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McSweeney B, Campbell RB, Grewal EK, Gu J, Campbell DJT. Group Versus Individual Diabetes Education for Persons With Experience of Homelessness in Canada. Sci Diabetes Self Manag Care 2023; 49:415-425. [PMID: 37771237 PMCID: PMC10666507 DOI: 10.1177/26350106231201365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
PURPOSE The purpose of the study was to explore various forms of diabetes self-management education (DSME), including group and individual sessions, for persons with lived experiences of homelessness (PWLEH) in Canada. METHODS A qualitative descriptive study using open-ended interviews with health care and homeless sector service providers was utilized to serve those experiencing homelessness in 5 cities across Canada. NVivo qualitative data analysis software was used to facilitate thematic analysis, focusing on variations in DSME for PWLEH. RESULTS We conducted interviews with 96 unique health and social care providers. Four themes were identified through focused coding of interviews. First, the use of a harm reduction approach during diabetes education tailored to PWLEH considered patients' access to food, medications, and supplies and other comorbidities, including mental health and substance use disorders. The second theme related to the unsuitability of the curriculum in mainstream diabetes education in a group setting for PWLEH. Third, the role of group education in community building is to create supportive relationships among members. The final theme was the importance of trust and confidentiality in DSME, which were most easily maintained during individual education, compared to group formats. CONCLUSIONS Overall, PWLEH experience unique challenges in managing diabetes. DSME adapted to these individuals' unique needs may be more successful and could be delivered in both individual and group settings.
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Affiliation(s)
- Breanna McSweeney
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Rachel B. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Eshleen K. Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jenny Gu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Thurman W, Semwal M, Moczygemba LR, Hilbelink M. Smartphone Technology to Empower People Experiencing Homelessness: Secondary Analysis. J Med Internet Res 2021; 23:e27787. [PMID: 34586073 PMCID: PMC8726764 DOI: 10.2196/27787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the United States, the number of people experiencing homelessness has continually increased over the last 3 years. Homelessness is associated with poor health, and people experiencing homelessness are often burdened with high rates of chronic and mental health conditions, functional limitations, and cognitive impairment. Despite the high burden of chronic illness and functional limitations, there is limited literature exploring self-management among homeless populations. OBJECTIVE This study aims to investigate how access to smartphone technology facilitates self-management, including the attainment of social needs within the context of homelessness. METHODS A secondary analysis of 33 exit interviews from 2 feasibility studies related to mobile health interventions among people experiencing homelessness was conducted. Iterative thematic analysis was used to identify themes representative of participants' experiences using smartphone technology. RESULTS Collectively, participants revealed not only how the context of homelessness constrained their ability to engage in activities necessary to self-manage health and meet social needs but also how consistent and predictable access to the tools available through a smartphone changed their behaviors and outlook. The global theme of empowered by technology was identified and defined as how having a smartphone with a plan for unlimited text, calling, data, and transportation allowed participants to navigate homelessness and facilitated self-management. CONCLUSIONS People experiencing homelessness used the tools on a smartphone to make decisions, take action, solve problems, and use the resources-skills necessary for fulfilling tasks required for effective self-management. Further, consistent access to smartphone technology and transportation empowered participants to meet the requirements for the attainment of social needs.
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Affiliation(s)
- Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Monika Semwal
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Leticia R Moczygemba
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Mark Hilbelink
- Sunrise Homeless Navigation Center, Austin, TX, United States
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Diabetes management interventions for homeless adults: a systematic review. Int J Public Health 2020; 65:1773-1783. [PMID: 33095271 PMCID: PMC7716851 DOI: 10.1007/s00038-020-01513-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/08/2020] [Accepted: 10/13/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recent studies investigating diabetes show that inequalities to access appropriate care still persists. Whilst most of the general population are able to access a suitable quality of care, there are a number of groups who fail to receive the same standard. The objective of this review was to identify existing diabetes management interventions for homeless adults. METHODS A literature search was conducted in February 2017, and repeated in September 2020. RESULTS Of the 223 potentially relevant articles identified, only 26 were retrieved for detailed evaluation, and 6 met the inclusion criteria. Papers focusing on the management of diabetes in homeless people were included. The studies used interventions including diabetes education; medication support and supplies for blood monitoring; improvements in self-care behaviours; improvements in diabetes control; patient empowerment/engagement; and community engagement/partnerships. CONCLUSIONS Effective strategies for addressing the challenges and obstacles that the homeless population face, requires innovative, multi-sectored, flexible and well-coordinated models of care. Without appropriate support, these groups of people are prone to experience poor control of their diabetes; resulting in an increased risk of developing major health complications.
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Merdsoy L, Lambert S, Sherman J. Perceptions, needs and preferences of chronic disease self-management support among men experiencing homelessness in Montreal. Health Expect 2020; 23:1420-1430. [PMID: 32965730 PMCID: PMC7752203 DOI: 10.1111/hex.13106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 04/23/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023] Open
Abstract
Objective This study explored the perceptions, needs and preferences for chronic disease self‐ management (SM) and SM support among men experiencing homelessness. Design A qualitative interpretive approach was used. Eighteen semi‐structured interviews were conducted with 18 homeless men with a chronic disease at an emergency overnight shelter of Welcome Hall Mission (WHM) in Montreal, Quebec. Interviews were audio‐recorded, transcribed verbatim and thematically analysed. Results The majority of participants perceived SM as important, described confidence to perform medical SM behaviours, and creatively adapted their SM behaviours to homelessness. Emotional SM was described as most challenging, as it was intertwined with the experience of homelessness. Three vulnerable groups were identified: (a) those with no social networks, (b) severe physical symptoms and/or (c) co‐morbid mental illness. The preferred mode of delivery for SM support was through consistent contacts with health‐care providers (HCPs) and peer‐support initiatives. Discussion and Conclusions Despite competing demands to fulfill basic needs, participants valued chronic disease SM and SM support. However, SM support must address complex challenges relating to homelessness including emotional SM, multiple vulnerabilities and barriers to forming relationships with HCPs.
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Affiliation(s)
- Laura Merdsoy
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Sylvie Lambert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.,St. Mary's Research Centre, Montreal, QC, Canada
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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Zhang P, Gao J, Wang Y, Sun Q, Sun X. Effect of chronic disease self-management program on the quality of life of HIV-infected men who have sex with men: An empirical study in Shanghai, China. Int J Health Plann Manage 2019; 34:1055-1064. [PMID: 31364209 DOI: 10.1002/hpm.2874] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The HIV/AIDS epidemic rages on in China, particularly among men who have sex with men (MSM). MSM with HIV/AIDS also tend to have poorer quality of life than other members of the population. A major contributor to these issues is the huge gap between the increasing demand of MSM for medical services and the availability of such services; their current needs cannot be met only with the services of the Chinese Center for Disease Control and Prevention. The aim of the present study was to examine the quality of life of MSM with HIV/AIDS in Shanghai, as well as determine whether it is influenced by chronic disease self-management (CDSM). METHODS We conducted a pre-post study to evaluate the effect of CDSM on participants' quality of life. Four hundred twenty participants were assigned to either the CDSM group (n = 210) or the control group (n = 210). We collected data on quality of life (using the Medical Outcomes Study HIV Health Survey [MOS-HIV]) and various psychological and behavioral variables via interviewer-administered questionnaires. RESULTS The physical and mental health summary scores of the MOS-HIV were 53.7 and 49.9, respectively. The CDSM group showed a significant improvement in quality of life and a significant decrease in the proportion of participants with anxiety symptoms (from 38.6% to 22.6%). Furthermore, the frequency of condom use increased from 43.3% to 47.3%. CONCLUSION MSM with HIV generally had low quality of life in Shanghai. The CDSM program might help promote the quality of life of MSM while helping them practice healthy behaviors.
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Affiliation(s)
- Peng Zhang
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jing Gao
- School of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yanmei Wang
- Department of Nursing, Shanghai Gongli Hospital, Second Military Medical University, Shanghai, China
| | - Qiao Sun
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Xiaoming Sun
- School of Public Health, Fudan University, Shanghai, China.,Pudong Institute for Health Development, Shanghai, China
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Hanlon P, Yeoman L, Gibson L, Esiovwa R, Williamson AE, Mair FS, Lowrie R. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless. BMJ Open 2018; 8:e020161. [PMID: 29627814 PMCID: PMC5892758 DOI: 10.1136/bmjopen-2017-020161] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING Community. PARTICIPANTS Adults (≥18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsey Yeoman
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Gibson
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Regina Esiovwa
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
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