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Winther S, Fredens M, Skov Benthien K, Konstantin Nissen N, Palmhøj Nielsen C, Grønkjaer M. Exploring patient experiences of participating in a telephone-based self-management support intervention: Proactive Health Support (PaHS). J Adv Nurs 2020; 76:3563-3572. [PMID: 33022769 DOI: 10.1111/jan.14590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/28/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
AIM Proactive Health Support is a telephone-based self-management intervention that is carried out in Denmark by Registered Nurses who provide self-management support to people at risk of hospital admission. We aimed to explore participants' experiences of Proactive Health Support and to identify what the participants find important and meaningful during the intervention process. DESIGN Qualitative design involving semi-structured interview. METHODS Using a phenomenological-hermeneutical framework, we conducted semi-structured interviews with 62 participants in their own homes (32 women, 30 men; aged 20-81 years) in spring and fall 2018. RESULTS The participants felt confident that they could discuss every matter with the nurses. Participants benefitted from accessibility to the nurses' professional and medical competences and they felt relief that the nurses contacted them via the telephone due to their multiple health conditions. The participants felt that the nurses were available and helped them to navigate the healthcare system. CONCLUSION The participants valued the intervention because they benefitted from the nurses' holistic approach. They described the nurses' knowledge and professionalism in relation to their symptoms, treatments, and medicine as important and meaningful. Accordingly, the intervention seemed to promote feelings of independence and self-management among the participants. IMPACT From a nursing perspective, the study highlights that it is possible to establish a close relationship and behavioural change among participants through regular telephone contact.
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Affiliation(s)
- Susanne Winther
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Mia Fredens
- DEFACTUM - Social & Health Services and Labor Market, Aarhus, Denmark
| | - Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | | | - Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Devienne C, Delpech G, Untas A. La photo-expression : un outil pour accompagner le patient en éducation thérapeutique et pour évaluer son évolution. PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Devienne C, Delpech G, Untas A. WITHDRAWN: La photo-expression : un outil pour accompagner le patient en éducation thérapeutique et pour évaluer son évolution. PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nunstedt H, Rudolfsson G, Alsen P, Pennbrant S. Patients´ Variations of Reflection About and Understanding of Long-Term Illness- Impact of Illness Perception on Trust in Oneself or Others. Open Nurs J 2017; 11:43-53. [PMID: 28567169 PMCID: PMC5420171 DOI: 10.2174/1874434601711010043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Patients' understanding of their illness is of great importance for recovery. Lacking understanding of the illness is linked with the patients' level of reflection about and interest in understanding their illness. Objective: To describe patients’ variations of reflection about and understanding of their illness and how this understanding affects their trust in themselves or others. Method: The study is based on the “Illness perception” model. Latent content analysis was used for the data analysis. Individual, semi-structured, open-ended and face-to-face interviews were conducted with patients (n=11) suffering from a long-term illness diagnosed at least six months prior to the interview. Data collection took place in the three primary healthcare centres treating the participants. Results: The results show variations in the degree of reflection about illness. Patients search for deeper understanding of the illness for causal explanations, compare different perspectives for preventing complication of their illness, trust healthcare providers, and develop own strategies to manage life. Conclusion: Whereas some patients search for deeper understanding of their illness, other patients are less reflective and feel they can manage the illness without further understanding. Patients' understanding of their illness is related to their degree of trust in themselves or others. Patients whose illness poses an existential threat are more likely to reflect more about their illness and what treatment methods are available.
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Jensen NK, Pals RA, Willaing I. The use of dialogue tools to promote dialogue-based and person-centred patient education for people with type 2 diabetes. Chronic Illn 2016; 12:145-56. [PMID: 26728482 DOI: 10.1177/1742395315625099] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore educator experiences of implementing dialogue tools in practice to engender participatory patient education. METHODS Data were collected through qualitative interviews with 31 educators and 20 ethnographic observations of group-based education sessions at eight education sites. Data were analysed using systematic text condensation and the theoretical concepts of script and de-script. Three dialogue tools including 'My Illness and Me', 'Goals and Plan's and 'Wheel of Change' were selected for analysis because they were used most frequently. The tools are intended to support educators in facilitating participatory patient education. RESULTS Consistent with the intended purpose of the dialogue tools, educators reported that the dialogue tools helped engender participatory education in the form of reflection and dialogue among participants regarding living with diabetes. However, educators also reported instances of discrepancies between the tools' intended purpose and their actual use because some participants found it difficult to relate to the tools. DISCUSSION The application of dialogue tools to engender participatory patient education is highly dependent on educators' and participants' understanding and use of dialogue tools in practice. This implies that substantial educator skills are needed to facilitate dialogue and participation in patient education.
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Affiliation(s)
- Natasja K Jensen
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark CopenRehab, Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Center for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Regitze As Pals
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center A/S, Gentofte, Denmark
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D'Souza MS, Karkada SN, Hanrahan NP, Venkatesaperumal R, Amirtharaj A. Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes? Glob J Health Sci 2015; 7:80-90. [PMID: 26156908 PMCID: PMC4803921 DOI: 10.5539/gjhs.v7n5p80] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/23/2014] [Indexed: 12/17/2022] Open
Abstract
Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (p<0.001). Age, education, duration of DM, prior DM education program and medications were significantly associated with DES. Conclusion: Diabetes nurse educators engaged in the care of adults with T2DM should assess self-empowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c.
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Kristiansen TM, Antoft R, Primdahl J, Petersen KH. The Significance of Everyday Life—An Ethnographic Study of Participation in Group-Based Patient Education. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aasoci.2015.52007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fonte D, Apostolidis T, Lagouanelle-Simeoni MC. Compétences psychosociales et éducation thérapeutique du patient diabétique de type 1 : une revue de littérature. SANTE PUBLIQUE 2014. [DOI: 10.3917/spub.146.0763] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Self-management in daily life with psoriasis: an integrative review of patient needs for structured education. Nurs Res Pract 2012; 2012:890860. [PMID: 23304484 PMCID: PMC3523575 DOI: 10.1155/2012/890860] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/26/2012] [Accepted: 10/10/2012] [Indexed: 11/17/2022] Open
Abstract
The aim of this integrative review is to identify and discuss patient needs for education to support self-management in daily life with psoriasis. As psoriasis increasingly gains recognition as a serious chronic autoimmune skin disease with long-term impairment on the life course, and not mainly a cosmetic problem, nurses are highly challenged to develop efficient education to support patient self-management. The paper includes five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and synthesis, and (5) presentation, based on theoretic scaffolding around the concept “need.” Nineteen of 164 original papers within nursing, medicine and psychology, and reflecting patient perspective were included. To capture the patients' cultural understanding of the implications of the disease and care, we developed an interlevel model indicating that self-experienced burden of disease and its visibility, personal conditions such as illness perception, and the patient's age at onset time are high-impact factors that should be addressed in future structured patient education programmes. The research on patient needs has hitherto focused on adults, but the problems and vulnerability associated with having a chronic and visible disease during adolescence must be acknowledged, and patient education initiatives designed for this young group are recommended.
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Casey D, Murphy K, Lawton J, White FF, Dineen S. A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time. BMC Public Health 2011; 11:672. [PMID: 21878104 PMCID: PMC3175192 DOI: 10.1186/1471-2458-11-672] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 08/30/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The literature reveals that structured education programmes, such as DAFNE, result in many positive outcomes for people with Type 1 diabetes including a decrease in HbA1c levels and reductions in hypoglycaemia. While there is evidence that some of these outcomes are maintained we do not know at present what factors are most important over time. The study aim was to identify the key factors impacting on persons with Type 1 diabetes ability to assimilate the Dose Adjustment For Normal Eating (DAFNE) DAFNE principles into their daily lives and how these factors change over time. METHODS This is a longitudinal descriptive qualitative study. Interviews were undertaken with 40 participants who had attended DAFNE in one of 5 study sites across the Island of Ireland, at 6 weeks, 6 and 12 months after completion of the programme. The interviews lasted from 30 to 60 minutes and were transcribed verbatim. Data were analysed in three ways, a within time analysis, a cross sectional analysis for each participant and a thematic analysis which focused on examining changes over time RESULTS Four themes that influenced participants' ability to assimilate DAFNE into their daily lives over time were identified. These were: embedded knowledge, continued responsive support, enduring motivation and being empowered. Support at the 6 month period was found to be crucial to continued motivation. CONCLUSIONS Understanding the factors that influence people's ability to assimilate DAFNE principles over time into their daily lives can help health professionals give focused responsive support that helps people with diabetes become more empowered. Understanding that continued support matters, particularly around 6 months, is important as health professionals can influence good management by providing appropriate support and enhancing motivation. TRIAL REGISTRATION ISRCTN79759174.
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Affiliation(s)
- Dympna Casey
- School of Nursing & Midwifery, National University of Ireland, Galway, Ireland.
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Murphy K, Casey D, Dinneen S, Lawton J, Brown F. Participants' perceptions of the factors that influence diabetes self-management following a structured education (DAFNE) programme. J Clin Nurs 2011; 20:1282-92. [PMID: 21492274 DOI: 10.1111/j.1365-2702.2010.03564.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. BACKGROUND The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity. DESIGN A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique. METHODS Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim. RESULTS Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'. CONCLUSION Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management. RELEVANCE TO CLINICAL PRACTICE Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources.
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Affiliation(s)
- Kathy Murphy
- National University of Ireland, Galway, Ireland.
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Long AF, Gambling T. Enhancing health literacy and behavioural change within a tele-care education and support intervention for people with type 2 diabetes. Health Expect 2011; 15:267-82. [PMID: 21521430 PMCID: PMC3639467 DOI: 10.1111/j.1369-7625.2011.00678.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making. Health literacy provides an additional, potentially powerful explanatory framework to guide research and practice. OBJECTIVE To examine the changes in the depth and detail of diabetes-related knowledge and confidence for persons with type 2 diabetes. DESIGN Two-year, prospective, observational study, using questionnaire data at two time points (baseline and 2 years later) and in-depth interviews with a theoretically selected subsample. SETTING AND PARTICIPANTS A total of 319 patients initially recruited from a deprived urban area in north-west England. INTERVENTION Dedicated tele-carer education and support, tailored to the individual circumstances of the patient. MAIN OUTCOME MEASURES Perceptions of confidence, levels of empowerment, learning for self-care and most helpful aspects of the intervention. RESULTS Over 90% expressed confidence in keeping their blood sugar controlled, and high levels of perceived empowerment (mean = 4.25; 95% CI, 4.17-4.33) were found. Changes in the depth and detail of diabetes-related knowledge and confidence, from the specific to the more general, were observed and enhanced competence in translating knowledge into practice. DISCUSSION AND CONCLUSIONS The intervention, built within a developed working partnership between tele-carer and patient, operated at two levels: health literacy, enhancing knowledge, developing personal skills and enabling self-control; and socio-psychological behavioural change, tailored to individuals within their socio-economic environments, enabling increased motivation and supportive problem-solving. Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data.
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Affiliation(s)
- Andrew F Long
- School of Healthcare, University of Leeds, Leeds, UK.
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Ho AYK, Berggren I, Dahlborg-Lyckhage E. Diabetes empowerment related to Pender's Health Promotion Model: a meta-synthesis. Nurs Health Sci 2011; 12:259-67. [PMID: 20602700 DOI: 10.1111/j.1442-2018.2010.00517.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diabetes self-management is a challenge for both clients and health-care professionals. Empowerment plays a vital role in helping clients to achieve successful self-management. This study adopted a meta-ethnographic approach. Nine qualitative studies were synthesized in order to contribute to a deeper understanding of what clients perceive as being important in an effective empowerment strategy for diabetes self-management. Four central metaphors that influenced empowerment were identified: trust in nurses' competence and awareness, striving for control, a desire to share experiences, and nurses' attitudes and ability to personalize. The lines-of-argument synthesis suggested the need for an evaluation system to appraise clients' diabetes knowledge, health beliefs, and negative emotions, as well as the outcome of interventions. Based on Pender's Health Promotion Model, this study emphasizes the fact that health-care professionals need to understand and address modifiable behavior-specific variables. The study suggests that an effective empowerment strategy would be to use activity-related affect, as well as interpersonal and situational influences, as a means of facilitating and enhancing clients' health-promoting behaviors.
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Affiliation(s)
- Agnes Yin Kwan Ho
- Department of Nursing, Health and Culture, University West, Trollhättan, Gothenburg, Sweden.
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How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK. Soc Sci Med 2010; 71:486-493. [DOI: 10.1016/j.socscimed.2010.04.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 03/30/2010] [Accepted: 04/26/2010] [Indexed: 11/20/2022]
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Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the value of diabetes education. DIABETES EDUCATOR 2009; 35:752-60. [PMID: 19783766 DOI: 10.1177/0145721709343609] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care). METHODS Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not. RESULTS Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education. CONCLUSIONS The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.
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Affiliation(s)
- Ian Duncan
- Solucia Consulting, Hartford, Connecticut (Mr Duncan, Mr Birkmeyer, Dr Coughlin, Ms Li)
| | - Christian Birkmeyer
- Solucia Consulting, Hartford, Connecticut (Mr Duncan, Mr Birkmeyer, Dr Coughlin, Ms Li)
| | - Sheryl Coughlin
- Solucia Consulting, Hartford, Connecticut (Mr Duncan, Mr Birkmeyer, Dr Coughlin, Ms Li)
| | - Qijuan Emily Li
- Solucia Consulting, Hartford, Connecticut (Mr Duncan, Mr Birkmeyer, Dr Coughlin, Ms Li)
| | - Dawn Sherr
- American Association of Diabetes Educators, Education and Content Development, Chicago, Illinois (Ms Sherr)
| | - Sue Boren
- Department of Health Management and Informatics, University of Missouri, School of Medicine, Columbia, Missouri (Dr Boren)
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