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Chen L, Zhou Y. Symptom management experiences of Chinese individuals with Crohn's disease: A longitudinal descriptive qualitative study. Res Nurs Health 2024; 47:423-434. [PMID: 38564311 DOI: 10.1002/nur.22386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 01/13/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Individuals diagnosed with Crohn's disease, a chronic lifelong condition, experience a dynamic or fluctuating process of developing symptom management behavior. However, less clear is how these individuals respond to and manage their symptoms over time. The aim of this study was to longitudinally explore the symptom management experiences of individuals with Crohn's disease in China. A longitudinal qualitative design was used. Eighteen individuals with newly diagnosed Crohn's disease were purposely selected. Semi-structured interviews were conducted on four occasions over a 12-month period. Interviews at each time point were transcribed and coded using conventional content analysis. Afterward, data analyses of each time point were compared longitudinally to form a holistic understanding. Three themes and eight subthemes emerged from the analysis: (1) disclosing symptoms strategically: voluntary disclosure, reluctance to disclose, no need to disclose; (2) decreasing vigilance in symptom prevention: preventing symptoms stringently, preventing symptoms discriminatively, preventing symptoms with decreased diligence; and (3) increasing autonomy in symptom treatment: actively seeking medical advice, self-treatment and self-observation. The participants were inclined to keep symptoms hidden from relatives and friends and showed a downward trend in actively disclosing physical discomfort to medical staff within the course of 1 year. The participants' attention to symptom prevention declined, but the enthusiasm and independence to eliminate symptoms on their own increased over time. Nurses could implement targeted interventions according to the characteristics of different periods to assist individuals with Crohn's disease in managing symptoms effectively, reducing symptom burden and improving their quality of life.
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Affiliation(s)
- Lingxi Chen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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Yu J, Chen J, Wang B, Wen H, Li H, Wu Y, Hu R. Symptom experience and self-management strategies of adults undergoing hematopoietic stem cell transplantation after hospital discharge: A longitudinal qualitative study. Eur J Oncol Nurs 2024; 72:102666. [PMID: 39163757 DOI: 10.1016/j.ejon.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE To explore the symptom experience and self-management strategies of adults undergoing hematopoietic stem cell transplantation after hospital discharge. METHODS A longitudinal qualitative study was employed. A heterogeneous sample of 22 patients who underwent hematopoietic stem cell transplantation from August 2022 to April 2023 were included. Semi-structured interviews were conducted at three time points post-discharge and provided a dataset of 56 interviews. The content analysis method was used for manual analysis. This study followed the COREQ checklist. RESULTS The data from this study were categorized into four themes and 14 subthemes: (1) complexity and multidimensionality of symptom experience: diversity, dynamism, continuity, relatedness, and functional loading; (2) multiple variations in symptom self-management; (3) barriers to symptom self-management: limited access to information resources, insufficient awareness and skills in symptom self-management, lack of economic and social support, and difficulties in medical visits and reviews; and (4) facilitators of symptom self-management: perceived benefits, experience-driven, and peer experiences. CONCLUSION Patients undergoing hematopoietic stem cell transplantation experience multiple and complex symptom experiences after hospital discharge, and their symptom self-management remains challenging. The findings underscore the necessity for healthcare professionals to regularly and consistently evaluate the symptoms and self-management practices of patients undergoing hematopoietic stem cell transplantation and execute focused interventions to alleviate their symptom load and enhance their long-term well-being.
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Affiliation(s)
- Jiejie Yu
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jingyi Chen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Binbin Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hongmei Wen
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hao Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yong Wu
- Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Rong Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
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Loughlin J, Das V, Manchaiah V, Beukes E, Andersson G, Shekhawat GS. The positive side of living with tinnitus: a cross-sectional study. Int J Audiol 2024; 63:358-365. [PMID: 37004170 DOI: 10.1080/14992027.2023.2185756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/22/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The aim of the current study was to examine the presence of positive experiences reported by individuals with tinnitus in the United States. DESIGN The study used a cross-sectional survey design. The data were analysed using qualitative (content analysis) and quantitative (t-test or Chi-square test) analyses. STUDY SAMPLE Study participants were individuals participating in clinical trials involving Internet-based cognitive behavioural therapy (ICBT) for tinnitus. A total of 439 respondents, 211 (48.1%) male and 228 (51.9%) female responded, and data were collected via an online questionnaire. RESULTS Of the 439 participants, 164 (i.e. 37.4%) reported at least one positive experience. Younger participants and those with lower hearing disability were more likely to report positive experiences. The responses were categorised into six categories: Outlook (n = 139), Personal development (n = 42), Treatment-related (n = 42), Coping (n = 29), Support (n = 19), and Disease-specific (n = 19). CONCLUSIONS The ability of individuals with chronic tinnitus to identify positive experiences may give insights regarding acceptance and coping with tinnitus as well as the temperament of individuals reporting positive experiences. Considering these variables may help when planning individualised rehabilitation programs.
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Affiliation(s)
- Jeremy Loughlin
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Vedas Das
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Vinaya Manchaiah
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, USA
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, CO, USA
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Eldre Beukes
- Virtual Hearing Lab, Collaborative Initiative between University of Colorado School of Medicine and University of Pretoria, Aurora, CO, USA
- Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Giriraj Singh Shekhawat
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
- Ear Institute, University College London, London, UK
- Tinnitus Research Initiative, Regensburg, Germany
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Brunner K, Weisschuh L, Jobst S, Kugler C, Rebafka A. Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study. NURSING REPORTS 2024; 14:961-987. [PMID: 38651485 PMCID: PMC11036239 DOI: 10.3390/nursrep14020073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
Patients with Solid Organ Transplantations (SOTx) face long-term lifestyle adaptations, psychological and social adjustments, and complex self-care regimes to maintain health post-transplant. Self-management (SM) skills represent important aspects of nursing communication with SOTx patients; however, there is potential for SM to be defined narrowly in terms of medication adherence. The study presented here collated the existing definitions in a mixed method review in order to identify SM attributes for this group (including those unique to this population). Secondary analysis of a dataset and bibliographic analysis and an expert panel were used to develop a comprehensive working definition of SOTx patients. The analysis comprised critical interpretation of the evolving definition content, concepts, and contexts of application in current usages and over time. We identified eight definitions and 63 cited definition sources from bibliographic analysis. Findings identified limitations of the existing definitions. Population-specific attributes included optimisation of transplant outcomes, active engagement in healthy behaviours, control, structure, and discipline characteristics, and moderating factors of patient motivation, self-efficacy, and cognitive function. A critical appraisal of definitions indicated inadequately defined aspects such as setting, temporal dimension, concept interaction, interventions, and measurable outcomes. The bibliographic analysis highlighted the influence of broader chronic illness constructions of SM, underpinning the generalisable SM attributes in current definitions. Further research may advance the development of a definition in exploring the relevance of SOTx-specific attributes of the definition.
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Affiliation(s)
| | | | | | | | - Anne Rebafka
- Institute of Nursing Science, University Medical Centre, Albert-Ludwigs University Freiburg, Breisacher Straße 153, 79110 Freiburg, Germany (S.J.); (C.K.)
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Ferreira PL, Morais C, Pimenta R, Ribeiro I, Amorim I, Alves SM. Empowerment and Knowledge as Determinants for Quality of Life: A Contribution to a Better Type 2 Diabetes Self-Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4544. [PMID: 36901554 PMCID: PMC10001584 DOI: 10.3390/ijerph20054544] [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: 01/24/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to assess how knowledge and empowerment impact the quality of life (QoL) of a person with type 2 diabetes, leading to better communication and disease management. We conducted a descriptive and observational study of individuals with type 2 diabetes. The Diabetes Empowerment Scale-Short Form (DES-SF), Diabetes Knowledge Test (DKT), and EQ-5D-5L were used, in addition to sociodemographic and clinical characteristics. Evaluating the variability in the DES-SF and DKT in relation to the EQ-5D-5L and identifying possible sociodemographic and clinical determinants were conducted using univariate analyses followed by a multiple linear regression model to test whether the factors significantly predicted QoL. A total of 763 individuals were included in the final sample. Patients aged 65 years or older had lower QoL scores, as well as patients who lived alone, had less than 12 years of education, and experienced complications. The insulin-treated group showed higher scores in DKT than the non-insulin-treated group. It was also found that being male, being under 65 years of age, having no complications present, and having higher levels of knowledge and empowerment predicted higher QoL. Our results show that DKT and DES are still determinants of QoL, even after adjusting for sociodemographic and clinical characteristics. Therefore, literacy and empowerment are important for the improvement of the QoL of people with diabetes, by enabling them to manage their health conditions. New clinical practices focused on education, increasing patients' knowledge, and empowerment may contribute to better health outcomes.
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Affiliation(s)
- Pedro L. Ferreira
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
- Faculty of Economics, University of Coimbra, 3004-512 Coimbra, Portugal
| | - Carminda Morais
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
- Superior School of Health, Polytechnic of Viana do Castelo, 4900-314 Viana do Castelo, Portugal
| | - Rui Pimenta
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
- School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
| | - Inês Ribeiro
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
| | - Isabel Amorim
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
- Superior School of Health, Polytechnic of Viana do Castelo, 4900-314 Viana do Castelo, Portugal
| | - Sandra Maria Alves
- Centre for Health Studies and Research, University of Coimbra, 3004-512 Coimbra, Portugal
- School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
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Striving towards normality in an unpredictable situation. A qualitative interview study of how persons newly diagnosed with incurable oesophageal and gastric cancer manage everyday life. Eur J Oncol Nurs 2023; 63:102302. [PMID: 36893571 DOI: 10.1016/j.ejon.2023.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE Getting an incurable oesophageal or gastric cancer diagnosis is a major stressful life event associated with severe physical, psychosocial and existential challenges. To provide timely and efficient support, based on patients' experiences, the aim of the study was to explore how patients newly diagnosed with incurable oesophageal and gastric cancer manage everyday life. METHOD Semi-structured interviews were conducted with 12 patients 1-3 months after being diagnosed with incurable oesophageal or gastric cancer. Four participants were interviewed twice, which resulted in 16 interviews. Data were analysed with qualitative content analysis. RESULTS An overall theme, "Striving towards normality in an unpredictable situation", with three related themes - "Trying to comprehend the disease", "Dealing with the consequences of illness" and "Re-evaluating what is important in everyday life" - and seven sub-themes were identified. The participants described an unexpected and unpredictable situation, in which they strived to maintain their normal life. Amidst struggling to manage problems related to eating, fatigue and an incurable diagnosis the participants talked about the importance of focusing on the positive and normal aspects of life. CONCLUSIONS The findings in this study point to the importance of supporting patients' confidence and skills, particularly with regard to managing eating, so that they can hold on to their normal life as much as possible. The findings further point to the possible benefit of integrating an early palliative care approach and could provide guidance for nurses and other professionals on how to support patients post diagnosis.
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Qama E, Rubinelli S, Diviani N. Factors influencing the integration of self-management in daily life routines in chronic conditions: a scoping review of qualitative evidence. BMJ Open 2022; 12:e066647. [PMID: 36585140 PMCID: PMC9809267 DOI: 10.1136/bmjopen-2022-066647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Self-management of chronic diseases is regarded as dynamic experience which is always evolving and that requires constant adjustment. As unexpected and new shifts in diseases occur, patients tend to abandon acquired behaviours calling into question their sustainability over time. Developing a daily self-management routine as a response to lifestyle changes is considered to facilitate self-management performance. However, fitting self-management recommendations in one's daily life activities is a constant challenge. In this review, we describe the performance of self-management routines within daily settings in people living with chronic conditions with the aim of identifying factors that challenge its integration in daily life. DESIGN Scoping review. DATA SOURCES We searched PubMed, Web of Science, CINAHL and PsycINFO on February 2022. ELIGIBILITY CRITERIA We included qualitative studies on self-management experience, in English, with adult participants, original and peer-reviewed, and depicting the performance of self-management activities in one's own environment. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened titles and abstracts. After agreement, one reviewer screened the full text of relevant articles and extracted the data. The data were synthesised and analysed thematically. PRISMA Extension for Scoping Reviews checklist was used for reporting the steps. RESULTS Twenty-two studies were included. The thematic analysis brought up two overreaching themes. The first one is the Environment support with three subthemes: family and cultural norms; health professionals and guiding communication; and society and disease perceptions. The second theme is comprehension gap with two subthemes: reading the body and applying information. CONCLUSIONS The integration of self-management requirements in a daily routine is affected by the patients' inability to apply disease knowledge in different context and by the challenge of understanding body symptoms and predicting body reactions in advance.
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Affiliation(s)
- Enxhi Qama
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
| | - Nicola Diviani
- Person-centered Healthcare & Health Communication Group, Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Lucerne, Switzerland
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He X, Wang Y, Feng C, Luo L, Khaliq U, Rehman FU, Zhang X. Preferring self-management behavior of patients with chronic kidney disease. Front Public Health 2022; 10:973488. [PMID: 36530662 PMCID: PMC9755185 DOI: 10.3389/fpubh.2022.973488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
This study explores the preferred behavior of self-management among chronic kidney disease (CKD) patients and offers suggestions for different patients from personalized medicine. According to some related references, a questionnaire was designed in 2020 to collect data from 131 patients with CKD in a general hospital. The Sampling patients showed no difference in their disease progress. The questionnaire covered two aspects of demographic and behavior with 29 items on six dimensions. Statistical methods such as a descriptive analysis of the F test in behavior dimensions on demographic characteristics and Principal component analysis from items have been applied to classify some kinds of self-management behavior into different groups. In the demographic insight, employment status closely relates to self-management behavior, and income is insignificant. In the behavior aspects, according to some key items, we found four types of self-management behavior preferred in the sorting: cognitive-knowledge, Diet-exercise-medical, emotion management, and exercise-medical, which were defined by behavior dimensions. Although patients had the same disease progress, their self-management behavior mainly existed in four types based on critical factors. According to their favorite behavior and personality group, healthcare stakeholders can offer lean support for improving patients' self-management of CKD in China.
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Affiliation(s)
- Xiaoli He
- West China School of Nursing/Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Industry Engineering and Management, Business School, Sichuan University, Chengdu, China
| | - Chenchen Feng
- West China School of Nursing/Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Le Luo
- School of Civil Engineering and Geomatics, Southwest Petroleum University, Chengdu, China
| | - Usama Khaliq
- Department of Industry Engineering and Management, Business School, Sichuan University, Chengdu, China
| | | | - Xinli Zhang
- Department of Industry Engineering and Management, Business School, Sichuan University, Chengdu, China,*Correspondence: Xinli Zhang
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Ardissone A. Selective adoption of therapeutic devices among people with type 1 diabetes. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2022; 31:278-292. [PMID: 34932918 DOI: 10.1080/14461242.2021.2007160] [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: 04/28/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
This paper contributes to the debate regarding the adoption/rejection of technologies by focusing on the selective use of therapeutic devices among people with type 1 diabetes. I show that patients often refuse to use a device (either insulin pumps or sensors for glycaemic control), despite suggestions from diabetologists. The study was conducted in Italy in 2019. Theoretically, the paper relied on a perspective that amalgamates actor-network theory and postphenomenology around the key concept of multistability. I then detected the three main features of stabilities that explain device use/non-use: relation to embodied users, contextual embedment (within larger social assemblages), concrete tailoring. Findings helped to stress the relevance of not only focusing on the type of device and its technical functioning, but also unveiling the underlying ongoing and situated socio-technical processes. Selective adoption of devices should be investigated at the level of the whole patient-device assemblage in order to assess the diverse stabilities that may arise from such networks.
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Kephart G, Packer T, Audulv Å, Chen YT, Robinson A, Olsson I, Warner G. Item selection, scaling and construct validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) measurement tool in adults. Qual Life Res 2022; 31:2867-2880. [PMID: 35759127 PMCID: PMC9356954 DOI: 10.1007/s11136-022-03165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Purpose To select and scale items for the seven domains of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and assess its construct validity. Methods Using an online survey, data on 100 potential items, and other variables for assessing construct validity, were collected from 1055 adults with one or more chronic health conditions. Based on a validated conceptual model, confirmatory factor analysis (CFA) and item response models (IRT) were used to select and scale potential items and assess the internal consistency and structural validity of the PRISM-CC. To further assess construct validity, hypothesis testing of known relationships was conducted using structural equation models. Results Of 100 potential items, 36 (4–8 per domain) were selected, providing excellent fit to our hypothesized correlated factors model and demonstrating internal consistency and structural validity of the PRISM-CC. Hypothesized associations between PRISM-CC domains and other measures and variables were confirmed, providing further evidence of construct validity. Conclusion The PRISM-CC overcomes limitations of assessment tools currently available to measure patient self-management of chronic health conditions. This study provides strong evidence for the internal consistency and construct validity of the PRISM-CC as an instrument to assess patient-reported difficulty in self-managing different aspects of daily life with one or more chronic conditions. Further research is needed to assess its measurement equivalence across patient attributes, ability to measure clinically important change, and utility to inform self-management support. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03165-4.
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Affiliation(s)
- George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada. .,School of Health Administration, Dalhousie University, Halifax, Canada. .,Department of Nursing, Umeå University, Umeå, Sweden.
| | - Tanya Packer
- School of Health Administration, Dalhousie University, Halifax, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Canada.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Åsa Audulv
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Yu-Ting Chen
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Ingrid Olsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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Othman MM, Al-Wattary NA, Khudadad H, Dughmosh R, Furuya-Kanamori L, Doi SAR, Daher-Nashif S. Perspectives of Persons With Type 2 Diabetes Toward Diabetes Self-Management: A Qualitative Study. HEALTH EDUCATION & BEHAVIOR 2022; 49:680-688. [PMID: 35658556 DOI: 10.1177/10901981221098373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The global increase in type 2 diabetes (T2D) poses a significant public health challenge worldwide. Due to the chronic and complex nature of the disease, management does not depend on pharmacotherapy alone; rather, a comprehensive medical and self-management plan is required. Diabetes Self-Management Education programs should address diabetes-specific behaviors and be grounded in patients' perceptions of their disease and its consequences. Aim. The study aims to understand perceptions of diabetes self-management (DSM) among persons of different nationalities with T2D living in Qatar. Method. A phenomenological qualitative study was implemented using four focus group interviews using Triandis Interpersonal Behavior Model to understand factors influencing DSM perceptions and behaviors. Therefore, deductive content analysis was used, also inductive content analysis used to find new emerging themes. Twenty-nine participants with T2D of 12 different nationalities were recruited. Results. Content analyses revealed that participants were mainly motivated to manage their diabetes by fear of future health complications-and the resulting impact on their families-triggered by witnessing these complications on other family members and friends. Factors that influenced DSM included cultural factors such as food content and holidays' customs, weather conditions, psychological distress, and social factors such as lack of family support. Furthermore, access to healthy food, number of working hours and time, and cost of DSM supplies were found to be among the barriers to DSM. Conclusion. Understanding and considering patients' perspectives is a core component of culturally competent and evidence-based DSM programs, and it should be considered in any DSM program.
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Affiliation(s)
- Manal M Othman
- College of Medicine, Qatar University, Doha, Qatar.,Hamad Medical Corporation, Medicine Department, Doha, Qatar
| | | | - Hanan Khudadad
- Research Department, Primary Health Care Corporation, Doha, Qatar
| | - Ragae Dughmosh
- Hamad Medical Corporation, Medicine Department, Doha, Qatar
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Elkhalii-Wilhelm S, Sippel A, Riemann-Lorenz K, Kofahl C, Scheiderbauer J, Arnade S, Kleiter I, Schmidt S, Heesen C. Experiences of persons with Multiple Sclerosis with lifestyle adjustment-A qualitative interview study. PLoS One 2022; 17:e0268988. [PMID: 35622783 PMCID: PMC9140290 DOI: 10.1371/journal.pone.0268988] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Persons with Multiple Sclerosis (pwMS) follow individual strategies to cope with this highly heterogeneous disease. As surveys show, lifestyle habits play an important role in pwMS. However, little is known about individual experiences of pwMS with different lifestyle adjustment strategies. OBJECTIVE This study aims to describe and understand individual experiences of pwMS with lifestyle adjustments. METHODS Semi-structured interviews were conducted with 50 pwMS in Germany. Criteria for inclusion were age ≥ 18 years and a diagnosis of relapsing-remitting Multiple Sclerosis. Data were analyzed inductively and deductively according to a six-step thematic analysis. RESULTS The three main themes for experience-based lifestyle adjustments were: 1) nutrition and supplements, 2) exercise and physical activity, and 3) stress management. Influencing factors on the decision-making process such as active disease management, information and advice, desire for mental health and social support, and the wish for self-determination were identified. Impacts of starting or maintaining lifestyle habits included, for example, MS-specific, general, and mental health benefits, the development of coping strategies, social support, and barriers that led to a termination of lifestyle adjustments. CONCLUSION This study provides a rich and nuanced amount of experiences of pwMS with lifestyle adjustments and leads to three important conclusions: 1) Further research is warranted to better describe the perceived effects of lifestyle habits on MS symptoms and progression, in particular with regard to nutrition and stress reduction; 2) patient education in MS should include the available evidence on lifestyle management and 3) patients need to be actively supported in changing their lifestyle behavior.
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Affiliation(s)
- Saskia Elkhalii-Wilhelm
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Sigrid Arnade
- LEBENSNERV–Stiftung zur Förderung der Psychosomatischen MS-Forschung, Berlin, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke GmbH, Berg, Germany
| | - Stephan Schmidt
- Neurologische Gemeinschaftspraxis, Gesundheitszentrum St. Johannes, Bonn, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Evans N, Connelly DM, Hay ME. The process of commitment to exercise among stroke survivors in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e706-e716. [PMID: 34041792 DOI: 10.1111/hsc.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
The objective of this research was to understand the process of commitment to exercise participation for functional recovery among community-living survivors of stroke following discharge from formal rehabilitation. Participants were recruited from a mid-sized city in south-western Ontario, Canada. Between September 2017 and March 2018, 10 individuals living in the community with the effects of stroke, who continued to engage in regular exercise post-stroke, were recruited for participation. Constructivist grounded theory methodology was employed, utilising in-depth individual interviews and theoretical sampling, whereby data collection and analysis occurred simultaneously. Analysis involved constant comparison between data and codes to reduce knowledge gaps and formulate the proposed theory. The process of commitment to exercise involved four phases. Initiation of the process followed a significant interaction with a healthcare provider who advocated for participants to learn the foundations of exercise. Through planned exercise, maintenance of a positive attitude and comparisons with their pre-stroke selves and peers, participants identified future goals and imparted the desire to get back to life before stroke. Over time individuals navigated exercise opportunities-trialling different types and environments-to learn what works. Finally, participants developed a commitment to exercise as a way of life, supported by social connections and reinforced with pride in successes-mastering self-care skills, improved mobility and meaningful function. The process of commitment to exercise among survivors of stroke required early interactions with healthcare providers to initiate exercise participation for long-term engagement, and navigation through various exercise elements fuelled by a desire to reconnect with their pre-stroke selves.
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Affiliation(s)
- Nicole Evans
- Health and Rehabilitation Sciences Program, Western University, London, ON, USA
| | - Denise M Connelly
- Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western University, London, ON, USA
- Interprofessional Education and Practice (IPEP) Office, Western University, London, ON, USA
- School of Physical Therapy, Western University, London, ON, USA
| | - Melissa E Hay
- Health and Rehabilitation Sciences Program, Western University, London, ON, USA
- Graduate and Postdoctoral Studies, Faculty of Health Sciences, Western University, London, ON, USA
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Othman MM, Khudadad H, Dughmosh R, Furuya-Kanamori L, Abou-Samra AB, Doi SAR. Towards a better understanding of self-management interventions in type 2 diabetes: A concept analysis. Prim Care Diabetes 2022; 16:142-149. [PMID: 34556438 DOI: 10.1016/j.pcd.2021.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Diabetes self-management educational (DSME) interventions can vary considerably, and it is unclear what is the operational conceptualization of the ideal delivery to individuals with type 2 diabetes (T2D). DESIGN From a search conducted concurrently we extracted and evaluated the 50 most recently published DSME intervention studies. Based on an analysis of these studies, we undertook a concept analysis using the Walker and Avant framework. RESULTS Five attributes describing the concept were recognized and organized into two groups. Group (a): skills related attributes that included (1) decision making, (2) problem solving and (3) taking action. Group (b): information related attributes that included (4) patient-provider interaction and (5) resource utilization. CONCLUSIONS The outcomes of this study make the operational conceptualization of the ideal DSME intervention measurable through its attributes and hence clarifies its delivery. This will improve the implementation of the key attributes in diabetes self-management intervention programs for T2D.
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Affiliation(s)
- Manal M Othman
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Medicine Department, Hamad General Hospital, Doha, Qatar.
| | - Hanan Khudadad
- Department of Clinical Research, Primary Health Care Corporation, Doha, Qatar.
| | - Ragae Dughmosh
- Medicine Department, Hamad General Hospital, Doha, Qatar.
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute and Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Nair D, Cukor D, Taylor WD, Cavanaugh KL. Applying A Biopsychosocial Framework to Achieve Durable Behavior Change in Kidney Disease. Semin Nephrol 2022; 41:487-504. [PMID: 34973694 DOI: 10.1016/j.semnephrol.2021.10.002] [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: 12/26/2022]
Abstract
Chronic disease self-management is the establishment and maintenance of behaviors needed to be an active participant in one's health care and experience the best health outcomes. Kidney disease self-management behaviors to slow disease progression include engaging in exercise or physical activity; adhering to a diet low in sodium, potassium, and phosphorus; monitoring laboratory parameters; managing complex medication regimens; coping with disease-related emotional distress; and communicating effectively with providers. Durable behavior change has been difficult to achieve in kidney disease, in part because of an incomplete understanding of the multilevel factors determining chronic disease self-management in this patient group. The biopsychosocial model of chronic illness care posits that an individual's health outcomes result from biological, psychological, social, and environmental factors as part of a multilevel systems hierarchy. Although this theoretical model has been used to comprehensively identify factors driving self-management in other chronic conditions, it has been applied infrequently to behavioral interventions in kidney disease. In this scoping review, we apply the biopsychosocial model of health to identify individual, interpersonal, and systems-level drivers of kidney disease self-management behaviors. We further highlight factors that may serve as novel, impactful targets of theory-based behavioral interventions to understand and sustain behavior change in kidney disease.
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Affiliation(s)
- Devika Nair
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt O'Brien Center for Kidney Disease, Nashville, TN.
| | - Daniel Cukor
- Behavioral Health Program, The Rogosin Institute, New York, NY
| | - Warren D Taylor
- Division of Geriatric Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt O'Brien Center for Kidney Disease, Nashville, TN; Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, TN
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Ladner J, Alshurafa S, Madi F, Nofal A, Jayasundera R, Saba J, Audureau E. Factors impacting self-management ability in patients with chronic diseases in the United Arab Emirates, 2019. J Comp Eff Res 2021; 11:179-192. [PMID: 34806911 DOI: 10.2217/cer-2021-0177] [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: 11/21/2022] Open
Abstract
Aim: Poor adherence to chronic disease therapy is a critical global problem that negatively effects the long-term therapy for chronic diseases, resulting in negative population health and economic effects. The WHO multidimensional model proposed a systems-based approach for improving adherence to chronic disease therapy. Patients & methods: In the current study, the WHO five-dimension framework was used to evaluate factors among, chronic-disease patients in the United Arab Emirates. Results: We show that patient's understanding of disease, involvement in treatment decision, age more than 40 years, time spent with physician and fear of how patients were perceived by others were the most predictive factors associated with a high ability to self-manage a chronic disease. Conclusion: Sociocultural factors have an indirect impact on disease self-management.
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Affiliation(s)
- Joel Ladner
- Department of Epidemiology & Health Promotion, Rouen University Hospital, Rouen, France
| | | | | | | | | | | | - Etienne Audureau
- Clinical Epidemiology and Ageing, Paris Est Université, Hôpital Henri Mondor Hôpital, Public Heath, Assistance Publique Hôpitaux de Paris, Créteil, France
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da Silva RC, Gondim MC, Cavalcante AMRZ, Bachion MM, da Silva VM, de Oliveira Lopes MV. Ineffective health management: A systematic review and meta-analysis of related factors. J Nurs Scholarsh 2021; 54:376-387. [PMID: 34811891 DOI: 10.1111/jnu.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/13/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE A standardized language system can support the elaboration of clinical guidelines by matching information from similar patterns of response to people. To identify the factors that are related to a higher likelihood of an ineffective health management nursing diagnosis. METHODS We conduct a systematic review and meta-analysis. An electronic search was conducted in MEDLINE databases via PubMed, Web of Science, SciELO, CINAHL, SCOPUS, and Embase between October and November 2020. Descriptive data were extracted from each article. The odds ratios for each etiological factor related to ineffective health management were directly extracted from the articles or calculated from the data described in the articles. The analysis of the measurements of exposure and the magnitude of the effect was performed using the statistical software R, and a forest plot was constructed for each etiological factor. FINDINGS Ten studies were included, and 15 related factors were recovered from the primary studies. The factors that significantly increased the likelihood of an ineffective health management nursing diagnosis were insufficient knowledge of the therapeutic regimen, perceived barriers, powerlessness, economic disadvantage, and difficulty managing complex treatment regimens. No effect was verified with the following factors: decision conflict, family pattern of healthcare, and inadequate number of cues to action. CONCLUSION Factors related to a higher likelihood of ineffective health management may be the focus of early and targeted nursing interventions, contributing to an improved quality of care. CLINICAL RELEVANCE Understanding exposure to these factors can improve diagnostic reasoning at different population levels.
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PAINSTORIES - Exploring the Temporal Developments in the Challenges, Barriers, and Self-Management Needs of Adolescents with Longstanding Knee Pain: A Qualitative, Retrospective Interview Study with Young Adults Experiencing Knee Pain Since Adolescence. THE JOURNAL OF PAIN 2021; 23:577-594. [PMID: 34718151 DOI: 10.1016/j.jpain.2021.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/28/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
Patient education is essential to enable rehabilitation and self-management of longstanding knee pain in adolescents. Currently, a lack of insights into the socio-cognitive processes governing adolescents' self-management remains an obstacle for enhancing treatment efficacy. This study developed a conceptual model for integrating adolescents' challenges and barriers into future treatments. We conducted semi-structured retrospective interviews with 14 young adults (age 21-25 years) with knee pain since adolescence (9 years mean duration). Temporal developments in participants' knee pain were captured through a memorization exercise. Data was analyzed via the General Inductive Approach. Themes were organized into a matrix, extracting a conceptual model, which was tested with eight new participants. The analysis identified seven themes. Further interpretation, via the matrix, organized these within a four-stage trajectory of; gaining awareness, knowledgeability, contextual application and reconceptualization, each with different challenges and dilemmas, participants had to overcome to progress their self-management. Testing the conceptual model, confirmed stages and highlighted acceptance as key to overcoming barriers. The study described adolescents' integration of self-management as proximal and inquiry-based, with acceptance, driving increasingly complex management behaviors. We hypothesize future interventions may benefit from exploring supporting adolescents' inquiries into their knee pain at different stages of the trajectory. PERSPECTIVE: This study presents a conceptual model and vocabulary for optimizing patient education concepts, to target the challenges, barriers and needs of adolescents with knee pain at different stages of their mastery journey. We believe our findings may inform reflections among clinicians and researchers, and development of more effective education interventions.
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Lawless MT, Tieu M, Feo R, Kitson AL. Theories of self-care and self-management of long-term conditions by community-dwelling older adults: A systematic review and meta-ethnography. Soc Sci Med 2021; 287:114393. [PMID: 34534780 DOI: 10.1016/j.socscimed.2021.114393] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE The proportion of older adults living with long-term conditions (LTCs) is increasing. Self-care and self-management approaches are seen as valuable in helping older people with LTCs to manage their health and care, yet the theoretical overlaps and divergences are not always clear. OBJECTIVES The objectives of this review were to: (1) systematically identify and appraise studies of self-care or self-management of LTCs by community-dwelling older adults (aged ≥60 years) either informed by, applying, creating, or testing theory; (2) explore similarities or points of convergence between the identified theories; and (3) use a meta-ethnographic approach to synthesise the theories and group related concepts into core constructs. METHODS We conducted a systematic theory synthesis, searching six electronic databases. Three reviewers independently screened titles and abstracts followed by full texts and two reviewers appraised study quality. Theoretical data were synthesised within and across individual theories using meta-ethnographic line-of-argument synthesis. RESULTS A total of 141 articles (138 studies) and 76 theories were included in the review. Seven core constructs were developed: (1) temporal and spatial context; (2) stressors; (3) personal resources; (4) informal social resources; (5) formal social resources; (6) behavioural adaptations; and (7) quality of life outcomes. A line of argument was developed that conceptualised older adults' self-care and self-management as a dynamic process of behavioural adaptation, enabled by personal resources and informal and formal social resources, aimed at alleviating the impacts of stressors and maintaining quality of life. CONCLUSION This synthesis provides an overview of theories used in research on older adults' LTC self-care and self-management. Our synthesis describes the complex interplay of intrinsic and extrinsic factors influencing self-care and self-management behaviours and provides considerations for future research, intervention design, and implementation. The utility of the constructs in research and practice requires further attention and empirical validation.
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Affiliation(s)
- Michael T Lawless
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Matthew Tieu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; College of Humanities, Arts, and Social Sciences, Flinders University, Bedford Park, SA, 5042, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; Caring Futures Institute, Flinders University, Bedford Park, SA, 5042, Australia
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Brandberg C, Ekstedt M, Flink M. Self-management challenges following hospital discharge for patients with multimorbidity: a longitudinal qualitative study of a motivational interviewing intervention. BMJ Open 2021; 11:e046896. [PMID: 34330857 PMCID: PMC8327841 DOI: 10.1136/bmjopen-2020-046896] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe challenges in self-management activities among people with multimorbidity during a 4-week post-discharge period. DESIGN This is a longitudinal qualitative study using data from a randomised controlled trial (RCT) of motivational interviewing (MI) sessions. SETTING The RCT was conducted at six wards in two hospitals-one university hospital and one general hospital in Stockholm, Sweden, during 2016-2018. PARTICIPANTS Sixteen participants from the intervention group, diagnosed with heart failure or chronic obstructive pulmonary disease and at least one other chronic condition, were purposively selected for this study. INTERVENTIONS Each participant had four or five post-discharge MI sessions with a trained social worker during a period of approximately 4 weeks. The sessions were recorded digitally and analysed using content analysis. Altogether, 70 recorded sessions were analysed. RESULTS Self-management after hospital discharge was a dynamic process with several shifting features that evolved gradually over time. Patients with multimorbidity experienced two major challenges with self-management in the first 4 weeks following hospital discharge: 'Managing a system-centred care' and 'Handling the burden of living with multiple illnesses at home post-discharge'. CONCLUSIONS Self-management for patients with multimorbidity in the first post-discharge period does not equate to a fixed set of tasks, but varies over the post-discharge period. Self-management challenges include not only the burden of the disease itself, but also that of navigating and understanding the healthcare system. Hence, self-management support post-discharge involves both aiding patients with care coordination and meeting their gradually shifting disease-related needs. TRIAL REGISTRATION NUMBER NCT02823795.
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Affiliation(s)
- Carina Brandberg
- Department of Learning, Informatics, Managmenet and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Managmenet and Ethics (LIME), Karolinska Institute, Stockholm, Sweden
- School of Health and Caring Sciences, Linnaeus University Faculty of Health and Life Sciences, Kalmar, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Ardissone A. From loyalty to resignation: Patient-doctor figurations in type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1388-1404. [PMID: 34050536 PMCID: PMC8453939 DOI: 10.1111/1467-9566.13304] [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: 05/25/2020] [Revised: 04/17/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
This paper contributes to the debate on the patient-doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self-management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational-processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors.
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Marrocco AM, El-Masri MM. Exploring the Application of Interpretive Description in Chronic Illness: A Scoping Review. Res Theory Nurs Pract 2021; 35:RTNP-D-20-00022. [PMID: 34162757 DOI: 10.1891/rtnp-d-20-00022] [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: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Chronic illness is a complex condition that affects over one billion people. To develop a deeper insight of the needs of this patient population, interpretive description uses disciplinary knowledge as the source of understanding. This methodology is a pragmatic approach to research without focusing on a strict methodological directive. The aims of this scoping review are twofold, (a) to describe the findings of studies that have used Thorne's interpretive description to research chronic illness and (b) to discuss the application of interpretive description in clinical research. Thereby, showing interpretive description as a valuable tool to advance nursing knowledge and patient care. METHODS The methodological framework for this review was based on the Johanna Briggs Institute guidelines for scoping reviews. RESULTS To develop an understanding of interpretive description, it is essential to examine the results of studies which have applied the methodology. Our scoping review showed that researchers utilizing interpretive description identified four common challenges experienced by individuals living with chronic illness: symptom management, education and knowledge, supportive care, and cultural disadvantages. By demonstrating how interpretive description is applied, it shows how it can be used to understand and interpret clinical phenomena to improve practice. IMPLICATION FOR PRACTICE This scoping review demonstrates how interpretive description was used to develop knowledge about chronic illness. The premise of interpretive description is that disciplinary knowledge offers a sufficient foundation to develop meaningful research to support health practices. By approaching research from a disciplinary perspective, new knowledge can be discovered to complex health problems.
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Affiliation(s)
- Anna M Marrocco
- Cardiovascular Intensive Care, Henry Ford Health System, Detroit, MI
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Durosier Mertilus DS, Lengacher CA, Rodriguez CS. A Review and Conceptual Analysis of Cancer Pain Self-Management. Pain Manag Nurs 2021; 23:168-173. [PMID: 34006496 DOI: 10.1016/j.pmn.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In this concept analysis article, we will clarify the concept "self-management of cancer pain" by identifying related antecedents, attributes, and consequences to further refine the conceptual and operational definitions of the concept. DESIGN A review was conducted. REVIEW/ANALYSIS METHODS The Walker and Avant method was used for this concept analysis. DATA SOURCES CINAHL, PubMed, and PsycInfo were searched systemically.A total of eight studies on "self-management of cancer pain or self-care of cancer pain" published between 2004 and 2019 were identified. RESULTS Attributes for self-management of cancer pain include self-efficacy, integration of methods for pain relief into daily life, decision-making related to pain management, process for solving pain-related issues, and initiation of interactions with healthcare professionals. Antecedents include knowledge regarding pain assessment and management, cognitive abilities, motivation, undergoing pain treatment, patient education and counseling, social support, and accountability from all parties involved. Consequences include pain control, improved quality of life, and increased opioid intake. CONCLUSIONS Self-management of cancer pain was reported to be a self-regulation process with the aim to encourage patients to use skills attained through development of self-efficacy, so they can actively participate in their pain management. This outcome may enhance their quality of life by decreasing their pain, depression, and anxiety and increasing the availability of social support.
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Luckett T, Roberts M, Swami V, Smith T, Cho JG, Klimkeit E, Wheatley JR. Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study. BMJ Open 2021; 11:e050149. [PMID: 33986071 PMCID: PMC8126310 DOI: 10.1136/bmjopen-2021-050149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support. DESIGN A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach. SETTING The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits. PARTICIPANTS Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier. RESULTS Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A 'chaos narrative' appeared to be prevalent, and many participants had poor recall of the programme. CONCLUSIONS Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management. TRIAL REGISTRATION NUMBER ACTRN12617000499381.
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Affiliation(s)
- Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary Roberts
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vinita Swami
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Jin-Gun Cho
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Ester Klimkeit
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - John R Wheatley
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
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Kim JS, Kim CJ, Schlenk EA. Psychometric Properties of the Korean Version of the Patient Knowledge Questionnaire-Osteoarthritis. Clin Nurs Res 2021; 31:69-79. [PMID: 33749315 DOI: 10.1177/10547738211001964] [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: 11/15/2022]
Abstract
This study examined the psychometric properties of the Korean version of the Patient Knowledge Questionnaire-Osteoarthritis (PKQ-OA-K). A cross-sectional survey was conducted with 157 adults with osteoarthritis from the outpatient clinic at a university hospital in Korea. The overall correct answer rate for the PKQ-OA-K was 60.4%; notably, the drug therapy subscale had the lowest median score percentage (42.9%). For structural validity, exploratory factor analysis identified the PKQ-OA-K as two-dimensional, explaining 52.4% of the total variance. Confirmatory factor analysis showed that the two-factor model adequately fit the data. The PKQ-OA-K was positively correlated with education level (r = 0.24) and osteoarthritis outcomes (r = 0.17), thus verifying the hypotheses of construct validity. The intraclass correlation coefficient for test-retest reliability was 0.52; alpha was 0.44. The PKQ-OA-K has excellent validity but imperfect reliability for adults with osteoarthritis. This study recommends cautious use of the PKQ-OA-K to assess Korean patients' knowledge of osteoarthritis.
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Mayo CD, Farzam-Kia N, Ghahari S. Identifying Barriers to and Facilitators of Health Service Access Encountered by Individuals with Multiple Sclerosis. Int J MS Care 2021; 23:37-44. [PMID: 33658905 DOI: 10.7224/1537-2073.2020-026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background The symptoms of multiple sclerosis (MS) can be diverse, complex, and progressive, creating a need for frequent and long-standing health care services. The purpose of this scoping review was to identify the barriers people with MS encounter when attempting to access multidisciplinary health services and the reported facilitators for better access to health services. Methods The MEDLINE, Embase, and CINAHL databases were searched, without date or geographic restrictions, using the following terms: multiple sclerosis, health services accessibility, health care access, health care delivery, and delivery of health care. After screening based on exclusion criteria, 23 articles were included in the final review. Results Five main themes were identified as barriers and facilitators to accessing health services: 1) information (information available to people with MS, health care provider knowledge of and familiarity with MS), 2) interactions (interactions between health care providers and people with MS, social networks and support of people with MS, collaboration among health care providers), 3) beliefs and skills (personal values and beliefs, perceived time to travel to and attend appointments, and self-assessment of symptoms and needs of people with MS), 4) practical considerations (wait times, physical barriers, affordability of services), and 5) nature of MS (complexity and unpredictability of disease symptoms). Conclusions People with MS and their health care providers may benefit from structured and comprehensive MS-specific education to address barriers to accessing health care services. The education can ultimately facilitate the process of addressing unmet health care needs and contribute to a greater quality of life for people with MS.
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Qiu R, Tang L, Wang X, Ye Z. Life Events and Adaptive Coping Approaches to Self-Management From the Perspectives of Hospitalized Cardiovascular Patients: A Qualitative Study. Front Psychiatry 2021; 12:692485. [PMID: 34603098 PMCID: PMC8481653 DOI: 10.3389/fpsyt.2021.692485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/23/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives: This study aimed to explore the association between hospitalized cardiovascular patients' life events and adaptive coping approaches to self-management. Methods: The study was a qualitative study that was conducted in a cardiology department of one affiliated university hospital in Hangzhou, China. Twenty-eight participants with cardiovascular diseases were recruited through a purposive sampling procedure. Semi-structured interviews were used to gain insights into adaptive coping approaches to self-management when living with different life events. Interviews were audio-recorded and transcribed, and the data were analyzed by thematic analysis. Results: Life events reported by hospitalized cardiovascular participants could be summarized in four categories: daily routines, life changes, life-threatening experiences, and emotional sufferings. The adaptive coping approaches were also summarized in four themes: decision-making, avoidance, consistent responses, and episodic responses. Conclusion: This study described essential insights into the mutual influences between various life events and adaptive coping approaches to self-management by a group of hospitalized cardiovascular patients. Participants coped with their problems flexibly by processing comprehensive information from various and unpredictable life events regarding the situations and contexts. While inequity was cumulated, psychological resilience was a vital mediator between stressful events and their responses. The study illuminated the importance of understanding context, situations, and experiences on how cardiovascular patients adapted to their self-management regimens.
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Affiliation(s)
- Ruolin Qiu
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Leiwen Tang
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiyi Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihong Ye
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Packer T, Kephart G, Audulv Å, Keddy A, Warner G, Peacock K, Sampalli T. Protocol for development, calibration and validation of the Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC). BMJ Open 2020; 10:e036776. [PMID: 32998919 PMCID: PMC7528366 DOI: 10.1136/bmjopen-2020-036776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Assessing and measuring patients' chronic condition self-management needs are critical to quality health care and to related research. One in three adults around the world live with multiple chronic conditions. While many patient-reported measures of self-management have been developed, none has emerged as the gold standard, and all have one or more of the following limitations: (1) they fail to measure the different domains of self-management important to patients, (2) they lack sufficient specificity to support patient-centred care or identify the specific components of self-management interventions that work and/or (3) they lack suitability for patients with multiple chronic conditions. METHODS AND ANALYSIS The Patient-Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is being developed to overcome these shortcomings. It will measure respondents' perceived success (or difficulty) in self-managing seven domains important to patients. The protocol has three phases. Phase 1 is conceptual model development and item generation. Phase 2 is assessment of the relevance and understanding of items by people with chronic conditions. Phase 3 is item analysis, dimensionality assessment, scaling and preliminary validation of the PRISM-CC using an online survey of people with chronic conditions (n~750). The expected completion date is early 2021. ETHICS AND DISSEMINATION This study will adhere to the Canadian Tri-Council Policy Statement on Ethical Conduct for Research Involving Humans. Ethics approval for all phases has been obtained from the Nova Scotia Health Authority Research Ethics Board. Once completed, the PRISM-CC will be made available for research and healthcare at minimal to no cost.
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Affiliation(s)
- Tanya Packer
- Schools of Occupational Therapy and Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Rehabilitation Department, Radboud Unversity Medical Centre, Nijmegen, Gelderland, The Netherlands
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Åsa Audulv
- Department of Nursing, Umeå Universitet Medicinska fakulteten, Umea, Sweden
| | - America Keddy
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Warner
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
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Wang L, Guo Y, Wang M, Zhao Y. A mobile health application to support self-management in patients with chronic obstructive pulmonary disease: a randomised controlled trial. Clin Rehabil 2020; 35:90-101. [PMID: 32907384 DOI: 10.1177/0269215520946931] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the effects of a mobile health smartphone application to support self-management programmes on quality of life, self-management behaviour and exercise and smoking cessation behaviour in patients with chronic obstructive pulmonary disease (COPD). DESIGN A randomised controlled, single-blind trial, was carried out from November 2017 to February 2019, which included 78 participants admitted with COPD to the Affiliated Hospital of Zunyi Medical University in Guizhou. The study participants were randomised into intervention (n = 39) and control groups (n = 39). METHODS Participants in the intervention group undertook a mobile medical application-based programme in addition to routine care, and participants in the control group received only routine care. The outcome measures were health-related quality of life evaluated by the COPD Assessment-Test, self-management behaviour using the COPD Self-Management Scale and physical activity and smoking behaviour were measured using a self-designed questionnaire. Data collection was conducted at baseline, third month, sixth month and 12th months. RESULTS Thirty-five participants in the intervention group and 33 in the control group completed the study. Compared to the control group, participants in the intervention group showed statistically significant improvement in the COPD -Assessment -Test scores (P < 0.01) and in all domains of the COPD Self-Management Scale scores (P < 0.01) at 12th 12 months. Improvements in the COPD -Assessment -Test scores by 4.3 and 0.3 units, and in the total scores of the COPD Self-Management Scale total score by 23.01 and 2.28 units, respectively, were observed in the intervention and control groups, respectively over the 12-month study period. Meanwhile, the mobile health application programme also improved participants' exercise and smoking cessation behaviour. CONCLUSIONS The mobile health smartphone application to support self-management programmes was effective in improving health-related quality of life and self-management behaviour in patients with COPD. TRIAL REGISTRATION This study was registered in Chinese clinicaltrials.gov.
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Affiliation(s)
- LianHong Wang
- The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Nursing Department of ZunYi Medical University, ZunYi, China
| | - YunMei Guo
- Nursing Department of ZunYi Medical University, ZunYi, China
| | - Meili Wang
- The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yan Zhao
- Nursing Department of ZunYi Medical University, ZunYi, China
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Teng AK, Han S, Lin SY, Demiris G, Zaslavsky O, Chen AT. Using an Innovative Discussion Platform to Give Voice to Aging-Related Experiences: A Pilot Study. J Gerontol Nurs 2020; 45:33-40. [PMID: 31755541 DOI: 10.3928/00989134-20191105-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/06/2019] [Indexed: 12/13/2022]
Abstract
Exchanging information with peers may support older adults' management of aging-related health changes, including frailty. The current pilot study used a mixed-methods approach to develop and evaluate an online virtual community for older adults to discuss aging-related health issues and management strategies. Eight older adults (mean age = 84) were enrolled at the start of the study. During a 10-week moderated discussion, participants contributed a total of 133 responses. Common themes included (a) symptoms (e.g., pain, weakness/tiredness, sleep difficulties) and (b) management strategies (e.g., health behavior changes, psychosocial support). A positive trend of change was noted in participants' average self-reported health and chronic disease management self-efficacy scores. This platform could facilitate information exchange among older adults, empowering them to leverage their own knowledge to improve their health management strategies. Future research should expand on this study to include older adults of diverse racial, educational, and cultural backgrounds. [Journal of Gerontological Nursing, 45(12), 33-40.].
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Johnson EK, Fraser RT, Lashley S, Barber J, Brandling-Bennett EM, Vossler DG, Miller JW, Caylor L, Warheit-Niemi T. Program of Active Consumer Engagement in Self-Management in Epilepsy: Replication and extension of a self-management randomized controlled trial. Epilepsia 2020; 61:1129-1141. [PMID: 32401339 DOI: 10.1111/epi.16530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The Program of Active Consumer Engagement in Self-Management in Epilepsy (PACES) is an evidenced-based self-management intervention for adults with epilepsy. Prior randomized controlled trial (RCT) data show that PACES reduces depression and improves self-management, self-efficacy, and quality of life for 6 months postprogram. The objective of this study was to replicate a PACES RCT with key extensions: more diverse patient pool from community-based epilepsy centers; option for telephone-based participation; and longer follow-up (12 months with booster support for intervention group), to examine duration of impact and inform dissemination and implementation. METHODS Participants were adults with chronic epilepsy (n = 101) without serious mental illness or substantive intellectual impairment, recruited from three epilepsy centers. Participants were randomly assigned to intervention or waitlist control groups. Outcomes included the Epilepsy Self-Management Scale (ESMS), Epilepsy Self-Efficacy Scale (ESES), Quality of Life in Epilepsy-31, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, administered at baseline, postintervention (8 weeks), and 6 and 12 months postintervention. Intervention was an 8-week group of five to eight adults co-led by a psychologist and trained peer with epilepsy that met once per week by teleconference or in person at a hospital for 60-75 minutes. Topics included medical, psychosocial, cognitive, and self-management aspects of epilepsy, as well as community integration and epilepsy-related communication. Treatment group provided program evaluation. RESULTS PACES participants (n = 49) improved relative to controls (n = 52) on the ESES (P < .022) and overall distress composite (P = .008). At 6 months, PACES participants remained improved on the ESES (P = .008) and composite (P = .001), and were improved on the ESMS (P = .005). At 12 months, PACES participants remained improved on the ESMS (P = .006) and were improved on an overall distress composite of combined measures (P = .018). Attrition was low (<6% in each group), and all program satisfaction ratings exceeded 4.0/5.0. SIGNIFICANCE A consumer-generated epilepsy self-management program with broad psychosocial and medical emphasis can be effectively delivered by telephone or in person and facilitates long-term epilepsy self-management, adjustment, and coping up to 1 year after treatment.
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Affiliation(s)
- Erica K Johnson
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
| | - Robert T Fraser
- Health Promotion Research Center, University of Washington, Seattle, Washington, USA.,Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Department of Neurology, University of Washington, Seattle, Washington, USA.,Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Steven Lashley
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - David G Vossler
- Department of Neurology, University of Washington, Seattle, Washington, USA.,UW Medicine, Valley Medical Center, Renton, Washington, USA
| | - John W Miller
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Lisa Caylor
- Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Tessala Warheit-Niemi
- Neurology Vocational Services Unit, University of Washington, Seattle, Washington, USA
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Lucherini M. Spontaneity and serendipity: Space and time in the lives of people with diabetes. Soc Sci Med 2019; 245:112723. [PMID: 31838333 DOI: 10.1016/j.socscimed.2019.112723] [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: 06/28/2019] [Revised: 11/06/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
This article considers the relevance of non-representational theory to understanding the lived experience of diabetes. While non-representational theory has gained traction in the social sciences, especially Human Geography, its usefulness in extending our understanding of experiences of health and illness is often restricted to an idea of wellbeing that assumes an able and healthy body. This article draws on qualitative research on the everyday experiences of living with diabetes, to consider how non-representational theory can be applied to understanding the everyday experience of ill bodies. The analysis moves through ideas of mobility, routine, anticipation and adjustment to highlight the challenges of spontaneity and serendipity in the everyday lives of people with diabetes. The article concludes by considering some of the advantages of a non-representational approach for healthcare practice.
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Affiliation(s)
- Mark Lucherini
- School of Geography, Geology and the Environment, Keele University, Keele, ST5 5BG, United Kingdom.
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Warner G, Packer TL, Kervin E, Sibbald K, Audulv Å. A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies. PATIENT EDUCATION AND COUNSELING 2019; 102:2162-2182. [PMID: 31301922 DOI: 10.1016/j.pec.2019.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes. METHODS This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported. RESULTS The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences. CONCLUSION SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught. PRACTICE IMPLICATIONS Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada; Radboud University Medical Center and HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Emily Kervin
- Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
| | - Kaitlin Sibbald
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Åsa Audulv
- Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
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Veenhuizen Y, Cup EHC, Jonker MA, Voet NBM, van Keulen BJ, Maas DM, Heeren A, Groothuis JT, van Engelen BGM, Geurts ACH. Self-management program improves participation in patients with neuromuscular disease: A randomized controlled trial. Neurology 2019; 93:e1720-e1731. [PMID: 31570565 DOI: 10.1212/wnl.0000000000008393] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/06/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of Energetic, a self-management group program combining aerobic training, energy conservation management, and relapse prevention to improve social participation in patients with neuromuscular disease (NMD) and chronic fatigue. METHODS In this multicenter, assessor-blinded, 2-armed randomized controlled trial with repeated measurements, 53 patients with various types of NMD and chronic fatigue were randomly allocated to Energetic, a 4-month group intervention, or to usual care. The primary endpoint was social participation assessed with the Canadian Occupational Performance Measure (COPM) performance scale immediately postintervention. Secondary outcomes included COPM satisfaction scale, 6-Minute Walk Test (6MWT), and Checklist Individual Strength-subscale fatigue. Participants were followed for 11 months postintervention. Data were analyzed with linear models that account for repeated measurements. RESULTS Directly after intervention, the mean group difference for COPM-performance was 1.7 (95% confidence interval [CI] 1.0-2.4; p < 0.0001) in favor of the intervention group (n = 29), adjusted for baseline, sex, diagnosis, and work status. This effect was retained at 11 months follow-up (0.9; 95% CI 0.0-1.7; p = 0.049). The COPM satisfaction scale and 6MWT improved more in the intervention group compared to usual care. After 3 and 11 months follow-up, most beneficial effects on social participation and functional endurance were retained. CONCLUSION Energetic led to sustainable improvements in social participation and functional endurance compared to usual care in patients with NMD and chronic fatigue.Clinicaltrials.gov IDENTIFIER: NCT02208687. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a combination of aerobic training, energy conservation management, and relapse prevention improves social participation in patients with NMD and chronic fatigue.
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Affiliation(s)
- Yvonne Veenhuizen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands.
| | - Edith H C Cup
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Marianne A Jonker
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Nicoline B M Voet
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Bianca J van Keulen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Daphne M Maas
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Anita Heeren
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Jan T Groothuis
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Baziel G M van Engelen
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
| | - Alexander C H Geurts
- From the Departments of Rehabilitation (Y.V., E.H.C.C., N.B.M.V., D.M.M., J.T.G., A.C.H.G.) and Neurology (B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen; Department of Health Evidence (M.A.J.), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen; and Rehabilitation Center Klimmendaal (N.B.M.V., B.J.v.K., A.H.), Arnhem, the Netherlands
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Kaveh O, Peyrovi H. Exploring the Experiences of Iranian Women Regarding Obesity Self-Management: A Qualitative Study. Open Access Maced J Med Sci 2019; 7:2377-2383. [PMID: 31592042 PMCID: PMC6765089 DOI: 10.3889/oamjms.2019.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the high and growing prevalence of obesity in Iran and a variety of interventions by the healthcare providers control the problem, and it is still a prevalent health problem among Iranian women. AIM The aim of this study is to explore the perspective of obese Iranian women in the process of self-management regarding the facilitating factor in self-management of obesity. METHODS In a qualitative study, the participants were selected through purposeful sampling, and the data were collected using semi-structured interviews and focus group (n = 25) between July 2017 and September 2018. All the interviews were transcribed verbatim and the data were analysed using constant comparative method. RESULTS Supporting the umbrella was the main category found in the present study. The participating obese individuals found "support" as the main factor with an outstanding effect on motivating, incentivising and keeping diet in long-term. This category contains subcategories: self-help; family, friends, and peers' support; and medical team's support. CONCLUSION The findings suggested the critical role of support in obesity self-management process. This critical factor improves our perception of the multi-aspect and complicated nature of obesity self-management. Moreover, policymakers and providers of health services can utilise this finding in the design of care plans with higher chance of success.
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Affiliation(s)
- Omolhoda Kaveh
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Nursing Care Research Centre, Iran University of Medical Sciences, Tehran, Iran
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Van de Velde D, De Zutter F, Satink T, Costa U, Janquart S, Senn D, De Vriendt P. Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open 2019; 9:e027775. [PMID: 31315862 PMCID: PMC6661649 DOI: 10.1136/bmjopen-2018-027775] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Self-management is a concept frequently used within healthcare but lacks consensus. It is the aim of this study to clarify the concept. DESIGN Concept analysis according to Walker and Avant, comprises eight steps: select concept, determine purpose, identify uses, determine defining attributes, identify model case, identify additional cases, identify antecedents and consequences and define empirical referents. SOURCES USED PubMed, Scopus and Web of Science. RESULTS Ten attributes delineating the concept have been identified and organised into three groups. Group (a): person-oriented attributes: the person must (1) actively take part in the care process, (2) take responsibility for the care process and (3) have a positive way of coping with adversity. Group (b): person-environment-oriented attributes: (4) the person must be informed about the condition, disease and treatment and self-management, (5) should be individualised, which entails expressing needs, values and priorities, (6) requires openness to ensure a reciprocal partnership with healthcare providers and (7) demands openness to social support. Finally, Group (c): summarising attributes: self-management (8) is a lifetime task, (9) assumes personal skills and (10) encompasses the medical, role and emotional management. CONCLUSIONS The findings of this study recognise the complexity of the concept, but also show the need for further investigation to make the concept more measurable. Clarity about the concept will enhance understanding and facilitate implementation in self-management programmes for chronic conditions.
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Affiliation(s)
- Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
- Occupational Therapy, Artevelde University College, Ghent, Belgium
| | - Freya De Zutter
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
| | - Ton Satink
- Occupational Therapy, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Ursula Costa
- Occupational Therapy and Occupational Science, Health University of Applied Science Tyrol, Innsbruck, Austria
| | - Sara Janquart
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
| | - Daniela Senn
- Occupational Therapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Patricia De Vriendt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
- Occupational Therapy, Artevelde University College, Ghent, Belgium
- Department of Gerontology and Frailty in Ageing Research Group, Vrije Universiteit, Brussel, Belgium
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Ghahari S, Forwell SJ, Suto MJ, Morassaei S. Multiple sclerosis self-management model: Personal and contextual requirements for successful self-management. PATIENT EDUCATION AND COUNSELING 2019; 102:1013-1020. [PMID: 30612828 DOI: 10.1016/j.pec.2018.12.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/07/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore self-management strategies used by people with multiple sclerosis (MS) with aim of developing a MS self-management model. METHODS A grounded theory approach guided development of a MS self-management model. Eighteen individuals living with MS for three or more years and self-identifying as successfully managing their MS were interviewed twice using semi-structured face-to-face or telephone interviews six months apart. Demographic and disease characteristics were descriptively analyzed. Field notes and interview data were qualitatively analyzed to identify concepts and categories. RESULTS The emerging model revealed six person-related categories describing self-management strategies: adjusting outlook, managing stress, managing symptoms, healthy lifestyle, effective communication, and setting priorities and planning. Three context-related categories that required successful navigation for self-management were also identified: physical environment, personal social network, and community services and resources. CONCLUSIONS The emerging self-management model that is grounded in the perspective of people with MS includes person and context-related strategies that can be used concurrently to guide self-management in the variety of challenges experienced by people with MS. PRACTICAL IMPLICATIONS A self-management model of MS is useful to service providers, health professionals, advocacy organizations and people with MS to draw upon an organized and comprehensive approach to self-management.
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Affiliation(s)
- Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada; Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.
| | - Susan J Forwell
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Melinda J Suto
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Sara Morassaei
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
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Setiawan IMA, Zhou L, Alfikri Z, Saptono A, Fairman AD, Dicianno BE, Parmanto B. An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies. JMIR Form Res 2019; 3:e12982. [PMID: 31021324 PMCID: PMC6658284 DOI: 10.2196/12982] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs' self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. OBJECTIVE The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. METHODS A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs' evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. RESULTS The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. CONCLUSIONS We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs.
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Affiliation(s)
- I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Computer Science, Udayana University, Badung, Bali, Indonesia
| | - Leming Zhou
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zakiy Alfikri
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andi Saptono
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea D Fairman
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, United States
| | - Brad Edward Dicianno
- Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
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van Maarschalkerweerd PEA, Schaapveld M, Paalman CH, Aaronson NK, Duijts SFA. Changes in employment status, barriers to, and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis. Disabil Rehabil 2019; 42:3052-3058. [PMID: 30907148 DOI: 10.1080/09638288.2019.1583779] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To qualitatively investigate changes in employment status, barriers to and facilitators of (return to) work in breast cancer survivors 5-10 years after diagnosis.Materials and methods: Women were eligible to participate in the focus groups if they were younger than 55 years and were employed at time of diagnosis. Data were analysed by two independent researchers using thematic content analysis.Results: Nineteen women participated in three semi-structured focus groups, of whom 18 reported a change in employment status 5-10 years after diagnosis. Perceived barriers to (return to) work shortly after breast cancer diagnosis tended to be disease- and treatment-related, while 5-10 years later, they were personal- and work-related. Participants recommended open communication and support at the workplace, and comprehensive information from (occupational) health care professionals to facilitate dealing with breast cancer at work.Conclusions: Breast cancer survivors still experience changes in employment status 5-10 years after diagnosis. (Occupational) health care professionals should be alert that perceived barriers for returning to work change over time. Future research should focus on increasing awareness (at work) of breast cancer survivors' needs, providing adequate information and support to all involved, and developing interventions to sustain survivors' work ability at the long term.IMPLICATIONS FOR REHABILITATIONEven long after diagnosis and treatment, a sizeable number of breast cancer survivors report a change in employment status, such as job loss.(Occupational) health care professionals should be alert that barriers for returning to work and retaining work change over time.There is a lack of awareness and a shortage of interventions regarding work-related issues for breast cancer survivors at long-term follow-up.
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Affiliation(s)
| | - Michael Schaapveld
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Carmen H Paalman
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Saskia F A Duijts
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, Netherlands
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Kneck Å, Audulv Å. Analyzing variations in changes over time: development of the Pattern-Oriented Longitudinal Analysis approach. Nurs Inq 2019; 26:e12288. [PMID: 30834658 DOI: 10.1111/nin.12288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/30/2022]
Abstract
Longitudinal qualitative research in nursing is rare but becoming more common. Data collection and analysis over time provide some intriguing possibilities to better understand processes, development, and change in illness experience, healthcare organizations, and self-management. This paper aims to present a process for analyzing qualitative longitudinal data material, namely the Pattern-Oriented Longitudinal Analysis approach (POLA). We developed this approach after synthesizing experiences from two longitudinal qualitative projects and comparing our procedures and reflections with the relevant literature. Using the POLA approach, researchers can describe complexity and variation in changes over time. During the analysis process, emphasis is put on visualizing and identifying change at both an individual and a group level. Ontological and epistemological assumptions for the approach are also described. The benefit of this approach is the possibility to describe complexity and diversity in processes over time, which is important for the development of nursing knowledge. The analysis approach can be further used and developed by researchers seeking to understand variance or contextual features in processes and changes over time.
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Affiliation(s)
- Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Åsa Audulv
- Department of Nursing Sciences, Mid Sweden University, Sundsvall/Östersund, Sweden
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Thompson L, Ford H, Stroud A, Madill A. Tortoise or hare? Supporting the chronotope preference of employees with fluctuating chronic illness symptoms. Psychol Health 2019; 34:695-714. [PMID: 30693807 DOI: 10.1080/08870446.2019.1565128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Our aim is to understand how to facilitate the job retention of employees with chronic illness. We focus on multiple sclerosis (MS) as a criterion chronic illness. DESIGN An opportunity sample of 20 individuals of working age (13 female; 7 male) were recruited who had been in paid employment for over 28 months with a concurrent diagnosis of MS. Participants took part in one of three focus groups with a topic guide comprising keywords: work, coping, performance, support, future, expectations, sharing and symptoms. Data were analysed using dialogical analysis. MAIN OUTCOME MEASURES As a qualitative study, no outcome measure was used. However, the specific focus of interest was to search for differential patterns of 'timespace' - chronotope - that people with chronic illness utilise to manage their condition in the workplace. RESULTS Participants oriented to two distinct chronotope types: unsustainable epic (characterised by condensed time) and temporary idyll (characterized by condensed space). Perceived managerial discretion was identified as possibly influencing participants' chronotope preference. CONCLUSION Identifying chronotope preference has practical implications for health psychologists and related professionals who provide and advise on support to facilitate people with chronic illness to thrive in the workplace.
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Affiliation(s)
- Laura Thompson
- a Centre for Sustainable Working Life , Birkbeck University of London , London , UK
| | - Helen Ford
- b Leeds Teaching Hospitals NHS Trust , Leeds , UK
| | | | - Anna Madill
- c School of Psychology, University of Leeds , Leeds , UK
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Dunne S, Coffey L, Sharp L, Desmond D, Gooberman-Hill R, O'Sullivan E, Timmons A, Keogh I, Timon C, Gallagher P. Integrating self-management into daily life following primary treatment: head and neck cancer survivors' perspectives. J Cancer Surviv 2018; 13:43-55. [PMID: 30535901 DOI: 10.1007/s11764-018-0726-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-management may help cancer survivors to better deal with challenges to their physical, functional, social and psychological well-being presented by cancer and its treatment. Nonetheless, little is known about how people integrate cancer self-management practices into their daily lives. The aim of this study was to describe and characterise the processes through which head and neck cancer (HNC) survivors attempt to integrate self-management into their daily lives following primary treatment. METHODS Using a purposeful critical case sampling method, 27 HNC survivors were identified through four designated cancer centres in Ireland and participated in face-to-face semi-structured interviews. Interviews were audio-recorded, transcribed and analysed using thematic analysis. RESULTS Six themes describing HNC survivors' attempts to integrate self-management into their lives following treatment were identified: grappling with having to self-manage, trying out self-management strategies, becoming an expert self-manager, struggling to integrate self-management strategies into daily life, avoiding recommended self-management and interpreting self-management. CONCLUSIONS This is the first study to describe HNC survivors' attempts to integrate self-management into their daily lives following primary treatment. The findings indicate that HNC survivors exhibit highly individualised approaches to self-management integration and abandon self-management strategies that fail to meet their own specific needs. IMPLICATIONS FOR CANCER SURVIVORS Survivors may benefit from skills training and structured support to assist their transition between in-patient care and having to self-manage after primary treatment, and/or ongoing support to deal with persistent and recurring challenges such as eating difficulties and fear of recurrence.
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Affiliation(s)
- Simon Dunne
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Laura Coffey
- Department of Psychology, Maynooth University, Co. Kildare, Ireland
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Deirdre Desmond
- Department of Psychology, Maynooth University, Co. Kildare, Ireland
| | | | | | | | - Ivan Keogh
- Academic Department of Oto Rhino Laryngology, National University of Ireland Galway, Galway, Ireland
| | - Conrad Timon
- Head and Neck Cancer Programme, St. James's Hospital, Dublin, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
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Danet Danet A, López Doblas M, March Cerdà JC, Prieto Rodríguez MÁ. [Heroine, but no Superwoman. Evaluation of a peer-training activity for women with breast cancer]. GACETA SANITARIA 2018; 34:26-36. [PMID: 30482408 DOI: 10.1016/j.gaceta.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity. METHOD Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement. RESULTS The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity. CONCLUSIONS The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer.
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Affiliation(s)
- Alina Danet Danet
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España.
| | - Manuela López Doblas
- Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Joan Carles March Cerdà
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - María Ángeles Prieto Rodríguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Instituto de Investigación Biosanitaria de Granada, Granada, España
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Xiao S, Fan L, Dai H. Omaha System‐based discharge guidance improves knowledge and behavior in Mainland Chinese patients with angina who are not receiving interventional treatment: A randomized controlled trial. Jpn J Nurs Sci 2018; 16:355-363. [PMID: 30485665 DOI: 10.1111/jjns.12244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 08/27/2018] [Accepted: 10/04/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Shiqi Xiao
- Department of NursingShengjing Hospital of China Medical University Shenyang China
| | - Ling Fan
- Department of NursingShengjing Hospital of China Medical University Shenyang China
| | - Heng Dai
- Department of Cardiovascular MedicineShengjing Hospital of China Medical University Shenyang China
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Hall KK, Petsky HL, Chang AB, O'Grady KF. Caseworker-assigned discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness. Cochrane Database Syst Rev 2018; 11:CD012315. [PMID: 30387126 PMCID: PMC6517201 DOI: 10.1002/14651858.cd012315.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic respiratory conditions are major causes of mortality and morbidity. Children with chronic health conditions have increased morbidity associated with their physical, emotional, and general well-being. Acute respiratory exacerbations (AREs) are common in children with chronic respiratory disease, often requiring admission to hospital. Reducing the frequency of AREs and recurrent hospitalisations is therefore an important goal in the individual and public health management of chronic respiratory illnesses in children. Discharge planning is used to decide what a person needs for transition from one level of care to another and is usually considered in the context of discharge from hospital to the home. Discharge planning from hospital for ongoing management of an illness has historically been referral to a general practitioner or allied health professional or self management by the individual and their family with limited communication between the hospital and patient once discharged. Effective discharge planning can decrease the risk of recurrent AREs requiring medical care. An individual caseworker-assigned discharge plan may further decrease exacerbations. OBJECTIVES To evaluate the efficacy of individual caseworker-assigned discharge plans, as compared to non-caseworker-assigned plans, in preventing hospitalisation for AREs in children with chronic lung diseases such as asthma and bronchiectasis. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trials registries, and reference lists of articles. The latest searches were undertaken in November 2017. SELECTION CRITERIA All randomised controlled trials comparing individual caseworker-assigned discharge planning compared to traditional discharge-planning approaches (including self management), and their effectiveness in reducing the subsequent need for emergency care for AREs (hospital admissions, emergency department visits, and/or unscheduled general practitioner visits) in children hospitalised with an acute exacerbation of chronic respiratory disease. We excluded studies that included children with cystic fibrosis. DATA COLLECTION AND ANALYSIS We used standard Cochrane Review methodological approaches. Relevant studies were independently selected in duplicate. Two review authors independently assessed trial quality and extracted data. We contacted the authors of one study for further information. MAIN RESULTS We included four studies involving a total of 773 randomised participants aged between 14 months and 16 years. All four studies involved children with asthma, with the case-planning undertaken by a trained nurse educator. However, the discharge planning/education differed among the studies. We could include data from only two studies (361 children) in the meta-analysis. Two further studies enrolled children in both inpatient and outpatient settings, and one of these studies also included children with acute wheezing illness (no previous asthma diagnosis); the data specific to this review could not be obtained. For the primary outcome of exacerbations requiring hospitalisation, those in the intervention group were significantly less likely to be rehospitalised (odds ratio (OR) 0.29, 95% confidence interval (CI) 0.16 to 0.50) compared to controls. This equates to 189 (95% CI 124 to 236) fewer admissions per 1000 children. No adverse events were reported in any study. In the context of substantial statistical heterogeneity between the two studies, there were no statistically significant effects on emergency department (OR 0.37, 95% CI 0.04 to 3.05) or general practitioner (OR 0.87, 95% CI 0.22 to 3.44) presentations. There were no data on cost-effectiveness, length of stay of subsequent hospitalisations, or adherence to medications. One study reported quality of life, with no significant differences observed between the intervention and control groups.We considered three of the studies to have an unclear risk of bias, primarily due to inadequate description of the blinding of participants and investigators. The fourth study was assessed as at high risk of bias as a single unblinded investigator was used. Using the GRADE system, we assessed the quality of the evidence as moderate for the outcome of hospitalisation and low for the outcomes of emergency department visits and general practitioner consultations. AUTHORS' CONCLUSIONS Current evidence suggests that individual caseworker-assigned discharge plans, as compared to non-caseworker-assigned plans, may be beneficial in preventing hospital readmissions for acute exacerbations in children with asthma. There was no clear indication that the intervention reduces emergency department and general practitioner attendances for asthma, and there is an absence of data for children with other chronic respiratory conditions. Given the potential benefit and cost savings to the healthcare sector and families if hospitalisations and outpatient attendances can be reduced, there is a need for further randomised controlled trials encompassing different chronic respiratory illnesses, ethnicity, socio-economic settings, and cost-effectiveness, as well as defining the essential components of a complex intervention.
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Affiliation(s)
- Kerry K Hall
- Griffith UniversityMenzies Health Institute QueenslandRecreation RoadNathanBrisbaneQueenslandAustralia4101
| | - Helen L Petsky
- Griffith UniversitySchool of Nursing and Midwifery, Griffith University and Menzies Health Institute QueenslandBrisbaneQueenslandAustralia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
- Lady Cilento Children's HospitalDepartment of Respiratory and Sleep MedicineBrisbaneAustralia
- Centre for Children's Health ResearchCough, Asthma, Airways Research GroupSouth BrisbaneAustralia
| | - KerryAnn F O'Grady
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
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Barnard E, Brown CR, Weiland TJ, Jelinek GA, Marck CH. Understanding barriers, enablers, and long-term adherence to a health behavior intervention in people with multiple sclerosis. Disabil Rehabil 2018; 42:822-832. [PMID: 30375258 DOI: 10.1080/09638288.2018.1510550] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The optimal management strategy for multiple sclerosis (MS), and many other chronic diseases, likely involves health behavior modification. Multimodal behavioral interventions may be most effective, but little is known about long-term adherence in people with MS.Methods: This qualitative study assessed barriers and enablers to long-term adherence by people with MS who self-selected for a 5-day health behavior intervention 3-5 years prior. Thirteen women and five men participated in semi-structured phone interviews, which were transcribed and thematically analyzed.Results: The experience was described as useful for information gathering, decision making, and practical strategies regarding health behaviors. The majority still followed supplementation and dietary recommendations most of the time, although consuming non-recommended food while eating out was common. Support at home, ability and enjoyment in food preparation, and ability to resist unhealthy foods were both barriers and enablers. Adherence to "time-consuming" exercise and meditation recommendations were less common and episodic. Many reported competing interests on time from work and family; and barriers including injuries and symptoms, weather, financial or geographical barriers, and lack of person-centred support and motivation. Increased fitness and mobility, weight loss, and a sense of accomplishment and control were advantages and motivators. Practical and attitudinal strategies employed included planning, tailoring activities to ability and preference, and self-monitoring.Conclusion: While most people attempted to engage with all components of the intervention initially, only some still engaged with all components, and none to the recommended levels. These data can inform future quantitative studies and health behavior interventions.Implications for rehabilitationA multimodal group lifestyle intervention may be useful to assist people with multiple sclerosis in information gathering, decision making, attitudinal changes, and practical strategies regarding health behaviors; as well as providing a sense of hope for the future and control over wellbeing.While participants are unlikely to engage with all components of a multimodal intervention to the recommended level, they are likely to make improvements to one or more health behaviors.Experiential learning, including going through recipes and ingredient lists, and practicing meditation and physical exercises, is helpful to instigate behavior change.The initiation and maintenance of behavior change was assisted by support from family, friends, and health practitioners; and practical strategies employed by participants, including planning, self-monitoring, and tailoring activities to ability and preference.
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Affiliation(s)
- Emma Barnard
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Chelsea R Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Claudia H Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Packer TL, Fracini A, Audulv Å, Alizadeh N, van Gaal BGI, Warner G, Kephart G. What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:579-595. [PMID: 29239734 DOI: 10.1016/j.pec.2017.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/10/2017] [Accepted: 10/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific). METHODS A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures. RESULTS Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains. CONCLUSIONS Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care. PRACTICE IMPLICATIONS In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.
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Affiliation(s)
- Tanya L Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Canada; Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - America Fracini
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Åsa Audulv
- Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
| | - Neda Alizadeh
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Betsie G I van Gaal
- Radboud University Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Faculty of Health and Social Studies, Han University of Applied Sciences, Nijmegen, The Netherlands.
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Simon-Tuval T, Shmueli A, Harman-Boehm I. Adherence of patients with type 2 diabetes mellitus to medications: the role of risk preferences. Curr Med Res Opin 2018; 34:345-351. [PMID: 29069921 DOI: 10.1080/03007995.2017.1397506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine whether risk tolerance is associated with adherence to oral hypoglycemic agents (OHAs). METHODS We performed a cross-sectional study among adult patients with type 2 diabetes mellitus (n = 308) presenting for routine out-patient visits, using validated questionnaires to estimate: risk preferences (risk-seeking, risk averse, risk neutral), motivation, self-efficacy, impulsivity, perception of the disease and of the interpersonal process of care, demographic and socioeconomic characteristics; computerized patient medical records to estimate disease severity and a computerized database for retrieval of medication adherence, 1 year before the interview. Adherence was estimated using prescription-based measures of proportion of days covered (PDC). Concurrent adherence was calculated as: PDC with ≥1 OHAs; average PDC; PDC of ≥80% for all OHAs. RESULTS Multivariable ordered logit model revealed that compared to others, risk-seeking patients had lower PDC with ≥1 OHAs (β = -0.50, p ≤ .1). Specifically, risk-seeking patients were 11.2 percentage points less likely to have ≥80% of the follow-up period covered with ≥1 OHAs available (p ≤ .1). In addition, risk-seeking patients had lower average PDC (β = -0.85, p ≤ .05). Specifically, these patients were 19.5 percentage points less likely to have an average PDC of ≥80% (p ≤ .05). Multivariable logistic model revealed that risk-seeking was associated with lower probability of having PDC ≥80% for all OHAs in the follow-up period (OR; 90% CI: 0.59; 0.35-0.97). CONCLUSIONS Risk-seeking patients are less adherent to OHA medications. Identifying these patients may enable practitioners to proactively tailor strategies to improve their adherence and health outcomes.
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Affiliation(s)
- Tzahit Simon-Tuval
- a Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences , Ben-Gurion University of the Negev , Israel
| | - Amir Shmueli
- b The Braun Hebrew University-Hadassah School of Public Health , Israel
| | - Ilana Harman-Boehm
- c Faculty of Health Sciences , Ben-Gurion University of the Negev , Israel
- d Diabetes Clinic, Department of Internal Medicine C , Soroka University Medical Center , Israel
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Janssen RMJ, Satink T, Ijspeert J, van Alfen N, Groothuis JT, Packer TL, Cup EHC. Reflections of patients and therapists on a multidisciplinary rehabilitation programme for persons with brachial plexus injuries. Disabil Rehabil 2018; 41:1427-1434. [PMID: 29385821 DOI: 10.1080/09638288.2018.1430175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE There is lack of knowledge, evidence, and guidelines for rehabilitation interventions for persons with neuralgic amyotrophy (NA) or brachial plexus pathology. A first pilot study, evaluating the effect of an integrated rehabilitation programme, showed improvements in activity and participation levels. AIM To gain insight, from the perspective of patients and therapists, into the critical ingredients of the programme, that contributed to improvements in activity and participation. MATERIALS AND METHODS A qualitative study using semi-structured interviews with eight patients and five therapists (three occupational therapists and two physical therapists). Participants were asked to identify and describe factors regarding the rehabilitation that they perceived as positive and aspects of the programme that could be improved. Data were analysed using a constant comparative approach. RESULTS Patients reported (1) Time to diagnose: "Finally I'm in the right place;" (2) Awareness: "They gave me a mirror;" (3) Partnership: "There was real contact with the therapists; we made decisions together;" (4) Close collaboration: "Overlapping scopes of practice; doing the same from a different perspective;" and finally (5) Self-management: "Now I can do it myself." Therapists reported (1) "Patients knowledge and understanding is critical to success;" (2) "Activate problem solving and decision making;" (3) "Personalize your therapy; it's more than just giving exercises and information;" (4) "Constant consultation within the team; consistency in messages and approach;" and (5)" Ultimately the patient is in charge." CONCLUSIONS The critical ingredients, correspond well with each other and include a person-centred approach, education, support in problem solving and decision making and an integrated team approach. These ingredients provided the patients with confidence to take responsibility to manage their everyday lives, the ultimate goal of the programme. Implications for rehabilitation Both patients and therapists believe that the ability to self-manage and take control should be the outcome of high quality integrated rehabilitation programmes for patients with neuralgic amyotrophy and/or other brachial plexus injuries. A person-centred, collaborative, and integrated team approach, among all members of the team, are critical components of care delivery in personalised interventions. Critical programme ingredients are knowledge and education of both the patient and therapists; partnership between patient-therapist and within the team; patient activation and self-reflection; and personalised care. Patients recommend more options for personalisation of the intensity and duration of rehabilitation, the possibility to consult a psychologist and peer support within a group setting.
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Affiliation(s)
- Renske M J Janssen
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Ton Satink
- b Department of Occupational Therapy , HAN University of Applied Sciences , Nijmegen , The Netherlands
| | - Jos Ijspeert
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nens van Alfen
- c Department of Neurology and Clinical Neurophysiology , Donders Center for Medical Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Jan T Groothuis
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tanya L Packer
- d School of Occupational Therapy , Dalhousie University , Halifax , Canada
| | - Edith H C Cup
- a Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour , Radboud University Medical Center , Nijmegen , The Netherlands
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Due-Christensen M, Zoffmann V, Willaing I, Hopkins D, Forbes A. The Process of Adaptation Following a New Diagnosis of Type 1 Diabetes in Adulthood: A Meta-Synthesis. QUALITATIVE HEALTH RESEARCH 2018; 28:245-258. [PMID: 29235942 DOI: 10.1177/1049732317745100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
While Type 1 diabetes (T1D) is generally associated with childhood, half of all cases occur in adulthood. The adaptive strategies individuals employ during the initial adaptive phase may have an important impact on their risk of future diabetes complications and their psychosocial well-being. We conducted a systematic review of six databases and included nine qualitative studies in a meta-synthesis, the aims of which were to develop a better understanding of how adults newly diagnosed with T1D experience the diagnosis and the phenomena associated with the early process of adaptation to life with diabetes. The meta-synthesis identified five constructs that shaped and influenced the early adaptive process: disruption, constructing a personal view of diabetes, reconstructing a view of self, learning to live with diabetes, and behavioral adaptations. The adaptive processes of adults to a diabetes diagnosis are highly referenced to prior life experiences, social habitus, and psychological orientation.
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Affiliation(s)
| | - Vibeke Zoffmann
- 2 Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - David Hopkins
- 4 King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
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