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Caballero J, Patel N, Waldrop D, Ownby RL. Patient activation and medication adherence in adults. J Am Pharm Assoc (2003) 2024; 64:102025. [PMID: 38320653 PMCID: PMC11081861 DOI: 10.1016/j.japh.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Patients' level of medication adherence provides conflicting results in its relationship to patient activation. Multiple factors may be contributing to these mixed results. OBJECTIVES The primary purpose was to assess the association of patient activation to medication adherence in adults with chronic health conditions and low health literacy (HL). Secondary objectives were to determine whether age, education, gender, and race were associated with activation. METHODS Participants completed self-report questionnaires regarding chronic disease self-management. Patient activation was measured using Hibbard's Patient Activation Measure (PAM). Self-report of medication adherence was determined using the Gonzalez-Lu adherence questionnaire. Block regressions first assessed the relation of demographic variables and education to adherence and then the added relation of patient activation in a second model. RESULTS The analyses included 301 participants (mean age 58 years; 53% female; mean chronic conditions of 6.6). Some of the most common chronic conditions included hypertension (60%), arthritis (51%), depression (49%), and hyperlipidemia (43%). The relation of older age to greater medication adherence was significant (P < 0.05) in both models. The addition of PAM was significantly related to better adherence (P < 0.001) and also increased the R squared value from 0.04 to 0.09. This change resulted in a moderate effect size (d = 0.50). CONCLUSION Evaluating patient activation at baseline may predict those more likely to be medication adherent in patients with low HL.
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Holmen H, Flølo T, Tørris C, Løyland B, Almendingen K, Bjørnnes AK, Albertini Früh E, Grov EK, Helseth S, Kvarme LG, Malambo R, Misvær N, Rasalingam A, Riiser K, Sandbekken IH, Schippert AC, Sparboe-Nilsen B, Sundar TKB, Sæterstrand T, Utne I, Valla L, Winger A, Torbjørnsen A. Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics. Int J Environ Res Public Health 2023; 21:36. [PMID: 38248501 PMCID: PMC10815593 DOI: 10.3390/ijerph21010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.
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Affiliation(s)
- Heidi Holmen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Intervention Centre, Oslo University Hospital, 4950 Oslo, Norway
| | - Tone Flølo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Surgery, Voss Hospital, Haukeland University Hospital, 5704 Voss, Norway
| | - Christine Tørris
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Borghild Løyland
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kari Almendingen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ann Kristin Bjørnnes
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Elena Albertini Früh
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ellen Karine Grov
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Gravdal Kvarme
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Rosah Malambo
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Nina Misvær
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Anurajee Rasalingam
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Kirsti Riiser
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway
| | - Ida Hellum Sandbekken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Ana Carla Schippert
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Bente Sparboe-Nilsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
| | - Turid Kristin Bigum Sundar
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Torill Sæterstrand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Inger Utne
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), 0484 Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
| | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; (T.F.); (C.T.); (B.L.); (K.A.); (A.K.B.); (E.A.F.); (E.K.G.); (S.H.); (L.G.K.); (R.M.); (N.M.); (A.R.); (K.R.); (I.H.S.); (A.C.S.); (B.S.-N.); (T.K.B.S.); (T.S.); (I.U.); (L.V.); (A.W.); (A.T.)
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Ownby RL, Waldrop D, Davenport R, Simonson M, Caballero J, Thomas-Purcell K, Purcell D, Ayala V, Gonzalez J, Patel N, Kondwani K. A mobile app for chronic disease self-management for individuals with low health literacy: A multisite randomized controlled clinical trial. medRxiv 2023:2023.04.01.23288020. [PMID: 37066256 PMCID: PMC10104214 DOI: 10.1101/2023.04.01.23288020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Objective The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in older adult patients with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. Methods A randomized controlled trial was completed at two sites. Individuals 40 years of age and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. Results All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. Conclusions The mobile app was effective in increasing participants' levels of several psychosocial variables, but reading difficulty level was not significantly related to outcomes.Registered at clinicaltrials.gov NCT02922439.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta GA
| | - Rosemary Davenport
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Michael Simonson
- Instructional Technology and Distance Education Program, Fischler College of Education, Nova Southeastern University, Fort Lauderdale FL
| | | | | | - Donrie Purcell
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Victoria Ayala
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Juan Gonzalez
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Neil Patel
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL
| | - Kofi Kondwani
- Department of Community Health & Preventive Medicine, Morehouse School of Medicine, Fort Lauderdale FL
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Purcell DJ, Cavanaugh G, Thomas-Purcell KB, Caballero J, Waldrop D, Ayala V, Davenport R, Ownby RL. e-Health Literacy Scale, Patient Attitudes, Medication Adherence, and Internal Locus of Control. Health Lit Res Pract 2023; 7:e80-e88. [PMID: 37162255 PMCID: PMC10169461 DOI: 10.3928/24748307-20230417-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Health literacy is related to a variety of health outcomes, including disease control, health-related quality of life, and risk for death. Few studies have investigated the relation of electronic health literacy (e-health literacy) to outcomes or the mechanism by which they may be related. METHODS Secondary data were drawn from participants in a larger study on chronic disease self-management who were age 40 years and older, had at least one chronic health condition and a health literacy score of 8th grade or below on the validated short form of the Rapid Estimate of Adult Literacy in Medicine. Participants completed the e-Health Literacy Scale (eHEALS), the Multidimensional Health Locus of Control scale, a modified version of the Attitudes Toward Health Care Providers Scale (ATHCPS), the Wake Forest Physician Trust Scale (WFPTS), and the Gonzalez-Lu adherence questionnaire. Hypothesized relations were evaluated in a bootstrapped path analytic model using the Mplus statistical software. KEY RESULTS Participants included 334 individuals (mean age: 57.5 years; 173 women and 161 men) with Black, Indigenous, and People of Color accounting for 83.3% of the participants and White individuals making up 16.7% of the participants. Model results showed that after controlling for age, education, gender, and race, the eHEALS score was significantly related to the ATHCPS and WFPTS but not to the Gonzalez-Lu adherence questionnaire (p < .05). The eHEALS score was significantly related to the Multidimensional Health Locus of Control scale. Analysis of indirect effects showed that a portion of the relation between e-health literacy and patient attitude and adherence was mediated by internal locus of control (all p < .05). CONCLUSIONS In this study, e-health literacy was related to important patient attitude and behavior variables via locus of control. This finding has implications for the importance of improving patients' ability to use the internet to access and effectively use health information. [HLRP: Health Literacy Research and Practice. 2023;7(2):e80-e88.].
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Abbasi F, Khajouei R, Ahmadinejad M, Razban F, Jahani Y. Need assessment and development of a mobile-based medication dosage calculation application for ICU nurses. Health Technol 2023. [DOI: 10.1007/s12553-022-00720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Patel N, Waldrop D, Ownby RL. Creating a Tailored Info App to Promote Self-Management Skills in Persons with Chronic Health Conditions: Development Strategies and User Experience. Distance Learn (Greenwich) 2023; 20:9-18. [PMID: 38440090 PMCID: PMC10911517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Persons with chronic health conditions, such as heart disease, diabetes, hypertension, and others, often experience self-management problems that are not disease specific. These include disrupted sleep, pain, memory issues, and challenges in working with healthcare providers. These patients may benefit from information and skill development for these problems, but simply providing them information in brief sessions during clinical appointments or in handouts or pamphlets may not have a substantial impact on their behavior. Providing information tailored to persons' needs and individual characteristics has a greater impact on patients' behavior and may increase these persons' abilities to manage their health. Creating tailored information for each person, however, is labor intensive, making it difficult to use in everyday clinical practice. Computer-based tailoring is an alternative, allowing automated tailoring of information presented to patients based on their interactions with a computer app. The purpose of this article is to describe our process in developing a series of modules for chronic disease self-management for persons 40 years of age or older with one or more chronic health conditions.
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Affiliation(s)
- Neil Patel
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta GA USA
| | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale FL USA
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Ownby RL, Waldrop D. Cogstim: A Shared Decision-making Model to Support Older Adults' Brain Health. Curr Alzheimer Res 2023; 20:202-208. [PMID: 37231715 DOI: 10.2174/1567205020666230525110814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
The lack of effective treatments for cognitive decline in older adults has led to an interest in the possibility that lifestyle interventions can help to prevent changes in mental functioning and reduce the risk for dementia. Multiple lifestyle factors have been related to risk for decline, and multicomponent intervention studies suggest that changing older adults' behaviors can have a positive impact on their cognition. How to translate these findings into a practical model for clinical use with older adults, however, is not clear. In this Commentary, we propose a shared decision-making model to support clinicians' efforts to promote brain health in older persons. The model organizes risk and protective factors into three broad groups based on their mechanism of action and provides older persons with basic information to allow them to make evidence- and preference-based choices in choosing goals for effective brain health programs. A final component includes basic instruction in behavior change strategies such as goal setting, self-monitoring, and problem-solving. The implementation of the model will support older persons' efforts to develop a personally relevant and effective brainhealthy lifestyle that may help to reduce their risk for cognitive decline.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL, 33316, USA
| | - Drenna Waldrop
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Thomas-Purcell K, Davenport R, Ayala V, Purcell D, Ownby RL. Chronic Disease Self-Management of Post-Acute Sequelae of COVID-19 Among Older Adults: A Mixed-Methods Analysis. Clin Interv Aging 2023; 18:607-617. [PMID: 37082741 PMCID: PMC10112475 DOI: 10.2147/cia.s393732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/05/2023] [Indexed: 04/22/2023] Open
Abstract
Introduction Approximately 20-30% of individuals who contract acute coronavirus disease (COVID-19) infection develop longer term complications of their initial infection, referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC). PASC is characterized by chronic, varying symptomatology. Methods Using a mixed methods study design, we aimed to gain insight into individuals' experience with PASC, including cognitive issues, fatigue, and sleep disturbances. We explored whether our previously developed application (app), aimed at improving self-management skills among individuals with chronic diseases, is relevant for individuals with PASC and gained information to adapt the app for individuals with PASC. The study included 19 individuals, aged 40 years and older, recruited from our research participant database, Nova Southeastern University clinics, and community locations. We included this age range because older adults are more likely to have comorbid conditions, allowing us to better understand the impact of COVID-19 infection in these individuals. Participants completed seven standardized self-report questionnaires online, and an individual semi-structured interview via videoconferencing. Quantitative data were assessed using descriptive statistics and calculating individuals' scores in relation to norms. Qualitative data were analyzed using a thematic analysis approach. Triangulation of the data was accomplished by calculating correlations between participants' responses on self-report scales and themes found in semi-structured interviews. Results Themes included disruption of everyday life, diverse physical symptoms, and cognitive problems including brain fog, fatigue, coping, and emotional upset. Quantitative analysis demonstrated that participants experienced high levels of fatigue, negative mood, cognitive problems, and overall reduction in health-related quality of life (HRQOL). Correlation analyses revealed that individual interview responses were related to participants' self-report of symptoms on standard questionnaires. Discussion Findings indicate that self-report questionnaires may reflect the experience of individuals with PASC and its impact. Additionally, further efforts to expand our prior mobile app are warranted among individuals with PASC.
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Affiliation(s)
| | - Rosemary Davenport
- Department of Psychiatry, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Victoria Ayala
- Department of Psychiatry, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Donrie Purcell
- Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Raymond L Ownby
- Department of Psychiatry, Nova Southeastern University, Ft. Lauderdale, FL, USA
- Correspondence: Raymond L Ownby, Nova Southeastern University, Center for Collaborative Research Suite 430, 3301 College Avenue, Ft. Lauderdale, FL, 33314, USA, Tel +1-954-608-4846, Email
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Thomas-Purcell K, Ibe TA, Purcell D, Quinn G, Ownby R. Exploring Spirituality and Technology Receptivity Among a Sample of Older Blacks to Inform a Tailored Chronic Disease Self-Management mHealth Intervention. Patient Relat Outcome Meas 2020; 11:195-207. [PMID: 33117016 PMCID: PMC7553651 DOI: 10.2147/prom.s260949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
Introduction Having multiple chronic conditions (MCC) is the most common health condition in older US adults of which Blacks are disproportionally affected. The management of each condition presents many challenges. Blacks in the US frequently cite spirituality as facilitator to well-being. More information is needed to understand the many aspects of spirituality that older Black patients use to manage MCCs. Methods In the current study, focus groups were conducted with 30 black men and women with MCCs to examine how spirituality can be incorporated into a mobile health intervention designed to increase chronic disease self-management (CDSM) skills by improving health literacy. Groups discussed spiritual practices used to facilitate CDSM and their perceptions about mobile technology use. Results Inductive thematic analysis suggested that a chronic disease wellness plan that acknowledges the relationship between spirituality and health was preferred by most participants. Additionally, the desire for mobile health (mHealth) among this group points to an opportunity for intervention. Discussion Creating culturally appropriate educational messages about CDSM that incorporate spiritual practices may be a useful method for building sustainable CDSM skills. Next steps include the development of a mHealth intervention prototype based on the results and pre-testing it prior to deployment.
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Affiliation(s)
- Kamilah Thomas-Purcell
- Department of Health Science, Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Tochukwu Adaobi Ibe
- Mayo Clinic, College of Medicine and Science, Department of Internal Medicine, Jacksonville, FL, USA
| | - Donrie Purcell
- Department of Psychiatry, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Gwendolyn Quinn
- Department of OB-GYN, Department of Population Health, New York University, Langone Medical Center, New York, NY, USA
| | - Raymond Ownby
- Department of Psychiatry, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Nichols M, Teufel R, Miller S, Madisetti M, Giovanni CS, Chike-Harris K, Jones L, Prentice M, Ruggiero K, Kelechi T. Managing Asthma and Obesity Related Symptoms (MATADORS): An mHealth Intervention to Facilitate Symptom Self-Management among Youth. Int J Environ Res Public Health 2020; 17:E7750. [PMID: 33470991 DOI: 10.3390/ijerph17217750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
Youth with multi-morbidity (one or more chronic diseases) are at increased risk of further morbidity and early mortality as they enter their adult years. Recent increases in both asthma and obesity among youth have led to high health care utilization, increased health related complications, and expanded risks of subsequent cardiovascular disease burden. Common symptoms seen with asthma and obesity include fatigue, pain, depression, and anxiety. These symptoms can result in decreased physical activity, social isolation, and poor quality of life, which also may contribute to increased morbidity and mortality over time. Youth ages 10–17 are in a transitionary period where their overall health and disease management shifts from one of parental oversight to one where the youth gradually experience increased autonomy over their health and care management. Managing Asthma and Obesity Related Symptoms (MATADORS), is a mHealth technology-enhanced nurse-guided intervention that incorporates a novel mobile health application and motivational enhancement principles within a behavioral activation framework. Providing high-risk youth with strategies to enhance symptom self-management may result in decreased symptom prevalence, improved quality of life, and long-term reduction of cardiovascular morbidity and mortality as they move into adulthood. Moreover, developing low-cost, scalable tools with end-user input may facilitate promote early intervention and improved access to care, and reduce overall disease burden and healthcare costs.
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Wehmeier PM, Fox T, Doerr JM, Schnierer N, Bender M, Nater UM. Development and Validation of a Brief Measure of Self-Management Competence: The Self-Management Self-Test (SMST). Ther Innov Regul Sci 2019:2168479019849879. [PMID: 31303020 DOI: 10.1177/2168479019849879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Self-management can be considered a way of dealing with oneself and relates to actions undertaken to create order, discipline, and control. The concept is closely linked to concepts of self-efficacy and self-regulation but can be distinguished from these. The Self-Management Self-Test (SMST) is a 5-item assessment scale designed to measure self-management competence in individuals with or without a psychiatric disorder (as screened using PHQ). The aim of this study was to validate the SMST in terms of convergent validity, the ability to differentiate, criterion validity, internal consistency, and test-retest reliability. METHODS Eighty-seven adults hospitalized for treatment of major depression (clinical sample) and 595 individuals from the general population (population sample) filled out the SMST and 5 other stress-related psychometric instruments measuring similar constructs. All instruments were repeated 4 to 6 weeks later. Convergent validity, internal consistency, and test-retest reliability were tested based on data from the population sample. Convergent validity was determined by correlations with other stress-related psychometric instruments. Correlations in the range of r = -0.4 to -0.6 were expected. To test for criterion validity, the clinical sample was matched with a subsample from the population sample, consisting only of individuals without a psychiatric disorder as screened using PHQ (nonclinical subsample, n = 87). The ability to differentiate was based on receiver operating characteristic (ROC) curve analysis. RESULTS Correlations between the SMST and the other stress-related tests were significant and in the expected direction and predominantly within the expected range (Pearson r = -0.40 to -0.64). The correlation with the Multidimensional Fatigue Inventory-20, measuring fatigue, and with the dimensional scale for depression in the PHQ was higher than expected and referred to very similar items. Thus, convergent validity mainly lay within the expected range. Internal consistency was high (Cronbach α = 0.80), and test-retest reliability was fairly low (r = 0.71). The SMST showed a significant difference, t(157) = 7.97, P < .001, between the clinical sample (M = 9.36, SD = 3.39) and the nonclinical subsample (M = 12.94, SD = 2.47) with a large effect size (d = 1.3). The area under the ROC curve (AUC) was excellent (AUC = 0.81, SE = 0.034, P < .001), suggesting that the SMST can distinguish between the clinical and nonclinical samples. CONCLUSIONS The SMST can be considered an effective self-rating test to assess self-management competence in individuals from the general population as well as in people with major depression. It may also be useful to detect treatment outcomes in people with major depression. The high internal consistency indicates that all 5 items are important for the test as a whole. The low test-retest reliability suggests sensitivity to change. The SMST is likely to differentiate particularly well at low levels of self-management competence, suggesting it may be a useful tool in studies investigating people with depression or other psychiatric disorders such as post-traumatic stress disorder. Furthermore, the SMST could be useful in assessing the effect of treatment interventions over time and evaluating patient-reported outcomes.
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Affiliation(s)
- Peter M Wehmeier
- 1 Vitos Hospital for Psychiatry and Psychotherapy, Weilmuenster, Germany
| | - Theresa Fox
- 2 Department of Psychology, University of Berlin, Berlin, Germany
| | - Johanna M Doerr
- 3 Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- 4 Department of Psychology, University of Marburg, Marburg, Germany
| | - Nadja Schnierer
- 1 Vitos Hospital for Psychiatry and Psychotherapy, Weilmuenster, Germany
| | - Matthias Bender
- 5 Vitos Hospital for Psychiatry and Psychotherapy, Kassel, Germany
| | - Urs M Nater
- 6 Department of Psychology, University of Vienna, Vienna, Austria
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Hajesmaeel Gohari S, Gozali E, Niakan Kalhori SR. Virtual reality applications for chronic conditions management: A review. Med J Islam Repub Iran 2019; 33:67. [PMID: 31456991 PMCID: PMC6708122 DOI: 10.34171/mjiri.33.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Virtual Reality (VR) as a computer technology that simulating real environments and situations exploited in numerous healthcare areas such as chronic diseases. The significance of timely treatment and rehabilitation of patients with chronic conditions is high due to the long lasting nature of these conditions. This paper sought to perform a review of published works in the field of VR application in chronic conditions for treatment and rehabilitation purposes.
Methods: We searched the MEDLINE database through PubMed in April 2016 for retrieving published papers from January 2001 to December 2015. From 117 retrieved papers, 52had the inclusion criteria, and their full texts were accessible. Data were extracted from papers based on following items: the name of the first author, year of the study, applied VR methods, type of condition and disease, number of subjects that participated in the study, and finally the status of success and failure of VR application. Data were analyzed using descriptive analysis.
Results: Results of the reviewed investigations have been considered in two main categories including treatment oriented papers (n=38, 73%) while twenty of these papers have been conducted on phobias (53%); also, there are rehabilitation-oriented experiments (n=14, 27%) while thirteen of these papers have been performed on stroke. In 40 papers (77%), the VR technology application reported proper and in 11 papers (21%) the application of VR resulted in relatively proper outcomes and only there is a work (2%) with poor results for VR intervention.
Conclusion: VR technology has been increasingly used in recent years for treatment and rehabilitation purposes among patients affected by chronic conditions in order to motivate them for more successful management.
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Affiliation(s)
- Sadrieh Hajesmaeel Gohari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Gozali
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Ownby RL, Acevedo A, Waldrop-Valverde D. Enhancing the Impact of Mobile Health Literacy Interventions to Reduce Health Disparities. Q Rev Distance Educ 2019; 20:15-34. [PMID: 31537979 PMCID: PMC6752043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health literacy is a key factor in health outcomes that should be considered when creating mobile health promotion apps. In this paper, we detail our work over the past 10 years in developing the theory and practice of targeting the content of mobile apps at a level appropriate for the intended audience. We include a review of our theory of health literacy as expertise, the ASK model, and integrate it with the Theory of Planned Behavior. We then provide data that support both the model and its use. More recently, we have developed a predictive analytic model that uses demographic information and patient performance on a 10-item screening measure to determine patient level of health literacy at a high level of accuracy. The predictive model will enable apps to automatically provide content to users at an appropriate level of health literacy. This strategy, along with other aspects of tailoring, will allow apps to be more personally relevant to users, enhancing their effects in promoting health behavior change.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Amarilis Acevedo
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL
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