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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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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Narasimhan M, Hargreaves JR, Logie CH, Abdool-Karim Q, Aujla M, Hopkins J, Cover J, Sentumbwe-Mugisa O, Maleche A, Gilmore K. Self-care interventions for women's health and well-being. Nat Med 2024; 30:660-669. [PMID: 38454127 DOI: 10.1038/s41591-024-02844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The human right to health is universal and non-exclusionary, supporting health in full, and for all. Despite advances in health systems globally, 3.6 billion people lack access to essential health services. Women and girls are disadvantaged when it comes to benefiting from quality health services, owing to social norms, unequal power in relationships, lack of consideration beyond their reproductive roles and poverty. Self-care interventions, including medicines and diagnostics, which offer an additional option to facility-based care, can improve the autonomy and agency of women in managing their own health. However, tackling challenges such as stigma is essential to avoid scenarios in which self-care interventions provide more choice for those who already benefit from access to quality healthcare, and leave behind those with the greatest need. This Perspective explores the opportunities that self-care interventions offer to advance the health and well-being of women with an approach grounded in human rights, gender equality and equity.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, including the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
| | - James R Hargreaves
- Center for Evaluation, London School of Hygiene and Tropical Medicine, London, UK
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Mandip Aujla
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Jane Cover
- Sexual and Reproductive Health Program, PATH, Seattle, WA, USA
| | | | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Kate Gilmore
- Department of International Development, London School of Economics and Political Science, London, UK
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Shrout MR, Weigel DJ, Laurenceau JP. Couples and concealable chronic illness: Investigating couples' communication, coping, and relational well-being over time. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2024; 38:136-148. [PMID: 37616088 PMCID: PMC10843698 DOI: 10.1037/fam0001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Couples managing chronic illnesses-the leading causes of death and disability in the United States-can experience challenges in their daily lives and relationships. Both couple members have reported lower satisfaction, greater burden, and communication difficulties. Many of these illnesses are nonvisible or concealable, increasing fear and uncertainty when sharing illness information, and reducing self-disclosure. These challenges can leave couples vulnerable to dissatisfaction and distress. In this longitudinal study, we integrated dyadic coping frameworks to examine how couples' communication and coping predicted relational well-being over time. Couples, where one partner was diagnosed with a concealable chronic illness, completed three online surveys 6 months apart (n = 242 couples at baseline, 146 couples at 6 months, and 123 couples at 12 months). Couples were recruited from university settings. Actor-partner interdependence mediation models using within-person multilevel dyadic path modeling tested the theoretical model. For patient and partner actor effects, at times when they saw the illness as shared and something that they could manage together, the more they talked about the illness and used dyadic coping strategies (p < .001). In turn, when using dyadic coping strategies more often, patients and partners felt more satisfied, close, and sexually satisfied than they typically felt that year (p < .001). For cross-partner effects, when patients talked about the illness more than usual, their partners also used dyadic coping strategies more often (p = .01). Patients' open communication may not only benefit themselves but also their partners. This multifaceted approach offers new insight into promoting relational well-being while managing concealable chronic illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- M. Rosie Shrout
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
| | - Daniel J. Weigel
- Human Development and Family Science, Interdisciplinary Social Psychology PhD Program, University of Nevada, Reno, Reno, NV, USA
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Tabrizi JS, Doshmangir L, Khoshmaram N, Shakibazadeh E, Abdolahi HM, Khabiri R. Key factors affecting health promoting behaviors among adolescents: a scoping review. BMC Health Serv Res 2024; 24:58. [PMID: 38212786 PMCID: PMC10782684 DOI: 10.1186/s12913-023-10510-x] [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: 11/01/2022] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Health-promoting behaviors have been noticed recently as one of the most critical factors in raising life expectancy, which can be formed during adolescence. Thus, the current scoping review aimed to identify the key factors affecting health-promoting behaviors among adolescents. METHODS In this scoping review, we searched multiple English online databases, including PubMed, Web of Science, Science Direct, ProQuest, and Scopus, for articles published between 1977 and 2020. All eligible studies describing health-promoting behaviors in adolescents were included. We followed the JBI guideline for conducting a scoping review and increasing the study's rigor. Extracted data were synthesized through inductive approaches. RESULTS A total of 3199 articles were identified during the first phase. After the screening process, 20 articles were found eligible for final inclusion. Educational factors (individualized education and school health promotion programs), Economic factors (income, economic incentives and national health insurance), Social factors (support system, responsibility and peers), Spiritual, Psychological and Personal factors (gender, family structure, patterns of living, and medical problems) were found effective in health-promoting behaviors among adolescents. CONCLUSIONS Health-promoting behaviors among adolescents require careful consideration. The current review identified some fundamental factors affecting health-promoting behaviors in adolescents. Based on the findings, it is recommended that policymakers and healthcare providers develop several interventions based on identified factors to increase adolescent's health-promoting behaviors among adolescents.
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Affiliation(s)
- Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Doshmangir
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Najibeh Khoshmaram
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hosein Mashhadi Abdolahi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghayeh Khabiri
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.
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Wasan T, Hayhoe B, Cicek M, Lammila-Escalera E, Nicholls D, Majeed A, Greenfield G. The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review. J R Soc Med 2024; 117:24-35. [PMID: 37449474 PMCID: PMC10858714 DOI: 10.1177/01410768231186224] [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: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING Community-based interventions. PARTICIPANTS Patients with multimorbidity. MAIN OUTCOME MEASURES Unplanned healthcare usage. RESULTS Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics.
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Affiliation(s)
- Tavleen Wasan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Meryem Cicek
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Elena Lammila-Escalera
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Dasha Nicholls
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK
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Decker-Palmer M, Klodowski D, Thompson T, Lanoue M, Messina A, Schroeder D, Barto S, Oglesby B, Frasso R. Freelisting: A Technique for Enhancing the Community Health Needs Assessment. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:201-208. [PMID: 36513364 DOI: 10.1177/2752535x221146232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
US health systems are required to conduct community health needs assessments (CHNAs). These assessments often rely solely on publicly reported disease prevalence data. The objective of this study was to identify a feasible qualitative method that can be implemented into CHNAs to confirm existing information and enhance them with new data and community narrative. Freelisting interviews were conducted in 2017 throughout a county in Pennsylvania. Individuals listed (1) things that improve health, (2) health problems, and (3) health barriers. Responses were grouped into like terms, Smith's salience index was calculated for each, subgroup variation was assessed. Community-reported health priorities were identified by salient terms juxtaposed with publicly reported disease prevalence data. 98 respondents throughout the county participated in freelisting interviews. Demographics resembled the population: median age 55, 46% female, 88% Caucasian, 9% uninsured. Salient terms that improve health included: "physical activity", "healthy eating", and "health services". Salient terms describing health problems included: "cardiovascular disease" and "spine and joint disease". Centers for Disease Control and Prevention (CDC)-reported chronic disease prevalence in the county included heart disease mortality (22% of deaths) and arthritis (26% of adults). Salient barriers to health included: "weight, physical activity, and dietary concerns", as well as "occupational concerns". This is in line with 2017 County Health Rankings related to obesity (reported 29%), however, while 10% were uninsured in the community, this was not a salient term. Freelisting can augment and inform CHNAs. In this single-county study, freelisting responses supported publicly available disease/mortality prevalence data and provided insight into community perceptions of health issues.
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Affiliation(s)
- Marquita Decker-Palmer
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Klodowski
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Trina Thompson
- 1889 Jefferson Center for Population Health, Johnstown, PA, USA
| | - Marianna Lanoue
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison Messina
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Diana Schroeder
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Shiryl Barto
- Center for Health Promotion and Disease Prevention, Johnstown, PA, USA
| | - Billy Oglesby
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- Jefferson College of Population Health at Thomas Jefferson University, Philadelphia, PA, USA
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Johnsson N, Strandberg S, Tuvesson H, Fagerström C, Ekstedt M, Lindberg C. Delineating and clarifying the concept of self-care monitoring: a concept analysis. Int J Qual Stud Health Well-being 2023; 18:2241231. [PMID: 37506372 PMCID: PMC10392281 DOI: 10.1080/17482631.2023.2241231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
AIM To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective. METHODS A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016-September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers' Evolutionary Method for Concept Analysis. RESULTS The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: "Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action." The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts' consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being. CONCLUSIONS This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.
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Affiliation(s)
- Natali Johnsson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Hanna Tuvesson
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Cecilia Fagerström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Mirjam Ekstedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
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Okanlawon Bankole A, Jiwani RB, Avorgbedor F, Wang J, Osokpo OH, Gill SL, Jo Braden C. Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study. AGING AND HEALTH RESEARCH 2023; 3:100158. [PMID: 38779434 PMCID: PMC11109937 DOI: 10.1016/j.ahr.2023.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity. Methods The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.
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Affiliation(s)
| | - Rozmin B Jiwani
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | | | - Jing Wang
- University of New Hampshire, Durham, New Hampshire, USA
| | - Onome H. Osokpo
- University of Pennsylvania, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Sara L. Gill
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | - Carrie Jo Braden
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
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10
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Cajamarca G, Proust V, Herskovic V, Cádiz RF, Verdezoto N, Fernández FJ. Technologies for Managing the Health of Older Adults with Multiple Chronic Conditions: A Systematic Literature Review. Healthcare (Basel) 2023; 11:2897. [PMID: 37958041 PMCID: PMC10648176 DOI: 10.3390/healthcare11212897] [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: 09/13/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Multimorbidity is defined as the presence of two or more chronic medical conditions in a person, whether physical, mental or long-term infectious diseases. This is especially common in older populations, affecting their quality of life and emotionally impacting their caregivers and family. Technology can allow for monitoring, managing, and motivating older adults in their self-care, as well as supporting their caregivers. However, when several conditions are present at once, it may be necessary to manage several types of technologies, or for technology to manage the interaction between conditions. This work aims to understand and describe the technologies that are used to support the management of multimorbidity for older adults. We conducted a systematic review of ten years of scientific literature from four online databases. We reviewed a corpus of 681 research papers, finally including 25 in our review. The technologies used most frequently by older adults with multimorbidity are mobile applications and websites, and they are mostly focused on communication and connectivity. We then propose opportunities for future research on addressing the challenges in the management of several simultaneous health conditions, potentially creating a better approach than managing each condition as if it were independent.
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Affiliation(s)
- Gabriela Cajamarca
- School of Mathematical and Computational Sciences, Yachay Tech University, San Miguel de Urcuquí 100119, Ecuador;
| | - Valentina Proust
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Valeria Herskovic
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile
| | - Rodrigo F. Cádiz
- Department of Electrical Engineering, School of Engineering, and Music Institute, Faculty of Arts, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Nervo Verdezoto
- School of Computer Science and Informatics, Cardiff University, Cardiff CF24 4AG, UK;
| | - Francisco J. Fernández
- Faculty of Communication, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile;
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11
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Engels LWS, van Merode T, Heijmans M, Menting J, Duncan P, Rademakers J. Measurement of treatment burden in patients with multimorbidity in the Netherlands: translation and validation of the Multimorbidity Treatment Burden Questionnaire (NL-MTBQ). Fam Pract 2023:cmad100. [PMID: 37878729 DOI: 10.1093/fampra/cmad100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes. OBJECTIVE We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden. METHODS Translating the MTBQ into Dutch included forward-backward translation, piloting, and cognitive interviewing (n = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (n = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed. RESULTS The mean age among 959 participants with multimorbidity was 69.9 (17-96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0-9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (α = 0.845), and provided good evidence on the construct validity of the scale. CONCLUSION The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support.
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Affiliation(s)
- Loes W S Engels
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Tiny van Merode
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Juliane Menting
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Polly Duncan
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Jany Rademakers
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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12
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Oliveira Hashiguchi L, Cox SE, Edwards T, Castro MC, Khan M, Liverani M. How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines. BMC Health Serv Res 2023; 23:1027. [PMID: 37749519 PMCID: PMC10519082 DOI: 10.1186/s12913-023-10015-7] [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: 03/06/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND People with diabetes mellitus (DM) have an estimated two- to three-times greater risk of adverse tuberculosis (TB) treatment outcomes compared to those without DM. Blood glucose control is a primary aim of managing DM during TB treatment, yet TB programmes are not generally adapted to provide DM services. The purpose of this study was to understand perceptions and the lived experiences of diabetic patients in TB treatment in the Philippines, with a view to informing the development of disease co-management strategies. METHODS This mixed methods study was conducted within a prospective cohort of adults newly-starting treatment for drug-sensitive and drug-resistant TB at 13 public TB clinics in three regions of the Philippines. Within the subset of 189 diabetic persons who self-reported a prior DM diagnosis, or were diagnosed by screenings conducted through the TB clinic, longitudinal blood glucose data were used to ascertain individuals' glycaemic control (controlled or uncontrolled). Univariable logistic regression analyses exploring associations between uncontrolled glycaemia and demographic and clinical factors informed purposive sampling of 31 people to participate in semi-structured interviews. All audio-recorded data were transcribed and thematic analysis performed. RESULTS Participants - both with controlled and uncontrolled blood glucose - were knowledgeable about diabetes and its management. However, a minority of participants were aware of the impact of DM on TB treatment and outcomes. Many participants newly-diagnosed with DM at enrolment in TB treatment had not perceived any diabetic symptoms prior and would have likely not sought clinical consult otherwise. Access to free glucose-lowering medications through TB clinics was a key enabling resource. However, participants expressed fear of side effects and interrupted access to glucose-lowering medications, and a preference for phytotherapy. Many participants felt that physical and financial impacts of TB and its treatment were challenges to DM management. CONCLUSIONS AND RECOMMENDATIONS Results of this study indicate that public TB clinics can provide diabetic patients with additional health care resources and education to address co-morbidity. TB programmes might consider identifying patients with complicated DM, and offering diabetic monitoring and management, as DM and diabetic complications may compound the burden of TB and its treatment.
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Affiliation(s)
- Lauren Oliveira Hashiguchi
- National Institute of Nursing Research, National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892-2178, USA.
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
- School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Sharon E Cox
- School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- United Kingdom Health Security Agency, 61 Colindale Avenue London NW9 5EQ, Collindale, UK
| | - Tansy Edwards
- School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki, 852-8523, Japan
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Mary C Castro
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
| | - Mishal Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- Aga Khan University, National Stadium Road, Karachi, 74800, Pakistan
| | - Marco Liverani
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
- School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Frazier WD, Beins M, DaVanzo J, Heath S, Dobson A. Six Months of Remote Patient Monitoring Is Associated with Blood Pressure Reduction in Hypertensive Patients: An Uncontrolled Observational Study. Telemed J E Health 2023; 29:1164-1170. [PMID: 36576990 PMCID: PMC10440637 DOI: 10.1089/tmj.2022.0418] [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: 09/26/2022] [Revised: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Remote physiological monitoring (RPM) is a form of telehealth that measures vital signs at home and automatically reports the results to providers, thereby possibly improving chronic disease management. Medicare payment for RPM began in 2019. Two potential obstacles to RPM growth are the paucity of published clinical outcomes data and the Medicare requirement that monitoring be done at least 16 days per month to bill for the service. To help address these issues, we report the following uncontrolled observational study. Methods: A total of 1,102 consecutive patients enrolled in RPM were divided into four groups based on initial average mean arterial pressure (MAP) and into six groups based on the number of days per month MAP was measured. We report changes in MAP after 6 months of RPM as a function of initial MAP, and number of days per month MAP was monitored. Results: After 6 months of RPM, average MAP dropped from 97 to 93 (p < 0.01). This drop was greatest in the 50% of patients initially hypertensive. These patients saw average MAP reductions from 106 to 97 (p < 0.001) and became normotensive. Although MAP reduction was greatest the more frequently patients measured, significant reduction occurred in the hypertensive patients whether they measured more or less than 16 days per month (p < 0.001). No minimum threshold of measurements was found that predicted failure of RPM to lower MAP. Conclusions: RPM is associated with clinically and statistically significant reductions in average MAP in patients who were initially hypertensive. This benefit occurred irrespective of the number of days per month patients measured MAP.
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Affiliation(s)
| | - Michael Beins
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Joan DaVanzo
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Steven Heath
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
| | - Allen Dobson
- Dobson, Devanzo and Associates, LLC, Vienna, Virginia, USA
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14
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Zhou L, Zhu C, Walsh CA, Zhang X. Assessing the effect of health status on multidimensional poverty among older adults: the Chinese longitudinal healthy longevity survey. Front Public Health 2023; 11:1150344. [PMID: 37475773 PMCID: PMC10355057 DOI: 10.3389/fpubh.2023.1150344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Background This study aimed to explore the association between health status (physical, mental, and self-rated health) and multidimensional poverty (subjective and objective poverty) in older adults. Method A panel binary logit regression approach was applied to four waves of CLHLS data (2008, 2011, 2014, and 2018). In total,1,445 individuals were included after data cleaning. Results The mean values and proportion of physical, mental, and self-rated health were 5.73 (87.42%), 0.93 (93.06%), and 3.46 (86.7%), respectively, and mean values and proportion of subjective and objective poverty were 0.19 (18.51%) and 0.21(21.4%). In addition, physical, mental, and self-rated health were all found to be associated with subjective poverty among older adults (r = -0.181, r = -0.630, r = -0.321, p < 0.05), that is, the better the physical, mental, and self-rated health, the lower the probability of subjective poverty. A comparable connection between self-rated health and objective poverty also exists (r = -0.157, p < 0.05). Furthermore, medical expenditure played a mediation role in the association between the health status and poverty of older adults. Conclusion In order to effectively alleviate the poverty of older adults, strategies should be taken to improve the health level of older adults, especially the physical and mental health of high-aged older adults, and the self-rated health of middle-aged older adults. Furthermore, social security and pensions should be further developed to adequately reimburse medical expenditures.
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Affiliation(s)
- Lulin Zhou
- Department of Management, Jiangsu University, Zhenjiang, China
| | - Change Zhu
- Department of Management, Jiangsu University, Zhenjiang, China
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | | | - Xinjie Zhang
- Department of Management, Jiangsu University, Zhenjiang, China
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15
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Albanesi B, Piredda M, Dimonte V, De Marinis MG, Matarese M. Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review. Healthcare (Basel) 2023; 11:1681. [PMID: 37372800 DOI: 10.3390/healthcare11121681] [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: 04/11/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.
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Affiliation(s)
- Beatrice Albanesi
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
- Palliative Care Centre 'Insieme nella Cura', Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
| | - Maria Matarese
- Department of Medicine and Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy
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16
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Tomé-Pires C, Aragonès E, Rambla C, López-Cortacans G, Sánchez-Rodríguez E, Caballero A, Miró J. Perceived barriers, facilitators and usefulness of a psychoeducational intervention for individuals with chronic musculoskeletal pain and depression in primary care. Front Psychol 2023; 14:1099419. [PMID: 37179874 PMCID: PMC10167008 DOI: 10.3389/fpsyg.2023.1099419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Background and aims Self-management interventions have the potential to improve patient' pain condition as they involve tasks aimed at managing symptoms and reducing interference with activities, mood and relationships due to pain. However, research on factors that facilitate or hinder pain self-management has overlooked patients with both chronic musculoskeletal pain and depression in primary care settings, also leaving unattended patient views on the usefulness of such programs. Thus, the main aim of this study was to gather meaningful information to help promoting adequate self-management. Specifically, it attempts to identify patients' perceptions of barriers and facilitators of group-based psychoeducational intervention and to explore its perceived usefulness in promoting self-management. Method This qualitative study explored perceived barriers and facilitators of a psychoeducational intervention for the management of chronic musculoskeletal pain and depression previously tested in a Randomized Control Trial. We conducted focus groups and individual interviews with fifteen adult patients with both chronic musculoskeletal pain and depression recruited from primary care centres in Tarragona province (Catalonia, Spain). A content thematic analysis was carried out to examine the data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results Findings revealed that perceived barriers included lack of motivation, time constraints, pain, depression, ineffectiveness of pain-relief strategies and activity avoidance. Facilitators were having a supportive family/friends, the positive effects of self-management, high motivation, being a proactive patient. Peer support and identification, the positive effect of sessions, and free expression were highlighted as key elements of the psychoeducational intervention. Conclusion The psychoeducational intervention was perceived as useful in promoting self-management practices. Barriers and facilitators in using self-management strategies were related, mainly, to internal personal characteristics of the patients being similar among different cultural backgrounds and distinct chronic conditions. Implications These findings can help to guide clinicians in the development and implementation of more effective pain self-management interventions for patients with chronic pain and depression by attending to their needs and preferences.
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Affiliation(s)
- Catarina Tomé-Pires
- Department of Psychology, Psychology Research Centre, Autonomous University of Lisbon, Lisbon, Portugal
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Enric Aragonès
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Concepción Rambla
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Germán López-Cortacans
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Chair in Pediatric Pain Universitat Rovira i Virgili (URV)—Fundación Grünenthal, Catalonia, Spain
| | - Antonia Caballero
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Chair in Pediatric Pain Universitat Rovira i Virgili (URV)—Fundación Grünenthal, Catalonia, Spain
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Barker K, Holland AE, Skinner EH, Lee AL. Clinical Outcomes Following Exercise Rehabilitation in People with Multimorbidity: A Systematic Review. J Rehabil Med 2023; 55:jrm00377. [PMID: 36876460 PMCID: PMC10015470 DOI: 10.2340/jrm.v55.2551] [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: 04/23/2022] [Accepted: 01/13/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events. DATA SOURCES A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. STUDY SELECTION AND EXTRACTION Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity. DATA SYNTHESIS Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1-7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45-82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI -3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes. CONCLUSION In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes.
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Affiliation(s)
- Kathryn Barker
- Department of Chronic and Complex Care, Western Health, St Albans; Discipline of Physiotherapy, La Trobe University, Bundoora
| | - Anne E Holland
- Discipline of Physiotherapy, La Trobe University, Bundoora; Central Clinical School, Monash University, Melbourne; Alfred Health, Melbourne; Institute for Breathing and Sleep, Austin Health, Heidelberg
| | - Elizabeth H Skinner
- Alfred Health, Melbourne; Department of Physiotherapy, Monash University, Frankston; Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Annemarie L Lee
- Institute for Breathing and Sleep, Austin Health, Heidelberg; Department of Physiotherapy, Monash University, Frankston.
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18
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McLeod KE, Karim ME. The relationship between mood disorder diagnosis and experiencing an unmet health-care need in Canada: findings from the 2014 Canadian Community Health Survey. J Ment Health 2023; 32:11-23. [PMID: 32967489 DOI: 10.1080/09638237.2020.1818192] [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: 10/23/2022]
Abstract
BACKGROUND Despite Canada's universal health-care system, millions of Canadians experience unmet health-care needs (UHCN). People with mood disorders may be at higher risk of UHCN due to barriers such as stigma and gaps in health-care services. AIM We aimed to examine the relationship between having a diagnosed mood disorder and experiencing UHCN using a recent, nationally representative survey. METHODS Using the 2014 Canadian Community Health Survey, we used multivariate logistic regression to estimate the association between mood disorder and UHCN in the past 12 months, adjusting for sociodemographic variables and health status. RESULTS Among 52,825 respondents, 11.8% reported UHCN. Respondents with a diagnosed mood disorder were more likely to report UHCN [adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38, 1.89]. Among respondents with a regular doctor, people with mood disorders were still more likely to report UHCN (OR 1.63, 95% CI 1.38, 1.93). Sensitivity analyses using propensity score and missing data imputation approaches resulted in similar estimates. CONCLUSIONS Adults diagnosed with a mood disorder are more likely to report UHCN in the past year, even those with a regular doctor. Our findings suggest that barriers beyond physician attachment may impact access to care for people with mood disorders.
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Affiliation(s)
- Katherine E McLeod
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
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Neba RA, Warner M, Manning SE, Wiener RC, Sambamoorthi U. The Association of Multimorbidity With Whole Health Activities Among Adults in the United States: Evidence From the NHIS and BRFSS. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231156857. [PMID: 37151572 PMCID: PMC10161296 DOI: 10.1177/27536130231156857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 01/24/2023] [Indexed: 05/09/2023]
Abstract
Background Whole health is a holistic approach encompassing integrative medicine, emotional, and spiritual health and is critical to improving health outcomes among individuals with multimorbidity. Objective To examine the prevalence of Whole Health activities and the association of multimorbidity and Whole Health activities using nationally representative datasets. Methods As no single dataset has information on Whole Health self-care activities, data from the 2017 National Health Interview Survey (n = 25 134) was used to measure participants' mind-body therapy usage, sleep, mental health, and physical activity. We used the 2017 Behavioral Risk Factor Surveillance System (n = 347 029) to assess regular vegetable and/or fruit consumption. Results A significantly lower percentage of adults with multimorbidity had adequate sleep (58.2%vs.67.1%), no psychological distress (71.8%vs.82.1%), adequate physical activity (48.2%vs.62.1%), and regular vegetable and/or fruit consumption (54.2%vs.56.6%) compared to those without multimorbidity. Although lower percentages of adults with multimorbidity utilized mind-body therapies (22.9%vs.25.2%), the association was reversed when adjusted for socioeconomic factors. In the fully adjusted models, adults with multimorbidity were more likely to use mind-body therapies (AOR = 1.19, 95%CI = 1.09, 1.31). Furthermore, when adjusting for other independent variables, the associations of multimorbidity with sleep, psychological distress, and diet were exacerbated, and the association of multimorbidity with physical activity was attenuated. Conclusion Adults with multimorbidity were less likely to engage in most of the Whole Health activities except mind-body therapies compared to the no multimorbidity group. Findings suggest that adjustment for other factors such as age and socioeconomic status changed the magnitude and direction of the association of multimorbidity with Whole Health activities.
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Affiliation(s)
- Rolake A. Neba
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Mayela Warner
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Sydney E. Manning
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - R. Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, USA
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20
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Konlan KD, Shin J. Determinants of Self-Care and Home-Based Management of Hypertension: An Integrative Review. Glob Heart 2023; 18:16. [PMID: 36968303 PMCID: PMC10038107 DOI: 10.5334/gh.1190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 02/16/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Patients with hypertension should perform diverse self-care activities that incorporate medication adherence and lifestyle modification, such as no smoking or alcohol, weight reduction, a low-salt diet, increased physical activity, increased self-monitoring, and stress reduction, for effective management at home. Aim This systematic review assessed and synthesized the factors that are associated with self-care and home-based management of hypertension. Methods The search of the articles incorporated the population, intervention, comparison, and outcome (PICO) framework. The literature was searched in four databases (PubMed, the Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, and Web of Science) until 2022. The articles retrieved and searched from the reference list (531) were transported to EndNote version 20, and duplicates (19) were identified and removed to produce 512 titles. Following the eventual title, abstracts, and full-text screening, 13 articles were appropriate for this study. The narrative and thematic data analysis were used to analyze and integrate the data. Results The analysis showed five themes were associated with home-based self-care and blood pressure (BP) control among patients diagnosed with hypertension. These themes that emerged were (1) the prevalence of control of BP, (2) sociodemographic factors, (3) treatment-related factors, (4) knowledge of management, and (5) knowledge of the prevention of risk factors of hypertension. The demographic factors influencing home-based self-care for hypertension were gender, age, and socioeconomic status. In contrast, the treatment factors were duration of hypertension treatment, medication burden, and medication adherence. Other factors that influenced self-care were inadequate knowledge of BP management, follow-up care, and risk factors of hypertension. Conclusion Hypertension self-care interventions must incorporate individual, societal, and cultural perspectives in increasing knowledge and improving home-based hypertension management. Therefore, well-designed clinical and community-dwelling interventions should integrate personal, social, and cultural perspectives to improve behavior in the home management of hypertension by increasing knowledge and self-efficacy.
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Affiliation(s)
- Kennedy Diema Konlan
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Jinhee Shin
- College of Nursing, Woosuk University, Jeollabuk-do, 55338, Korea
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Orme MW, Jayamaha AR, Santin L, Singh SJ, Pitta F. A Call for Action on Chronic Respiratory Diseases within Physical Activity Policies, Guidelines and Action Plans: Let's Move! INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16986. [PMID: 36554866 PMCID: PMC9779594 DOI: 10.3390/ijerph192416986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Global policy documents for the promotion of physical activity (PA) play an important role in the measurement, evaluation, and monitoring of population PA levels. The World Health Organisation (WHO) guidelines include, for the first time, recommendations for specific populations, including individuals living with a range of non-communicable diseases. Of note, is the absence of any chronic respiratory diseases (CRDs) within the recommendations. Globally, CRDs are highly prevalent, are attributable to significant individual and societal burdens, and are characterised by low PA. As a community, there is a need to come together to understand how to increase CRD representation within global PA policy documents, including where the evidence gaps are and how we can align with PA research in other contexts. In this commentary, the potential for synergy between evidence into the relationships between PA in CRDs globally and the relevance to current policies, guidelines and action plans on population levels of PA are discussed. Furthermore, actions and considerations for future research, including the need to harmonize and promote PA assessment (particularly in low- and middle-income countries) and encompass the synergistic influences of PA, sedentary behaviour and sleep on health outcomes in CRD populations are presented.
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Affiliation(s)
- Mark W. Orme
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK
| | - Akila R. Jayamaha
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
- Department of Research and Development, Faculty of Nursing, KAATSU International University, Battaramulla 10120, Sri Lanka
| | - Lais Santin
- Laboratory of Research in Respiratory Physiotherapy, Health Sciences Center, Universidade Estadual de Londrina, Londrina 86057-970, Brazil
| | - Sally J. Singh
- Department of Respiratory Sciences, University of Leicester, Leicester LE1 7RH, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester NHS Trust, Leicester LE3 9QP, UK
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Health Sciences Center, Universidade Estadual de Londrina, Londrina 86057-970, Brazil
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22
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Ryan A, Smith SM, Cummins V, Murphy C, Galvin R. Development and feasibility of an inter-agency physical activity and education programme for adults with multimorbidity in primary care: Activ8. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221142350. [PMCID: PMC9743022 DOI: 10.1177/26335565221142350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022]
Abstract
Background While physical activity is widely recommended for many long-term conditions, it may be difficult to achieve for patients managing multiple conditions. We aimed to determine the feasibility of an inter-agency exercise and education programme for patients with multimorbidity in primary care. Methods We conducted an uncontrolled pilot study with adults with multimorbidity, recruited in two community healthcare organisations in an urban area in Ireland. The six-week pilot intervention combined an individually tailored gym-based exercise programme and education to support self-management. Feasibility of the Activ8 programme was assessed using a mixed methods process evaluation. Outcome measures at baseline and at 6 weeks included recruitment and retention, gait speed, grip strength, quality of life and self-efficacy. Focus groups and interviews explored participants and facilitators’ perceptions of the programme. Results 19 participants with ≥2 chronic conditions were recruited over three-weeks with similar attrition at both sites (≤40%). Overall, the results indicate that Activ8 was feasible and acceptable to patients and practitioners. Quantitative outcome measures suggested improvements in most outcomes. Qualitative data analysis indicated that Activ8 addressed an overarching concept of patient-centeredness among participants. Three key themes included perceived personal programme impact, the personalised composition of the programme and the evolving nature of primary care practice. Conclusion While further definitive evidence is needed and attrition from the programme needs to be considered, the Activ8 Programme was acceptable to both patients and professionals in two different primary care areas with the potential for positive impacts for adults living with multimorbidity.
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Affiliation(s)
- Aine Ryan
- Department of Medical Professionalism, Royal College of Surgeons in Ireland, Dublin, Ireland,Aine Ryan, Centre for Professionalism in Medicine and Health Sciences, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland.
| | - Susan M Smith
- Department of Public Health and Primary Care, Trinity Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | | | - Catriona Murphy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
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23
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Profile and predictors of barriers to physical activities: a cross-sectional assessment focusing community dwellers visiting a public healthcare institute of Quetta city, Pakistan. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Mahmoud K, Nwakasi C, Oyinlola O. The influence of religion and socio-economic status on coping with chronic diseases among older adults in Nigeria. JOURNAL OF RELIGION, SPIRITUALITY & AGING 2022. [DOI: 10.1080/15528030.2022.2143996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kafayat Mahmoud
- University of Kansas, Lawrence, Kansas, USA
- Gerontology Program, Dole Human Development Center, Lawrence, Kansas, USA
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25
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Cai CX, Kim M, Lundeen EA, Benoit SR. Differences in receipt of recommended eye examinations by comorbidity status and healthcare utilization among nonelderly adults with diabetes. J Diabetes 2022; 14:749-757. [PMID: 36285845 PMCID: PMC9705799 DOI: 10.1111/1753-0407.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/27/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To evaluate the effect of diabetes comorbidities by baseline healthcare utilization on receipt of recommended eye examinations. METHODS Retrospective analysis of 310 691 nonelderly adults with type 2 diabetes in the IBM MarketScan Commercial Database from 2016 to 2019. Patients were grouped based on diabetes-concordant (related) or -discordant (unrelated) comorbidities. Logistic regression was used to estimate the prevalence ratio (PR) for eye examinations by comorbidity status, healthcare utilization, and an interaction between comorbidities and utilization, controlling for age, sex, region, and major eye disease. RESULTS Prevalence of biennial eye examinations varied by the four comorbidity groups: 43.5% (diabetes only), 52.7% (concordant + discordant comorbidities), 48.0% (concordant comorbidities only), and 45.3% (discordant comorbidities only). In the lowest healthcare utilization tertile, the concordant-only and concordant + discordant groups had lower prevalence of examinations compared to diabetes only (PR 0.95 [95% CI 0.92-0.98] and PR 0.91 [95% CI 0.88-0.95], respectively). In the medium utilization tertile, the discordant-only and concordant + discordant groups had lower prevalence of examinations (PR 0.89 [0.83-0.95] and PR 0.94 [0.90-0.98], respectively). In the highest utilization tertile, the concordant-only and concordant + discordant groups had higher prevalence of examinations. CONCLUSIONS Among patients with low healthcare utilization, having comorbid conditions is associated with lower prevalence of eye examinations. Among those with medium healthcare utilization, patients with diabetes-discordant comorbidities are particularly vulnerable. This study highlights populations of diabetes patients who would benefit from increased assistance in receiving vision-preserving eye examinations.
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Affiliation(s)
- Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins HospitalBaltimoreMarylandUSA
| | - Minchul Kim
- Center for Outcomes Research, Department of Internal MedicineUniversity of Illinois College of Medicine PeoriaPeoriaIllinoisUSA
| | - Elizabeth A. Lundeen
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Stephen R. Benoit
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGeorgiaUSA
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26
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Runnels P, Muskin R, Ansah A, Penman J, Pronovost P. A Longitudinal, Relationship-Based Model for Managing Complex Chronic Disease in the Medicaid Population. Popul Health Manag 2022; 25:535-541. [PMID: 35856846 DOI: 10.1089/pop.2022.0013] [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: 11/12/2022] Open
Abstract
Health care systems have made concerted efforts to improve value for individuals with complex and chronic disease. Despite these efforts, this population (and the Medicaid population in particular) has been historically difficult to impact as many members are disproportionately impacted by social determinants of health that interfere with their ability to engage the health care system effectively. Transactional, solutions-based interventions to resolve barriers to care have been ineffective at either improving outcomes or reducing cost in the long term. The authors identify 3 core barriers that prevent time-limited, transactional interventions from effectively solving complex health and social problems: trust, self-efficacy, and complexity. By evolving from a transactional framework to a relational framework, case managers can develop relationships with clients that will help overcome these barriers. More specifically, clinical case management can be utilized to resolve these barriers by implementing a long-term, relational approach with clients through 5 key principles: ensuring continuity of care, leveraging the case management relationship, titrating support and structure, engaging flexibility, and facilitating patient resourcefulness. This article discusses how these principles resolve the identified barriers and how such a model is currently being executed in University Hospital's system. RWJF Grant I.D Number is 98426.
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Affiliation(s)
- Patrick Runnels
- Department of Population Health, University Hospitals Health System, Shaker Heights, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ryan Muskin
- Department of Population Health, University Hospitals Health System, Shaker Heights, Ohio, USA.,Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Afua Ansah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - James Penman
- Department of Population Health, University Hospitals Health System, Shaker Heights, Ohio, USA
| | - Peter Pronovost
- Department of Anesthesiology and Critical Care, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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van der Gaag M, Heijmans M, Spoiala C, Rademakers J. The importance of health literacy for self-management: A scoping review of reviews. Chronic Illn 2022; 18:234-254. [PMID: 34402309 DOI: 10.1177/17423953211035472] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support. METHODS We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010. RESULTS A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients' perspective described mainly medical management and the communication and navigation of the health care system. DISCUSSION Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.
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Affiliation(s)
| | - Monique Heijmans
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands
| | - Cristina Spoiala
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands
| | - Jany Rademakers
- 8123Nivel, Netherlands Institute for Health Services Research, the Netherlands.,Department of Family Medicine, 168092Maastricht University, CAPHRI Care and Public Health Research Institute, the Netherlands
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Jäger M, Lindhardt MC, Pedersen JR, Dideriksen M, Nyberg M, Bricca A, Bodtger U, Midtgaard J, Skou ST. Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221100172. [PMID: 35615752 PMCID: PMC9125109 DOI: 10.1177/26335565221100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022]
Abstract
Background Behavior change and exercise are considered critical for successful self-management in people with multimorbidity, however, little is known about people’s needs, experiences, and preferences. Purpose The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. Research design Analysis was carried out by means of a hybrid inductive-deductive approach using Framework Analysis that enabled the subsequent use of the COM-B model in relation to the study of exercise behavior specifically. Study sample We conducted 17 interviews (9 focus groups; 8 key informants) with 48 informants from four groups (22 people living with multimorbidity, 17 healthcare professionals, 5 relatives, and 5 patient advocates). Data analysis Through an inductive Framework analysis, we constructed three themes: Patient education, supporting behavior change, and lack of a “burning platform.” Subsequent deductive application of the COM-B profile (applied solely to data related to exercise behavior) unveiled a variety of barriers to exercise and self-management support (pain, fatigue, breathlessness, lack of motivation, financial issues, accessibility, decreased social support). Results Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study.
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Affiliation(s)
- Madalina Jäger
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | | | - Julie Rønne Pedersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Mette Dideriksen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Mette Nyberg
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Zealand University Hospital Næstved, Næstved, Denmark.,Institute for Regional Heath Research, University of Southern Denmark, Odense M, Denmark
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
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Postma S, Schers H, van de Belt T, van Boven K, Ten Napel H, Stappers H, Gerritsen D, Olde Hartman T. Assessment of functioning in Dutch primary care: Development study of a consultation tool for patients with chronic conditions and multimorbidity. Health Expect 2022; 25:1363-1373. [PMID: 35607998 PMCID: PMC9327861 DOI: 10.1111/hex.13474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/17/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In primary care, a shift from a disease-oriented approach for patients with multimorbidity towards a more person-centred approach is needed. AIM To transform a self-report questionnaire for patients with chronic conditions in primary care, the Primary Care Functioning Scale (PCFS), into an understandable, visually attractive and feasible consultation tool for patients and health care providers. The consultation tool consists of a web-based version of the PCFS, which is filled in by the patient and is processed to a feedback report that summarizes and visualizes the main findings. The feedback report can be discussed with the patient to facilitate a more person-centred conversation for patients with chronic conditions and multimorbidity in general practice. DESIGN AND SETTING In this qualitative study, we developed the consultation tool by using design thinking in a participatory developmental process. METHODS In the first phase, we constructed five different feedback report templates to summarize and display the results of a completed PCFS questionnaire in a series of two expert meetings with patients and general practitioners (GPs). In the second phase, we performed an exploratory qualitative interview study involving dyads of patients with chronic conditions and their practice nurses. In an iterative process, we explored their experiences with the consultation tool. RESULTS Patients, as well as GPs, preferred a clear manner of presenting the results of the questionnaire in a feedback report. In 18 interviews with patients and practice nurses during three different interview rounds, we adjusted the feedback report and consultation tool based on the input from patients and practice nurses. After the final interview round, patients and practice nurses consented that the consultation tool was useful for having a more in-depth consultation about functioning and patients' preferences when integrated into the regularly scheduled consultations. CONCLUSION We were able to develop an understandable and feasible consultation tool that is applicable in already existing chronic disease management programmes in general practice in the Netherlands. PATIENT OR PUBLIC CONTRIBUTION To increase the understandability and feasibility of the consultation tool, we collaborated with end-users and actively involved patients, GPs and practice nurses in a participatory development process.
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Affiliation(s)
- Simone Postma
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom van de Belt
- Radboud REshape Innovation Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Huib Ten Napel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,WHO Collaborating Centre for Family of International Classifications, Nijmegen, The Netherlands
| | - Hugo Stappers
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debby Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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30
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Regeer H, van Empelen P, Bilo HJG, de Koning EJP, Huisman SD. Change is possible: How increased patient activation is associated with favorable changes in well-being, self-management and health outcomes among people with type 2 diabetes mellitus: A prospective longitudinal study. PATIENT EDUCATION AND COUNSELING 2022; 105:821-827. [PMID: 34274165 DOI: 10.1016/j.pec.2021.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/21/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To examine the relationship between risk factors for low patient activation and change in patient activation, well-being, and health outcomes in people with type 2 diabetes mellitus (T2DM). METHOD A longitudinal prospective study was conducted with measurements at baseline and 20-week follow-up among 603 people with T2DM participating in a group-based walking intervention. Patient activation and risk factors were assessed using online questionnaires. Health outcomes were assessed in participants' general practices. RESULTS No association was found between risk factors for activation and change in patient activation. Patient activation significantly increased (t(602) = 2.53, p = 0.012) and was associated with an increase in emotional well-being (β = 0.22), exercise behavior (β = 0.17), general diet behavior (β = 0.20), and a reduction in BMI (β = -0.28), weight (β = -0.29), and HbA1c (β = -0.27). CONCLUSION Favorable changes in patient activation, self-management, well-being, and health outcomes occurred during a walking intervention, despite highly prevalent risk factors for low activation and less engagement in self-management. PRACTICE IMPLICATIONS Group-based walking interventions might empower people with T2DM to begin taking a larger role in their self-care and improve (mental) health outcomes. Vulnerable groups of patients (with multiple risk factors for low activation) can change and presumably need this kind of interventions to be able to change.
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Affiliation(s)
- Hannah Regeer
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands; Bas Van De Goor Foundation, Arnhem, The Netherlands.
| | | | - Henk J G Bilo
- Diabetes Knowledge Centre, Isala, Zwolle, The Netherlands.
| | - Eelco J P de Koning
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Sasja D Huisman
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
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31
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Sunohara M, Sasaki J, Kogo S, Ryder AG. Japanese Clinical Psychologists' Consensus Beliefs about Mental Health: A
Mixed‐Methods
Approach. JAPANESE PSYCHOLOGICAL RESEARCH 2022. [DOI: 10.1111/jpr.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Doyle J, Murphy E, Gavin S, Pascale A, Deparis S, Tommasi P, Smith S, Hannigan C, Sillevis Smitt M, van Leeuwen C, Lastra J, Galvin M, McAleer P, Tompkins L, Jacobs A, M Marques M, Medina Maestro J, Boyle G, Dinsmore J. A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial. J Med Internet Res 2021; 23:e22672. [PMID: 34914612 PMCID: PMC8717138 DOI: 10.2196/22672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/31/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023] Open
Abstract
Background Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID) RR2-10.2196/22125
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Affiliation(s)
- Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Emma Murphy
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,TU Dublin, Dublin, Ireland
| | - Shane Gavin
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | | | | | | | - Suzanne Smith
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Caoimhe Hannigan
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, National University of Ireland, Dublin, Dublin, Ireland
| | | | | | | | - Mary Galvin
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patricia McAleer
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Lorraine Tompkins
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Marta M Marques
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,ADAPT SFI Research Centre, Trinity College Dublin, Dublin, Ireland
| | | | - Gordon Boyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - John Dinsmore
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Moore FR, Williams L, Dunbar M. Sociodemographic predictors of attendance at a Scottish pain management programme. Br J Pain 2021; 15:393-400. [PMID: 34840787 PMCID: PMC8611294 DOI: 10.1177/2049463720970579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We examined relationships between various sociodemographic factors and attendance at the Glasgow Pain Management Programme (n = 2899 from 2011 to 2019). We tested for associations between gender, age and socioeconomic deprivation of patients who were invited to attend, and uptake to a programme when invited, attendance at screening assessment, eligibility, adherence and attendance at 3- and 6-month reviews. Uptake was significantly higher for patients from more affluent areas (95% confidence interval (CI) = 0.93–0.99, p = 0.002) and for older patients (95% CI = 0.98–0.99, p = 0.006), although effect sizes were very small. Patients were significantly more likely to be assessed as suitable if they were younger (95% CI = 0.98–0.99, p = 0.013) or female (95% CI = 0.55–0.84, p < 0.001). Attendance at sessions and at 3- and 6-month reviews was higher for patients from more affluent areas (95% CI = 1–1.09, p = 0.001, and 95% CI = 1–1.1, p = 0.044 respectively). We argue that there are multiple potential explanations for these findings and that future work should attempt to determine whether these patterns replicate in other populations and to determine any modifiable causes.
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Affiliation(s)
- F R Moore
- Phoenix Centre, Raigmore Hospital, Inverness, UK
| | | | - M Dunbar
- New Victoria Hospital, Glasgow, UK
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Kim SN, Lee HJ, Kim SY, Lee N. [Validity and Reliability of Korean Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale]. J Korean Acad Nurs 2021; 51:617-629. [PMID: 34737253 DOI: 10.4040/jkan.21069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/06/2021] [Accepted: 09/13/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to examine the validity and reliability of the Korean version of the self-efficacy for managing chronic disease 6-item scale (SECD-6-K). METHODS The English version of the Self-Efficacy for Managing Chronic Disease 6-item Scale first underwent forward and backward translation procedures. The SECD-6-K was then used to collect data from 350 adults diagnosed with chronic diseases. Content, construct, convergent, discriminant, and criterion validity were all evaluated. Reliability was assessed using Cronbach's α. SPSS 25.0 and the data were analyzed using AMOS 26.0 software. RESULTS The SECD-6-K consists of six items in two domains: disease management and health behavior. The results for construct, convergent, and discriminant validity were good. Exploratory factor analysis produced eigen values between 2.27 and 3.28, with factors total explained cumulative variance of 91.1%. Confirmatory factor analysis supported goodness of fit and reliability for the modified SECD-6-K model. The criterion validity also showed significant correlation with both the Patient Health Questionnaire and 12-item Short-Form Health Survey version 2. Finally, reliability was found to be excellent. CONCLUSION This study identified the high reliability and validity of SECD-6-K. The SECD-6-K is an appropriate tool for determining Korean patients' self-efficacy in managing their chronic conditions. Therefore, this scale may be used in clinical settings as well as in educational and research settings.
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Affiliation(s)
- Sook-Nam Kim
- College of Nursing, Catholic University of Pusan, Busan, Korea
| | - Hyun-Ju Lee
- College of Nursing, Catholic University of Pusan, Busan, Korea.
| | - So-Young Kim
- College of Nursing, Catholic University of Pusan, Busan, Korea
| | - Nayoon Lee
- College of Nursing, Catholic University of Pusan, Busan, Korea
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Martínez N, Connelly CD, Pérez A, Calero P. Self-care: A concept analysis. Int J Nurs Sci 2021; 8:418-425. [PMID: 34631992 PMCID: PMC8488814 DOI: 10.1016/j.ijnss.2021.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives There is extensive literature from various disciplines on self-care, an important aspect of nursing intervention via evaluation and education, but its meaning remains unprecise due to the difficulty integrating the diverse definitions developed over time across disciplines. Therefore, it is vital to clarify the meaning of self-care and formulate the defining attributes, antecedents, and consequences to self-care. Methods Walker and Avant’s concept analysis approach was used to analyze the concept of self-care. A search of the literature was completed using the databases CINAHL, PubMed, and EBSCOhost for years 1975–2020; literature search included peer-review articles, full-text publications, and available in English. A total of 31 articles were reviewed, and saturation was reached. Results An extensive review of the literature revealed salient characteristics that reflected the most frequently used terms associated with the concept. Guided by Walker and Avant’s method, three defining attributes emerged as common themes: awareness, self-control, and self-reliance. Conclusions A clarified definition was identified: the ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being.
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Affiliation(s)
- Nicole Martínez
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, USA
| | - Cynthia D Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, USA
| | - Alexa Pérez
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, USA
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Zanga G, Drzewiscki E, Tagliani P, Smietniansky M, Esnaola Y Rojas MM, Caruso D. Predictors of adherence and persistence to disease-modifying therapies in Multiple Sclerosis. Ther Adv Neurol Disord 2021; 14:17562864211031099. [PMID: 34630632 PMCID: PMC8495537 DOI: 10.1177/17562864211031099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS In multiple sclerosis (MS), non-adherence/non-persistence is related to suboptimal response to treatment, including disease relapses and the need for more expensive healthcare. The aim of this study was to identify predictors related to adherence to disease modifying therapies (DMTs) in a cohort of Argentinian MS patients. METHODS We conducted a cross-sectional study at the National Medical Care Program from Argentina. MS patients with at least one claim for a DMT from 1 January 2017 to 1 October 2017 were identified. A telephone survey was performed to assess clinical and demographic factors. The medication possession ratio (MPR) was used to estimate adherence; MPR <80% defined non-adherence. Associations were studied using a logistic regression model. RESULTS Our database included 648 MS patients. A total of 360 patients (60% females, mean age 55.3 years) accepted to participate. Of these, 308 (85.5%) patients were receiving DMT at the time of the survey. Some 198 (63.7%) were receiving injectable therapies. Optimal adherence was 47.7%. Adherence was associated with oral medication [odds ratio (OR) 1.83 95% confidence interval (CI) 1.13-3.00, p = 0.014]. A factor related to oral drugs was higher educational level (OR 2.86 95%CI 1.41-5.81, p = 0.004). CONCLUSION This real-world study showed better adherence and persistence on treatment with oral therapies in MS patients in Argentina.
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Affiliation(s)
- Gisela Zanga
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, La Rioja 951, Buenos Aires, C1221ACI, Argentina
| | - Estefania Drzewiscki
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
| | - Paula Tagliani
- Servei de Neurologia-Neuroinmunologia, Centre d'Esclerosi Multiple de Catalunya, (CEMCAT), Vall d'Hebron Hospital Universitari, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maximiliano Smietniansky
- Department of Internal Medicine Interna, Programa de Medicine Geriatric Program, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maria M Esnaola Y Rojas
- Department of Neurology, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
| | - Diego Caruso
- Department of Internal Medicine, César Milstein Hospital, associated with University of Buenos Aires, Buenos Aires, Argentina
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BERRY ANDREWB, LIM CATHERINEY, LIANG CALVINA, HARTZLER ANDREAL, HIRSCH TAD, FERGUSON DAWNM, BERMET ZOEA, RALSTON JAMESD. Supporting collaborative reflection on personal values and health. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 5:1-39. [PMID: 36644216 PMCID: PMC9837878 DOI: 10.1145/3476040] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
People with multiple chronic conditions (MCC) need support to identify and articulate how their personal values relate to their health. We drew on previous research involving people with MCC to develop three prototypes for supporting reflection on relationships between values and health. We tested these prototypes in a qualitative study involving 12 people with MCC. We identified benefits and limitations to building on patients' existing visit-preparation practices; revealed varying levels of comfort with deep, exploratory reflection involving a facilitator; and found that reflection oriented toward the future could elicit hopeful attitudes and plans for change, while reflection on the past elicited strong resistance. We discuss these findings in relation to previous literature on designing for reflection in three areas: shifting between self-guided and facilitator-guided reflection, balancing between outcome-oriented and exploratory reflection, and exploring temporality in reflection.
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Affiliation(s)
| | | | | | | | | | | | - ZOE A BERMET
- KAISER PERMANENTE WASHINGTON HEALTH RESEARCH INSTITUTE, SEATTLE WA
| | - JAMES D RALSTON
- KAISER PERMANENTE WASHINGTON HEALTH RESEARCH INSTITUTE, SEATTLE WA
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38
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Savitz LA, Bayliss EA. Emerging models of care for individuals with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:980-989. [PMID: 34387358 PMCID: PMC8515217 DOI: 10.1111/1475-6773.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). DATA SOURCES/STUDY SETTING We conducted a rapid literature scoping augmented by key informant interviews with clinicians knowledgeable about MCC care from a broad spectrum of US delivery systems and feedback from multidisciplinary experts at two virtual meetings. STUDY DESIGN Literature findings were triangulated with data from semi-structured interviews with clinical experts. Reflections on early results were obtained from policy, research, clinical, advocacy, and patient representatives at two virtual meetings sponsored by the Agency for Healthcare Research and Quality. Emergent themes addressed were as follows: (1) more timely strategies for MCC care; and (2) trends not previously represented in the peer-reviewed literature. DATA COLLECTION/EXTRACTION METHODS The rapid literature scoping relied on Ovid MEDLINE(R) and Epub Ahead of Print databases for the most recent 5-year period. Qualitative interviews were conducted by telephone. Virtual meetings provided oral and written (chat) captured inputs. PRINCIPAL FINDINGS Although the literature scoping did not identify a specific set of evidence-based care models, key informant discussions identified eight themes reflecting emerging approaches to population-based MCC care. For example, addressing the needs of individuals with MCC through a complexity lens by assessing and addressing social risk factors; extending the care continuum with home-based care; understanding how to address ongoing patient and caregiver supports outside of clinical encounters; and engaging available community resources. CONCLUSIONS Integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources. Our learnings suggest a need for an ongoing MCC care research agenda to inform new approaches to care delivery incorporating innovations in technology and home-based supports for patients and caregivers.
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Affiliation(s)
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente ColoradoAuroraColoradoUSA
- Department of Family MedicineUniversity of ColoradoAuroraColoradoUSA
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Gao CC, Espinoza Suarez NR, Toloza FJK, Malaga Zuniga AS, McCarthy SR, Boehmer KR, Yao L, Fu S, Brito JP. Patients' Perspective About the Cost of Diabetes Management: An Analysis of Online Health Communities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:898-906. [PMID: 34585085 PMCID: PMC8455864 DOI: 10.1016/j.mayocpiqo.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To understand the perspectives of persons' living with diabetes about the increasing cost of diabetes management through an analysis of online health communities (OHCs) and the impact of persons' participation in OHCs on their capacity and treatment burden. Patients and Methods A qualitative study of 556 blog posts submitted between January 1, 2007 and December 31, 2017 to 4 diabetes social networking sites was conducted between March 2018 and July 2019. All posts were coded inductively using thematic analysis procedures. Eton's Burden of Treatment Framework and Boehmer's Theory of Patient Capacity directed triangulation of themes with existing theory. Results Three themes were identified: (1) cost barriers to care: participants describe individual and systemic cost barriers that inhibit prescribed therapy goals; (2) impact of financial cost on health: participants describe the financial effects of care on their physical and emotional health; and (3) saving strategies to overcome cost impact: participants discuss practical strategies that help them achieve therapy goals. Finally, we also identify that the use of OHCs serves to increase persons' capacity with the potential to decrease treatment burden, ultimately improving mental and physical health. Conclusion High cost for diabetes care generated barriers that negatively affected physical health and emotional states. Participant-shared experiences in OHCs increased participants' capacity to manage the burden. Potential solutions include cost-based shared decision-making tools and advocacy for policy change.
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Key Words
- BS, blood sugar
- BoTF, Burden of Treatment Framework
- DME, Durable Medical Equipment
- HMO, health maintenance organization
- IDDM, insulin-dependent diabetes mellitus
- IRB, institutional review board
- OHC, online health community
- PLWD, person living with diabetes
- PPA, Partnership for Prescription Assistance
- RX, prescription
- T1D, type 1 diabetes
- TPC, Theory of Patient Capacity
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Affiliation(s)
- Catherine C Gao
- Mayo Clinic Alix School of Medicine.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock
| | - Ariana S Malaga Zuniga
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Sarah R McCarthy
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Lixia Yao
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Sunyang Fu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Morgan JC, Kemp CL, Barmon C, Fitzroy A, Ball MM. Limiting and Promoting Resident Self-Care in Assisted Living. J Gerontol B Psychol Sci Soc Sci 2021; 76:1664-1672. [PMID: 33471097 PMCID: PMC8577204 DOI: 10.1093/geronb/gbab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Assisted living (AL) residents often manage multiple chronic conditions, functional and/or cognitive decline along with their individual needs and preferences for a full life. Although residents participate in their own care, little is known about their self-care activities and how to support them. This analysis focuses on residents' self-care and theorizing the dynamic, socially embedded process of negotiating self-care. METHODS We analyze data from a grounded theory study informed by the Convoys of Care model. Participants included 50 focal residents and 169 paid and unpaid convoy members in eight AL homes; each resident convoy was followed up for 2 years. Data collection included participant observation, interviews, and resident record review. RESULTS To the extent possible, most AL residents were involved in self-care related to activities of daily living, health promotion, and social, emotional, and mental well-being. Residents and care partners engaged in a dynamic process of limiting and promoting self-care activities. Multiple factors influenced self-care, including residents' past self-care behaviors, caregiver fear and availability, and the availability of services and supports. DISCUSSION Strategies for promoting self-care must involve residents and care partners and include convoy education in collaborative goal-setting, prioritizing care that supports the goals, and putting resources in place to support goal achievement.
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Affiliation(s)
- Jennifer C Morgan
- Gerontology Institute, Georgia State University, Atlanta, USA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Candace L Kemp
- Gerontology Institute, Georgia State University, Atlanta, USA
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Christina Barmon
- Department of Sociology, Central Connecticut State University, New Britain, USA
| | - Andrea Fitzroy
- Department of Sociology, Georgia State University, Atlanta, USA
| | - Mary M Ball
- Gerontology Institute, Georgia State University, Atlanta, USA
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Cheng C, Bai J. Coping with Multiple Chronic Conditions in the Family Context: A Meta-Synthesis. West J Nurs Res 2021; 44:972-984. [PMID: 34433327 DOI: 10.1177/01939459211041171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was to collect, synthesize, and interpret the current qualitative evidence from studies that investigated family coping among people with multiple chronic conditions (MCCs). A meta-synthesis approach was used to report this study. A systematic search was performed in five electronic databases, including CINAHL, EMBASE, PsycINFO, Web of Science, and PubMed from January 2000 to December 2020. The PRISMA flow chart and Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist are integrated into the meta-synthesis. A total of ten eligible studies including data from 381 participants were identified. Three meta-themes were identified in the synthesis: (1) family role maintenance in MCCs management, (2) coping as a family, and (3) be frustrated with family interactions. This meta-synthesis indicated the importance of maintaining social roles and family support within family interactions for coping with MCCs. It also demonstrated the frustrations in the family coping process experienced by people with MCCs. Health care professionals should understand the interactions between people with MCCs and their family members that may impact people's coping. Such an understanding may contribute to the development of supportive programs such as family-based interventions for people with MCCs.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jie Bai
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Lee K, Hong K, Kang S, Hwang J. Characteristics and Epidemiology of Discharged Pneumonia Patients in South Korea Using the Korean National Hospital Discharge In-Depth Injury Survey Data from 2006 to 2017. Infect Dis Rep 2021; 13:730-741. [PMID: 34449656 PMCID: PMC8395938 DOI: 10.3390/idr13030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
Despite the use of vaccines and various antibiotics, approximately 30% of the South Korean population is treated for pneumonia each year, and the number of deaths from pneumonia continues to increase. The present study used information on discharged patients in South Korea to investigate the number and characteristics of discharged pneumonia patients across 12 years. Using the Korean National Hospital Discharge In-Depth Injury Survey data, information on discharged patients from 2006 to 2017 were collected. The number of discharged pneumonia patients for each year and their age group was assessed, and the Charlson Comorbidity Index was used to assess the risk of comorbidities in these patients. The number of discharged pneumonia patients varied every year in South Korea. In particular, the total number of patients increased substantially in 2011, with a large increase in the number of infants and children. In addition, the number of discharged pneumonia patients increased in the elderly group compared to the other age groups. Moreover, a recent increase in the severity of comorbidities in pneumonia patients was noted. Given the continued increase in the number of elderly patients with pneumonia, chronic diseases, such as hypertension and diabetes, should be managed first in the elderly. Moreover, appropriate treatment methods should be selected based on the presence of comorbidities.
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Affiliation(s)
- Kyunghee Lee
- Department of Healthcare Management, Eulji University, Seongnam-si 13135, Korea;
| | - Kyunglan Hong
- Team of Medical Record, Seoul National University Hospital, Seoul 03080, Korea;
| | - Sunghong Kang
- Department of Health Policy & Management, Inje University, Gimhae-si 50834, Korea;
| | - Jieun Hwang
- College of Health Science, Dankook University, Cheonan-si 31116, Korea
- Correspondence:
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Mohan A, Vadhariya A, Majd Z, Esse TW, Serna O, Abughosh SM. Impact of a motivational interviewing intervention targeting statins on adherence to concurrent hypertension or diabetes medications. PATIENT EDUCATION AND COUNSELING 2021; 104:1756-1764. [PMID: 33402279 DOI: 10.1016/j.pec.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study explored if a motivational interviewing intervention customized for statins impacted adherence to concomitantly used antidiabetic/antihypertensive medications. METHODS The intervention was conducted among patients with a history of suboptimal adherence to statins and included 152 patients in intervention and 304 controls. This retrospective study design identified patients with claims for statins and either antidiabetic/antihypertensive medications. The outcome variable was adherence, measured as proportion of days covered ≥ 0.80, to antidiabetic/antihypertensive medications. Multivariable linear and logistic regression evaluated the effect of intervention on adherence to antidiabetic/antihypertensive medications during the 6 months post-intervention. RESULTS The antidiabetic group had 53 intervention patients and 102 controls. The antihypertensive group had 80 intervention patients and 159 controls. There was no significant improvement in adherence for antidiabetic/antihypertensive medications following the intervention. Adherence at baseline was a significant predictor of adherence post-intervention in the antidiabetic (OR = 6.5;P < 0.0001) and antihypertensive (OR = 4.1; P = 0.0001 & β = 0.09; P = 0.008) users. Physician specialty (OR = 3.902; P = 0.01& β = 0.09; P = 0.015) among antidiabetic users and age >70 years (OR = 2.148; P = 0.025) among antihypertensive users were predictors of adherence. CONCLUSION The intervention targeting statin did not significantly improve antihypertensive/antidiabetic adherence. PRACTICE IMPLICATIONS Targeted interventions tailored to patient past adherence and specific medications should be explored.
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Affiliation(s)
- Anjana Mohan
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | - Aisha Vadhariya
- Duquesne University School of Pharmacy Graduate School of Pharmaceutical Sciences, 418A Mellon Hall, United States.
| | - Zahra Majd
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
| | | | - Omar Serna
- CareAllies, Houston, Texas, United States.
| | - Susan M Abughosh
- University of Houston College of Pharmacy, Department of Pharmaceutical Health Outcomes and Policy, United States.
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Harris LK, Skou ST, Juhl CB, Jäger M, Bricca A. Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis. Trials 2021; 22:396. [PMID: 34127042 PMCID: PMC8204443 DOI: 10.1186/s13063-021-05346-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 05/30/2021] [Indexed: 12/18/2022] Open
Abstract
AIM To quantify recruitment, retention and differential retention rates and associated trial, participant and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. DATA SOURCES MEDLINE, EMBASE, CINAHL and CENTRAL from 1990 to April 20, 2020. STUDY SELECTION RCTs including people with multimorbidity comparing exercise therapy with a non-exposed comparator group reporting at least one of the following outcomes: physical function, health-related quality of life, depression symptoms, or anxiety symptoms. DATA EXTRACTION AND SYNTHESIS Recruitment rates (proportion of people randomised/proportion of people eligible), retention rates (proportion of people providing the outcomes of interest/proportion randomised) and differential retention rates (difference in proportion of people providing the outcomes in the intervention group and comparator group) were calculated. Meta-analysis using a random-effects model was used to estimate pooled proportions. Methodological quality was assessed using Cochrane ´Risk of Bias tool 2.0´ for individual studies, and the GRADE approach was used to assess the overall quality of the evidence. RESULTS Twenty-three RCTs with 3363 people were included. The pooled prevalence for recruitment rate was 75% (95%CI 66 to 84%). The pooled prevalence for retention rate was 90% (95%CI 86 to 94%) at the end of the intervention (12 weeks; interquartile range (IQR) (12 to 12)). Meta-regression analyses showed that increasing age and including a higher proportion of people with hypertension was associated with lower retention rates. Retention rates did not differ between the intervention and comparator groups. The overall quality of the evidence was deemed very low. CONCLUSION Three in four eligible people with multimorbidity were randomised to RCTs using exercise therapy, of which nine out of 10 provided end of treatment outcomes with no difference seen between the intervention and comparison groups. However, the results must be interpreted with caution due to large differences between the included studies. TRIAL REGISTRATION ClinicalTrials.gov CRD42020161329 . Registered on 28 April 2020.
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Affiliation(s)
- Lasse K. Harris
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Carsten B. Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen Herlev and Gentofte, Copenhagen, Denmark
| | - Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
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Cardoso Barbosa H, de Queiroz Oliveira JA, Moreira da Costa J, de Melo Santos RP, Gonçalves Miranda L, de Carvalho Torres H, Pagano AS, Parreiras Martins MA. Empowerment-oriented strategies to identify behavior change in patients with chronic diseases: An integrative review of the literature. PATIENT EDUCATION AND COUNSELING 2021; 104:689-702. [PMID: 33478854 DOI: 10.1016/j.pec.2021.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Chronic diseases in the Americas account for about 80 % (5.2 million) of all deaths. Instruments are needed to enhance knowledge, skills, behavior change and self-care attitudes drawing on patient autonomy. OBJECTIVE To identify empowerment-oriented strategies focused on behavioral change in patients with chronic diseases. PATIENT INVOLVEMENT None. METHODS This is an integrative review of articles published from any period until June 2020 by journals indexed in the following databases: National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Biblioteca Virtual em Saúde (BVS). RESULTS Out of 1,287 articles, 25 met our selection criteria. Reported health interventions were based on self-management and behavior change, shared decisions and a personalized collaborative process, peer support and self-confidence, as well as strategies involving educational media and health literacy. DISCUSSION Over 80 % of health interventions were patient-centered and focused on patient knowledge and skill development towards personal goal setting, including effective problem-solving strategy development. Behavior change is not only an outcome of education, but also implicates revisiting values, attitudes, and experiences. Knowledge is important to facilitate decision-making leading to positive outcomes in chronic disease management. PRACTICAL VALUE Empowerment-oriented strategies are important tools for providing trust and motivation to people with chronic diseases. Healthcare professionals should support and encourage patient empowerment as a strategy for behavior change and able to offer qualified care for shared decision making. Thus, patients will be able to participate more actively in their own health condition management and to make decisions to promote self-care.
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Topriceanu CC, Wong A, Moon JC, Hughes AD, Bann D, Chaturvedi N, Patalay P, Conti G, Captur G. Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies. BMJ Open 2021; 11:e045813. [PMID: 33737441 PMCID: PMC7978270 DOI: 10.1136/bmjopen-2020-045813] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities. DESIGN Cross-sectional study. SETTING Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946). PARTICIPANTS A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants. MAIN OUTCOMES MEASURED The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown. INTERVENTIONS Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator. RESULTS Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression. CONCLUSION The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiac Imaging Department, Barts Heart Center, London, UK
| | - Alun D Hughes
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - David Bann
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Nishi Chaturvedi
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Praveetha Patalay
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK
| | - Gaby Captur
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London, UK
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Topriceanu CC, Wong A, Moon JC, Hughes AD, Bann D, Chaturvedi N, Patalay P, Conti G, Captur G. Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies. BMJ Open 2021. [PMID: 33737441 DOI: 10.1101/2020.09.12.20191973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities. DESIGN Cross-sectional study. SETTING Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946). PARTICIPANTS A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants. MAIN OUTCOMES MEASURED The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown. INTERVENTIONS Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator. RESULTS Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression. CONCLUSION The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiac Imaging Department, Barts Heart Center, London, UK
| | - Alun D Hughes
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - David Bann
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Nishi Chaturvedi
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Praveetha Patalay
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK
| | - Gaby Captur
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London, UK
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Lee E, Cha S, Kim GM. Factors Affecting Health-Related Quality of Life in Multimorbidity. Healthcare (Basel) 2021; 9:healthcare9030334. [PMID: 33809631 PMCID: PMC8001381 DOI: 10.3390/healthcare9030334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
We investigated the effect of predisposing, enabling, need factors, and health behaviors on health-related quality of life (HRQoL) of patients with multimorbidity according to Andersen's model. This study is a secondary analysis of population-based cross-sectional surveys. Data from 328 patients with multimorbidity (≥3 co-occurring chronic diseases) from the 6th/7th Korea National Health and Nutrition Examination Surveys were analyzed using logistic regression. Patients ≥65 years, without private insurance, with poor subjective health, unmet medical needs, and/or limited activity were more likely to experience mobility problems. Self-care problems were more likely among those without private insurance and/or with limited activity. Patients lacking living security, with poor subjective health, limited activity, and/or who smoked were more likely to experience problems performing usual activities. Pain/discomfort was more likely among females, Medicaid beneficiaries, and patients with limited activity and/or with poor subjective health. Patients with poor subjective health, limited activity, and/or unmet medical needs were more likely to experience anxiety/depression. The investigation of HRQoL in multimorbidity should consider predisposing, enabling, need factors, and health behaviors. Interventions addressing movement restrictions and personalized care based on HRQoL domains should be prioritized.
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Affiliation(s)
- Eunmi Lee
- Department of Nursing, Hoseo University, Asan 31499, Korea;
| | - Sunkyung Cha
- Department of Nursing Science, Sun Moon University, Asan 31460, Korea
- Correspondence: ; Tel.: +82-41-530-2743; Fax: +82-41-530-2725
| | - Geun Myun Kim
- Department of Nursing, Gangneung-Wonju National University, Wonju 26403, Korea;
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Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis. Sci Rep 2021; 11:5731. [PMID: 33707604 PMCID: PMC7952541 DOI: 10.1038/s41598-021-85126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36–2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12–3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02–1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.
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