686 DOI: 10.1186/s12902-017-0172-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/23/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) patients experience many psychosocial problems related to their diabetes. These often lead to emotional disorders such as distress, stress, anxiety and depression, resulting in decreased self-care, quality of life and disease control. The purpose of the current study is to evaluate the effectiveness of a brief value-based emotion-focused educational programme in adults with T2DM on diabetes-related distress (DRD), depressive symptoms, illness perceptions, quality of life, diabetes self-efficacy, self-care and clinical outcomes. METHODS A cluster randomised controlled trial will be conducted in 10 public health clinics in Malaysia, all providing diabetes care according to national clinical practice guidelines. Patients' inclusion criteria: Malay, ≥ 18 years with T2DM for at least 2 years, on regular follow-up with one of three biomarkers HbA1c, systolic blood pressure and LDL-cholesterol sub-optimally controlled, and with a mean 17-item Diabetes Distress Scale (DDS-17) score ≥ 3. The intervention consists of four sessions and one booster over a period of 4 months that provide information and skills to assist patients in having proper perceptions of their T2DM including an understanding of the treatment targets, understanding and managing their emotions and goal-setting. The comparator is an attention-control group with three meetings over a similar period. With an estimated intra-cluster correlation coefficient ρ of 0.015, a cluster size of 20 and 20% non-completion, the trial will need to enroll 198 patients. PRIMARY OUTCOME the between groups difference in proportion of patients achieving a mean DDS-17 score < 3 (non-significant distress) at 6 months post-intervention. Secondary outcomes will be the differences in the above mentioned variables between groups. DISCUSSION We hypothesize that primary and secondary outcomes will improve significantly after the intervention compared to the comparator group. The results of this study can contribute to better care for T2DM patients with DRD. TRIAL REGISTRATION ClinicalTrials.gov NCT02730078 . Registered on 29 March 2016, last updated on 4 January 2017.
Collapse
Affiliation(s)
- Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str.6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rimke C. Vos
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str.6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Nurainul Hana Shamsuddin
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Aaron Fernandez
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Firdaus Mukhtar
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Mastura Ismail
- Health Clinic Seremban 2, Jalan S2, A2, Seremban 2, 27300 Seremban, Negeri Sembilan Malaysia
| | - Azainorsuzila Mohd Ahad
- Health Clinic Port Dickson, KM 1, Jalan Seremban-Port Dickson, 71000 Port Dickson, Negeri Sembilan Malaysia
| | | | | | - Guy E. H. M. Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str.6.131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| |
Collapse
|
42
|
Tang TS, Yusuf FLA, Polonsky WH, Fisher L. Assessing quality of life in diabetes: II - Deconstructing measures into a simple framework. Diabetes Res Clin Pract 2017; 126:286-302. [PMID: 28190527 DOI: 10.1016/j.diabres.2016.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/13/2016] [Indexed: 12/19/2022]
Abstract
A growing number of instruments measuring diabetes-specific health-related quality of life (HRQOL) have been identified in previous systematic reviews, the most recent being published in 2008. The purpose of this paper is report on an updated systematic review of diabetes-specific HRQOL measures highlighting the time period 2006-2016; to deconstruct existing diabetes-specific HRQOL measures into a simple framework for evaluating the goodness-of-fit between specific research needs and instrument characteristics; and to present core characteristics of measures not yet reported in other reviews to further facilitate scale selection. Using the databases Medline, Pubmed, CINAHL, OVID Embase, and PsycINFO, we identified 20 diabetes-specific HRQOL measures that met our inclusion criteria. For each measure, we extracted eight core characteristics for our measurement selection framework. These characteristics include target population (type 1 vs. type 2), number and type of HRQOL dimensions measured and scored, type of score and calculation algorithm, sensitivity to change data reported in subsequent studies, number of survey items, approximate time length to complete, number of studies using the instrument in the past 10years, and specific languages instruments is translated. This report provides a way to compare and contrast existing diabetes-specific HRQOL measures to aid in appropriate scale selection and utilization.
Collapse
Affiliation(s)
| | | | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, CA, USA
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
43
|
Heisler M, Mase R, Brown B, Wilson S, Reeves PJ. Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes - A randomized controlled trial. Contemp Clin Trials 2017; 55:24-33. [PMID: 28132876 PMCID: PMC5510884 DOI: 10.1016/j.cct.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
Background Racial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes. Methods 290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. Results 290 participants were enrolled. Discussion Tailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.
Collapse
Affiliation(s)
- Michele Heisler
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Rebecca Mase
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
| | - Brianne Brown
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Shayla Wilson
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Pamela J Reeves
- John D. Dingell VA Medical Center, Detroit, MI, United States
| |
Collapse
|
44
|
Devchand R, Nicols C, Gallivan JM, Tiktin M, Krause-Steinrauf H, Larkin M, Tuncer DM. Assessment of a National Diabetes Education Program diabetes management booklet: The GRADE experience. J Am Assoc Nurse Pract 2017; 29:255-263. [PMID: 28213915 DOI: 10.1002/2327-6924.12445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/06/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE The National Diabetes Education Program created the 4 Steps to Manage Your Diabetes for Life (4 Steps) booklet to help patients with diabetes learn the basics of self-management and care recommendations. The purpose of this study is to explore the impact of 4 Steps on participants' diabetes management knowledge and self-efficacy in the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). METHODS A sample of 348 adults with type 2 diabetes enrolled in GRADE was included in this analysis. Participants took a pretest, were sent home with 4 Steps, then took a posttest at their next visit. The Wilcoxon signed rank test was used to detect differences in knowledge and self-efficacy between scale scores pre- and posttest. CONCLUSIONS Analyses revealed increases in participants' diabetes management knowledge (p < .001) and self-efficacy (p < .001) from pre- to posttest. Participants who reported no formal previous diabetes education showed a statistically significant increase in knowledge scores compared to those with previous diabetes education (p < .05). IMPLICATIONS FOR PRACTICE Appropriate, relevant diabetes education materials may improve self-management knowledge and self-efficacy among adults with type 2 diabetes. Providers should feel confident using 4 Steps as a resource for clinical practice.
Collapse
Affiliation(s)
| | | | - Joanne M Gallivan
- National Diabetes Education Program (NDEP), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland
| | - Margaret Tiktin
- GRADE Study Group, Endocrinology, Case Western Reserve University, Cleveland, Ohio
| | - Heidi Krause-Steinrauf
- GRADE Coordinating Center, Biostatistics Center, The George Washington University, Washington, District of Columbia
| | - Mary Larkin
- GRADE Study Group, Diabetes Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Diane M Tuncer
- National Diabetes Education Program (NDEP), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland
| | -
- GRADE Coordinating Center, Biostatistics Center, The George Washington University, Washington, District of Columbia
| |
Collapse
|
45
|
Weiss I, Stepanovic S, Chinyemba U, Bateman J, Hemminger C, Burrows E. Use of a Nutrition Behavior Change Counseling Tool: Lessons from a Rapid Qualitative Assessment in Eastern Zambia. Front Public Health 2016; 4:179. [PMID: 27630980 PMCID: PMC5006147 DOI: 10.3389/fpubh.2016.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022] Open
Abstract
The U.S. Agency for International Development Feed the Future Mawa Project – led by Catholic Relief Services – aims to improve food and economic security for farming households in Zambia’s Eastern Province. Mawa employs social and behavior change (SBC) strategies with households and communities to improve nutrition and reduce stunting among children under two (CU2). To support these strategies, sub-partner University Research Co., LLC employed a participatory process to develop a series of 35 action cards, each illustrating one project-promoted behavior, that are used at household and community group levels. Caregivers of CU2 are given a full set of action cards to promote household dialogue and support for the promoted behaviors. As a final step in the action card tool development process, a qualitative rapid assessment was conducted 1 month after implementation to investigate preliminary ways action cards were being used, and if the methods of using the cards had the potential to impact behavior change. The research team conducted nine key informant interviews and four focus group discussions with Mawa staff and administered 41 qualitative interview questionnaires with project participants in the Chipata and Lundazi districts. Although not based on a representative sampling frame, the assessment produced valuable results for program improvement purposes. It also provided a feedback mechanism for community-based staff and project participants, a crucial step in the participatory tool development process. The assessment found that Mawa staff at every level use action cards combined with at least one other social behavior change tool for each nutrition intervention. Our results suggest that Mawa staff and project participants share a common understanding of the cards’ purpose. Each group noted that the cards provide a visual cue for action and reinforce previous Mawa nutrition messages. Intended uses confirmed by the assessment include encouraging household cooperation, negotiating behavior change, telling stories, and integrating messages with other project sectors. Based on the findings, recommendations for future project activities include aligning efforts against a theory of change to optimize use of all SBC tools; leveraging action card use to strengthen cross-sectoral integration within Mawa; and specific ongoing monitoring of action card use to improve activity implementation.
Collapse
Affiliation(s)
- Ingrid Weiss
- University Research Co., LLC , Bethesda, MD , USA
| | | | | | | | | | | |
Collapse
|
46
|
Bailey PK, Tomson CRV, Ben-Shlomo Y. What factors explain the association between socioeconomic deprivation and reduced likelihood of live-donor kidney transplantation? A questionnaire-based pilot case-control study. BMJ Open 2016; 6:e012132. [PMID: 27288388 PMCID: PMC4908905 DOI: 10.1136/bmjopen-2016-012132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Socioeconomically deprived individuals with renal disease are less likely to receive a live-donor kidney transplant (LDKT) than less deprived individuals. This study aimed to develop and pilot a questionnaire designed to determine what factors explain this association. DESIGN Questionnaire development and a pilot case-control study. Primary aims were to develop and evaluate a questionnaire, assess response rates, and to generate data to inform full-scale study design. SETTING A UK tertiary renal referral hospital and transplant centre. PARTICIPANTS Invited participants comprised 30 LDKT recipients (cases) and 30 deceased-donor kidney transplant (DDKT) recipients (controls). Stratified random sampling was used to select cases and controls from all adults who had been transplanted at Southmead Hospital North Bristol National Health Service Trust, between 1 August 2007 and 31 July 2013. METHODS Participants were posted questionnaires that were accompanied by an invitation letter from the renal consultant responsible for their care, and a patient information leaflet. Non-responders were sent a second questionnaire after 4-6 weeks. Data were extracted from returned questionnaires, and entered onto a Research Electronic Data Capture (REDCap) database. RESULTS 63% (n=38) of those invited returned questionnaires. 16 (42%) declined to answer the question on income. 58% of participants had not asked any of their potential donors to consider living kidney donation (52% LDKT vs 65% DDKT, p=0.44). There was some evidence of a difference between the R3K-T knowledge score for recipients of LDKTs (mean 6.7, SD 1.8) and for recipients of DDKTs (mean 4.9, SD 2.1), p=0.008. Variables' distribution for the exposure variables of interest was determined. CONCLUSIONS Findings from this study will inform a sample size calculation for a full-scale study. The findings of the full-scale case-control study will help us better understand how socioeconomic deprivation is related to the type of transplant an individual receives. This understanding will help us to design and appropriately tailor an intervention to reduce inequitable access to live-donor kidney transplantation.
Collapse
Affiliation(s)
- Phillippa K Bailey
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Charles RV Tomson
- Freeman Hospital, 6uu Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
47
|
McCusker J, Lambert SD, Cole MG, Ciampi A, Strumpf E, Freeman EE, Belzile E. Activation and Self-Efficacy in a Randomized Trial of a Depression Self-Care Intervention. HEALTH EDUCATION & BEHAVIOR 2016; 43:716-725. [PMID: 27179288 DOI: 10.1177/1090198116637601] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES In a sample of primary care participants with chronic physical conditions and comorbid depressive symptoms: to describe the cross-sectional and longitudinal associations of activation and self-efficacy with demographic, physical and mental health status, health behaviors, depression self-care, health care utilization, and use of self-care tools; and to examine the effects of a depression self-care coaching intervention on these two outcomes. Design/Study Setting. A secondary analysis of activation and self-efficacy data collected as part of a randomized trial to compare the effects of a telephone-based coached depression self-care intervention with a noncoached intervention. Activation (Patient Activation Measure) was measured at baseline and 6 months. Depression self-care self-efficacy was assessed at baseline, at 3 months, and at 6 months. PRINCIPAL FINDINGS In multivariable cross-sectional analyses (n = 215), activation and/or self-efficacy were associated with language, birthplace, better physical and mental health, individual exercise, specialist visits, and antidepressant nonuse. In longitudinal analyses (n = 158), an increase in activation was associated with increased medication adherence; an increase in self-efficacy was associated with use of cognitive self-care strategies and increases in social and solitary activities. There were significant improvements from baseline to 6 months in activation and self-efficacy scores both among coached and noncoached groups. The self-care coaching intervention did not affect 6-month activation or self-efficacy but was associated with quicker improvement in self-efficacy. CONCLUSIONS Overall, the results for activation and self-efficacy were similar, although self-efficacy correlated more consistently than activation with depression-specific behaviors and was responsive to a depression self-care coaching intervention.
Collapse
Affiliation(s)
- Jane McCusker
- McGill University, Montreal, Quebec, Canada .,St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Sylvie D Lambert
- McGill University, Montreal, Quebec, Canada.,St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Martin G Cole
- McGill University, Montreal, Quebec, Canada.,St. Mary's Hospital Center, Montreal, Quebec, Canada
| | | | | | - Ellen E Freeman
- Université de Montréal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Centre, Montreal, Quebec, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Montreal, Quebec, Canada
| |
Collapse
|
48
|
Kim SH, Lee A. Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2016; 13:324-33. [PMID: 27104337 DOI: 10.1111/wvn.12157] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Low health literacy is a potential barrier to self-management among patients with diabetes. A variety of strategies for low health literacy have been proposed for diabetes self-management interventions, but interventions accommodating low health literacy have been heterogeneous in terms of content and have produced mixed results. AIM To systematically review health-literacy-sensitive diabetes management interventions, with a focus on identifying strategies for accommodating patients with low health literacy, and to examine the efficacy of these interventions to improve health outcomes. METHODS PubMed, CINAHL, and EMBASE were searched for intervention studies published between January 2000 and January 2015. Two authors separately identified full-texts according to the inclusion criteria and assessed study quality using the quantitative components of the Mixed Methods Appraisal Tool. The final list of studies to be analyzed was made through discussion. The meta-analysis was conducted using a random effects model. RESULTS Thirteen studies were selected from the 490 studies found in our initial search. We identified a range of strategies for accommodating those with low health literacy in diabetes self-management interventions, which encompassed four domains: written communication, spoken communication, empowerment, and language/cultural consideration. Using at least one of the spoken communication strategies led to positive cognitive/psychological, self-care, and health outcomes. We found that, overall, health-literacy-sensitive diabetes management interventions were effective in reducing HbA1C level in the meta-analysis. LINKING EVIDENCE TO ACTION Healthcare providers should consider active implementation of strategies for accommodating people with low health literacy in diabetes self-management interventions. The routine use of spoken communication strategies would be necessary to achieve the best health outcomes in diabetes self-management interventions. More research is needed to determine the individual effects of the key strategies that improve health and reduce health disparity.
Collapse
Affiliation(s)
- Su Hyun Kim
- Associate Professor, College of Nursing, Research Institute of Nursing Science, Kyungpook National University, Korea
| | - Anna Lee
- Doctoral candidate, The University of North Carolina at Chapel Hill, NC
| |
Collapse
|
49
|
Bergjan M, Schaepe C. Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses' experiences. J Clin Nurs 2016; 25:1729-39. [PMID: 27074958 DOI: 10.1111/jocn.13191] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to explore renal nurses' experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. BACKGROUND Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. DESIGN Qualitative design formed by thematic qualitative text analysis. METHODS Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. RESULTS The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient's perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. CONCLUSIONS The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy - an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. RELEVANCE TO CLINICAL PRACTICE Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy.
Collapse
Affiliation(s)
- Manuela Bergjan
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Christiane Schaepe
- Institute of Health and Nursing Science, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| |
Collapse
|
50
|
McMaughan DK, Huber JC, Forjuoh SN, Vuong AM, Helduser J, Ory MG, Bolin JN. Physician Recommendation of Diabetes Clinical Protocols. Hosp Top 2016; 94:15-21. [PMID: 26980203 DOI: 10.1080/00185868.2016.1142313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors examined the responses of 63 primary care physicians to diabetes clinical protocols (DCPs) for the management of type II diabetes (T2DM). We measured physician demographics, current diabetes patient loads, and responses to DCPs (physician attitudes, physician familiarity, and physician recommendation of DCPs) using a 20-question electronic survey. Results of the survey indicate that primary care physicians may be unfamiliar with the benefits of diabetes clinical protocols for the self-management of T2DM. Given the importance of diabetes self-management education in controlling T2DM, those interested in implementing DCPs should address the beliefs and attitudes of primary care physicians.
Collapse
Affiliation(s)
- Darcy K McMaughan
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| | - John C Huber
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| | - Samuel N Forjuoh
- b Family and Community Medicine Department , Scott and White, Temple , Texas , USA
| | - Ann M Vuong
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| | - Janet Helduser
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| | - Marcia G Ory
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| | - Jane N Bolin
- a School of Public Health, Texas A&M Health Science Center, College Station , Texas , USA
| |
Collapse
|