Family members' or friends' involvement in self-care for patients with depressive symptoms and co-morbid chronic conditions

Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial

BACKGROUND

Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management.

METHODS

This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes.

DISCUSSION

This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

A Pilot Study Exploring Treatment Burden in a Skilled Nursing Population

PURPOSE

This study aimed to measure treatment burden in adults diagnosed with multiple chronic conditions transitioning from a skilled nursing facility to home.

DESIGN

Prospective, two-time point, cohort design utilizing convenience sampling from one skilled nursing facility in Northeast, Ohio.

METHODS

Seventy-four men and women participated answering self-report questions measuring treatment burden at two time points: prior to discharge and 30 days after discharge.

RESULTS

t-test analysis determined treatment burden was not statistically different between time points (p > .05). Multivariate analysis explained 23% of treatment burden's variance, with the severity of multiple chronic conditions and the presence of a caregiver predicting treatment burden (p < .05).

CONCLUSION

Findings were contrary to our hypothesis of this population being at risk for high treatment burden.

CLINICAL RELEVANCE

Moderate, fluctuating levels of treatment burden suggest that it is possible to estimate demands of treatment prior to discharge from the skilled nursing facility to better inform discharge planning.

Family Caregiver Support of Patient Self-Management During Chronic, Life-Limiting Illness: A Qualitative Metasynthesis

Family caregivers play an integral role in supporting patient self-management, yet how they perform this role is unclear. We conducted a qualitative metasynthesis of family caregivers' processes to support patient self-management of chronic, life-limiting illness and factors affecting their support. Methods included a systematic literature search, quality appraisal of articles, data abstraction, and data synthesis to produce novel themes. Thirty articles met inclusion criteria, representing 935 international family caregivers aged 18 to 89 years caring for patients with various health conditions. Three themes characterized family caregivers' processes to support patient self-management: "Focusing on the Patient's Illness Needs," "Activating Resources to Support Oneself as the Family Caregiver," and "Supporting a Patient Living with a Chronic, Life-Limiting Illness." Factors affecting family caregivers' support included Personal Characteristics, Health Status, Resources, Environmental Characteristics, and the Health Care System. The family caregiver role in supporting patient self-management is multidimensional, encompassing three processes of care and influenced by multiple factors.

Critical moments in long-term condition management: A longitudinal qualitative social network study

Objectives Recent literature has demonstrated the nature and importance of social networks. This study aimed to understand how support needs of people with long-term conditions change over time and how this influences their ability to self-manage. Methods A longitudinal qualitative design was used to explore changes in individual's social networks over a period of year. Thirty participants were recruited and completed initial in-depth face-to-face interviews, telephone follow-ups, and final face-to-face interviews. Results Findings illuminated that changes in health and changes in social networks can influence each other. The social networks implicated in the management of long-term conditions change over time at critical moments and can range between positive and negative reciprocal influences with self-management. Network changes, such as the breaking or reconnecting of ties influenced the context of health management and the degree of engagement with self-management activities. Discussion By examining the specific processes of support and resource provision, this study highlights how overtime the variety of relationships and support available implicated in long-term condition management changes. This has implications for the provision of formal support services and the need for a wider range of support to be identified that recognises change in support requirements as self-management strategies evolve.

To Share or Not to Share: A Cross-Sectional Study on Health Information Sharing and Its Determinants Among Chinese Rural Chronic Patients

To examine the determinants of the health information sharing among rural Chinese chronic patients. Two large population-based surveys in rural China were carried out from July 2011 to April 2012. Data used in this study were second hand and sorted out from the two previous databases. A binary logistic regression analysis was employed to discover the impact of demographic characteristics, level of health literacy, and other factors on respondents' health information sharing behavior. Among the total 1,324 participants, 63.6% share health information with others. Among all significant predictors, those who acquire health information via family and friends are 6.0 times the odds of sharing health information than those who do not. Participants who have more than six household members, with middle and high levels of health knowledge, and who are moderately involved in discussions or settlements of village affairs are also more likely to share health information. The reliance on interpersonal communication channels for health information, household size, the patients' preexisting health knowledge, and their activity in village affairs are crucial determinants for health information sharing among rural chronic patients. A more sophisticated model needs to be established to reveal the complex processes of health information communication.

Self-care difficulties and reliance on support among vulnerable middle-aged and older adults with chronic conditions: A cross-sectional study

OBJECTIVES

Chronic conditions are pervasive among middle-aged and older adults. This study identified: (1) factors associated with participants reporting difficulties self-managing their chronic condition(s); and (2) factors associated with participants' reliance on external sources for ongoing help and support to improve their health and manage their health conditions.

STUDY DESIGN

Cross-sectional data were collected using the National Council on Aging Chronic Care Survey, a nationally representative telephone survey of adults aged 45 years and older with at least one chronic condition.

MAIN OUTCOME MEASURES

Self-care difficulties among middle-aged and older adults with one or more chronic conditions and factors associated with reliance on ongoing help and support were examined.

RESULTS

Among 731 middle-aged and older adults with one or more chronic conditions, 31% of participants reported their health condition(s) made it difficult for them to care for themselves. Participants who were Hispanic (OR=3.08, P=0.009), had three or more chronic conditions (OR=3.05, P <0.001), took more medications daily (OR=1.07, P=0.046), and experienced certain healthcare-related frustrations (P≤0.023) were more likely to report difficulties self-managing their chronic condition(s). Participants relied on healthcare providers (40%), friends/relatives (20%), internet (9%), people with similar problems (6%), and community groups (3%) for help and support. Reliance on sources of support varied with participants' sociodemographic factors as well as healthcare and medication use.

CONCLUSIONS

Simultaneously considering patients' disease profiles, patient characteristics, difficulties managing their chronic conditions at home, and interactions with the healthcare system can inform tailored approaches and strategies to enhance patient education and resource identification, and can support service linkages.

La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec

La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.