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Zoffmann V, Jørgensen R, Graue M, Biener SN, Brorsson AL, Christiansen CH, Due-Christensen M, Enggaard H, Finderup J, Haas J, Husted GR, Johansen MT, Kanne KL, Hope Kolltveit BC, Krogslund KW, Lie SS, Lindholm AO, Marqvorsen EHS, Mathiesen AS, Olesen ML, Rasmussen B, Rothmann MJ, Simonsen SM, Tackie SHS, Thisted LB, Tran TM, Weis J, Kirkevold M. Person-specific evidence has the ability to mobilize relational capacity: A four-step grounded theory developed in people with long-term health conditions. Nurs Inq 2023:e12555. [PMID: 37062853 DOI: 10.1111/nin.12555] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023]
Abstract
Person-specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self-determination method with people with various long-term health conditions. It explains the mechanisms of mobilizing relational capacity by including person-specific evidence in shared decision-making. Person-specific self-insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self-management challenges. This step paved the way for sharing these insights and challenges in a relationship with a supportive health professional, who could then rely on person-specific evidence instead of assumptions or a narrow disease perspective for shared decision-making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person-specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self-insights in daily life with other people, decreasing loneliness they experienced in self-management. Relational capacity, the core of the theory, is mobilized in both people with long-term health conditions and healthcare professionals. Further research on person-specific evidence and relational capacity in healthcare is recommended.
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Affiliation(s)
- Vibeke Zoffmann
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Rikke Jørgensen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sigrid Normann Biener
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Cecilie Holm Christiansen
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Mette Due-Christensen
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Enggaard
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Research Unit for Child and Adolescent Psychiatry, Unit for Psychiatric Research and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Josephine Haas
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | | | - Katja Lisa Kanne
- Department of Infectious Diseases Centre of Excellence for Health, Immunity, and Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen Ø, Denmark
| | - Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Vossevangen Medical Center, Voss, Norway
| | | | - Silje S Lie
- Faculty of Health, VID Specialized University, Sandnes, Norway
| | - Anna Olinder Lindholm
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Emilie H S Marqvorsen
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Anne Sophie Mathiesen
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
- Department of Endocrinology, Center for Cancer and Organ Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Mette Linnet Olesen
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
- Department of Gynaecology, Juliane Marie Centre: Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Bodil Rasmussen
- Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Mette Juel Rothmann
- Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Odense M, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Susan Munch Simonsen
- Centre for Human Resources and Education, The Capital Region of Denmark, Hellerup, Denmark
| | - Sara Huld Sveinsdóttir Tackie
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Lise Bjerrum Thisted
- Klinik for Senfølger efter Kraeft, Klinisk Onkologisk Afdeling og Palliative Enheder, Sjaellands Universitetshospital - Roskilde, Roskilde, Denmark
| | - Trang Minh Tran
- The Interdisciplinary Research Unit of Women's, Children's and Families' Health, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Janne Weis
- Department of Neonatology, Juliane Marie Centre: Copenhagen University Hospital, Rigshospitalet, Copenhagen Ø, Denmark
| | - Marit Kirkevold
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Kaae S, Rossing C, Husted GR, Fosgerau CF. How patient-centredness takes place in pharmacy encounters: a critical common-sense interpretation of video-recorded meetings. Int J Clin Pharm 2023; 45:146-153. [PMID: 36371584 DOI: 10.1007/s11096-022-01508-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/16/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Counselling patients in community pharmacies is important to obtain the best usage of medicines. However, it does not seem to be sufficiently patient-centred. To become more patient-centred, communication guidelines could be used but the guidelines need to be supplemented with up-to-date research that specifies how patient-centredness takes place or could take place in the pharmacy encounters. AIM To use a qualitative methodology to investigate how patient-centeredness unfolds in Danish pharmacy encounters by analysing video-recorded encounters. METHOD A maximal variation sampling strategy was applied, including staff from 2 pharmacies. A preunderstanding of 'patient-centredness' guided the analyses with focus on the development of relationships, understanding the patient's situation, and coordination of care. Data were then subjected to a 'critical common-sense' interpretation. To validate identified themes, 'structural corroboration', 'researcher triangulation', and a 'meaning saturation process' were carried out. RESULTS Nineteen encounters were included. Overall, the staff took responsibility for ensuring patients' optimal medicine use and focused on biomedical aspects of the treatment. Important messages conveyed by staff appeared to be that there is one correct way of taking medicines and that taking the medicine is an uncomplicated process. Patients were rarely invited to provide their perspective. CONCLUSION Staff showed commitment to ensuring patients' optimal medicine use, but during this process, they predominantly relied on a reductionist approach to medicine. This must be addressed as it hampers patient-centredness. Suggestions for how to become more patient-centred are given.
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Affiliation(s)
- Susanne Kaae
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Universitetsparken 2, 2100, Copenhagen Ø, Denmark.
| | - Charlotte Rossing
- Pharmakon - Danish College of Pharmacy Practice, Milnersvej 42, 3400, Hillerød, Denmark
| | | | - Christina Fogtmann Fosgerau
- Psychology of Language, Department of Nordic Studies and Linguistics, University of Copenhagen, Njalsgade 120, 2300, Copenhagen S, Denmark
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Husted GR, Hansen RN, El-Souri M, Lorenzen JK, Iversen PB, Rossing CV. What do persons with diabetes want from community pharmacies? A qualitative study. Pharm Pract (Granada) 2022; 20:2677. [PMID: 35919802 PMCID: PMC9296095 DOI: 10.18549/pharmpract.2022.2.2677] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/14/2022] Open
Abstract
Background Diabetes is a demanding disease with a complex treatment regimen. Many persons with diabetes have difficulty managing their disease and taking medication as prescribed, possibly because they lack knowledge and sometimes misinterpret medical benefits. Community pharmacies continuously provide professional counselling to persons with diabetes. Objective This study aimed to explore 1) which services adults with type 1 and type 2 diabetes want from community pharmacies and 2) how pharmacies can meet these wishes. Methods A qualitative, explorative study design using focus group interviews was chosen. Informants were recruited from Region Zealand in Denmark. Data were digitally recorded, transcribed verbatim and analyzed by means of thematic analysis. Results Thirteen adults (11 female) with the mean age of 66.2 years (range 49-81 years) participated in one physical (n=6) or one online (n=7) focus group interview. Ten had type 2 diabetes, three had type 1 diabetes. The average duration of participants' diabetes was 13.4 years (range 2.3-33.0 years). The analysis revealed three overall themes of the functions which the informants would like community pharmacies to fulfil: 1) raise awareness of pharmacies' counselling service and competences; 2) act as a dialogue partner; 3) be a source of information and guidance about local activities and support. Conclusion The informants did not regard community pharmacies as a natural part of the healthcare system or as a place where they would expect counselling. They would like the community pharmacy to make their medical competences and services obvious and the community pharmacy staff to act as a dialogue partner and provide competent counselling. The informants would like to have a contact person with diabetes competences with whom they can book an appointment to complement over-the-counter counselling. They experience a gap in their care between routine visits in the healthcare system and suggest that community pharmacies counselling services become a natural supplement and that healthcare professionals in the primary and secondary sectors inform patients about the services - especially for patients newly diagnosed with diabetes. Finally, they would like a formal collaboration between diabetes associations and community pharmacies to make their competences, services and information visible.
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Affiliation(s)
- Gitte Reventlov Husted
- PhD, MScN, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Rikke Nørgaard Hansen
- MSc Pharmacy, Head of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | - Mira El-Souri
- MSc Pharmacy, Consultant, Department of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
| | | | | | - Charlotte Verner Rossing
- PhD, MSc. Pharmacy, Director of Research and Development, Danish College of Pharmacy Practice, Pharmakon, Denmark.
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Fosgerau CF, Husted GR, Clemmensen NB, Rossing CV, Kaae S. Using qualitative methods to explore the dynamics of patients’ perspective sharing in community pharmacy counseling–conversation analysis and video-stimulated recall interviews. Pharm Pract (Granada) 2022; 19:2582. [PMID: 35474642 PMCID: PMC9013196 DOI: 10.18549/pharmpract.2021.4.2582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background: For patient centered counseling to take place in community pharmacies, patients should feel encouraged to share their perspectives, yet studies show that this rarely happens. The process of patient perspective sharing relies on the interactional details that unfold during an encounter i.e. how patients verbally and nonverbally are encouraged to share their perspective, which in turn is affected by patients’ and pharmacy staff members’ psychological processes in the situation, i.e. how they perceive and feel when acting. Therefore, employing complimentary methods that study both interactional and psychological processes could deepen the understanding of the dynamics governing patients’ perspective sharing in pharmacy encounters. Objective: The objective of this study is twofold: 1) a methodological consideration of the benefits of employing Conversation Analysis (CA) and Video-Stimulated Recall Interviews (VSRI) in parallel, 2) to use the methodological combination to understand patient perspective sharing in community pharmacy interactions. Method: A single case study of one pharmacy encounter to explore the objectives in-depth. This was done through video recording of pharmacy encounters and subsequent CA-analysis; VSRIs were conducted with the involved patient and pharmacy staff member and analyzed using a qualitative thematic approach. Results: By exploring detailed interactional and psychological processes in parallel, specific occurrences which might hinder patients’ perspective sharing were revealed. CA demonstrated that staff member’s listening activities restricted the patient’s perspective sharing. VSRIs with patient and staff member supported this result: the staff member had a narrow conception of what counted as suitable answers and did not consider listening an active process. The patient harbored shame about needing to take the medication which affected her behavior during the encounter. Conclusion: The novelty of the methodological combination is promising in order to grasp the complex process of patient perspective sharing in pharmacy encounters, as it affords aspects such as emotionality to be considered a central part of pharmacy encounters. As a consequence, it is suggested that the psychological concept of mentalizing is added to pharmacy education, as it is a trainable capacity enabling staff to become aware of the mental states that affect both patients and staff themselves during the pharmacy encounter.
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Affiliation(s)
| | - Gitte Reventlov Husted
- PhD. Consultant Research and Development, Pharmakon - The Danish College of Pharmacy Practice, Research and Development, Denmark.
| | | | - Charlotte Verner Rossing
- PhD. Director of Research and Development, Pharmakon - The Danish College of Pharmacy Practice, Research and Development, Denmark.
| | - Susanne Kaae
- PhD. Associate Professor, University of Copenhagen, Denmark.
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Varming AR, Rasmussen LB, Husted GR, Olesen K, Grønnegaard C, Willaing I. Improving empowerment, motivation, and medical adherence in patients with poorly controlled type 2 diabetes: A randomized controlled trial of a patient-centered intervention. Patient Educ Couns 2019; 102:2238-2245. [PMID: 31239180 DOI: 10.1016/j.pec.2019.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/24/2018] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To test whether an intervention consisting of four patient-centered consultations improves glycemic control and self-management skills in patients with poorly regulated type 2 diabetes (T2DM), compared to a control group receiving usual care. METHODS Unblinded parallel randomized controlled trial including 97 adults diagnosed with T2DM ≥ 1 year and hemoglobin A1c (HbA1c) levels ≥ 8.0% (64 mmol/mol). Consultations incorporated tools supporting self-reflection, learning processes, and goal setting. Primary outcome was HbA1c. Secondary outcomes were autonomy support, motivation, self-management skills, and well-being. RESULTS Average HbA1c decreased slightly in both groups. Autonomy support and frequency of healthy eating were significantly higher in the intervention group. Most participants in the intervention group chose to set goals related to diet and physical exercise. Implementation of the intervention was inconsistent. CONCLUSION Despite increased autonomy support and individual goal-setting, the intervention was not superior to usual care in terms of glycemic control. More research is needed on how individual preferences and goals can be supported in practice to achieve sustainable behavior changes. PRACTICE IMPLICATIONS The intervention promoted participant engagement and supported exploration of participants' challenges and preferences. Further exploration of more flexible use of tools adapted to individual contexts is recommended.
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Affiliation(s)
- Annemarie R Varming
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Lone Banke Rasmussen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | | | - Kasper Olesen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Cecilia Grønnegaard
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
| | - Ingrid Willaing
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
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Castensøe-Seidenfaden P, Husted GR, Jensen AK, Hommel E, Olsen B, Pedersen-Bjergaard U, Kensing F, Teilmann G. Testing a Smartphone App (Young with Diabetes) to Improve Self-Management of Diabetes Over 12 Months: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e141. [PMID: 29945861 PMCID: PMC6039771 DOI: 10.2196/mhealth.9487] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/22/2018] [Accepted: 03/31/2018] [Indexed: 01/01/2023] Open
Abstract
Background Young people often struggle to self-manage type 1 diabetes during the transition from childhood to adulthood. Mobile health (mHealth) apps may have the potential to support self-management, but evidence is limited and randomized controlled trials are needed. Objective We assessed whether the mHealth app “Young with Diabetes” improved young people’s self-management measured by glycated hemoglobin (HbA1c) and three self-reported psychometric scales. Methods Young people (14-22 years) with inadequate glycemic control and their parents were enrolled in a randomized controlled trial and assigned either to Young with Diabetes and usual care (Young with Diabetes group) or to usual care alone (control). Young with Diabetes use was monitored; functions included a chat room, contact the health care provider, reminders, tips, information about the diabetes department and type 1 diabetes topics, carbohydrate counting, and a parents’ section. Outcomes included HbA1c and three self-reported psychometric scales: Perceived Competence in Diabetes Scale; Health Care Climate Questionnaire; and Problem Areas In Diabetes care survey. Data were collected at baseline and at 2, 7, and 12 months. Results A total of 151 young people were randomized (Young with Diabetes group=76, control=75) and 49 parents agreed to participate. At 12 months, HbA1c was significantly higher (4.1 mmol/mol; 0.4 %) in the Young with Diabetes group, compared to the control group (P=.04); this finding did not occur when comparing app users (Young with Diabetes use ≥5 days) with nonusers. Young people used Young with Diabetes on a mean of 10.5 days. They spent the most time chatting about alcohol and searching for information about sex. Most young people and half of the parents reported that Young with Diabetes helped them. More than 80% would recommend Young with Diabetes to peers. Conclusions Young with Diabetes did not improve HbA1c, but it may be a useful complement to self-management. Qualitative evaluation is needed to explore benefits and shortcomings of Young with Diabetes. Health care providers should address young peoples’ knowledge about sensitive topics, provide them with peer support, and be aware of parents’ need for information about how to support Trial Registration ClinicalTrials.gov NCT02632383; https://clinicaltrials.gov/ct2/show/NCT02632383 (Archived by WebCite at http://www.webcitation.org/6zCK2u7xM)
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Affiliation(s)
| | - Gitte Reventlov Husted
- Nordsjællands Hospital, Pediatric and Adolescent Department, University of Copenhagen, Hillerød, Denmark
| | - Andreas Kryger Jensen
- Institute of Public Health, Biostatistics, University of Copenhagen, Copenhagen, Denmark.,Nordsjællands Hospital, Department of Clinical Research, University of Copenhagen, Hillerød, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Copenhagen, University of Copenhagen, Gentofte, Denmark
| | - Birthe Olsen
- Herlev Hospital, Pediatric and Adolescent Department, University of Copenhagen, Herlev, Denmark
| | - Ulrik Pedersen-Bjergaard
- Nordsjællands Hospital, Department of Cardiology, Nephrology, and Endocrinology, University of Copenhagen, Hillerød, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Nordsjællands Hospital, Pediatric and Adolescent Department, University of Copenhagen, Hillerød, Denmark
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Husted GR, Weis J, Teilmann G, Castensøe-Seidenfaden P. Exploring the Influence of a Smartphone App (Young with Diabetes) on Young People's Self-Management: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e43. [PMID: 29490897 PMCID: PMC5856925 DOI: 10.2196/mhealth.8876] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 12/14/2022] Open
Abstract
Background Adequate self-management is the cornerstone of preventing type 1 diabetes mellitus (T1DM) complications. However, T1DM self-management is challenging for young people, who often struggle during the transition from childhood to adulthood. The mobile health (mHealth) app Young with Diabetes (YWD) was developed in collaboration with young people to enhance their T1DM self-management during this transition. Objective The purpose of this study was to explore the influence of YWD on young people’s self-management during a 12-month period. Methods A qualitative explorative approach was used, comprising a purposive sample of 20 young people (11 females and 9 males, ages 15 to 23 years, with app use of 3 to 64 days) from 3 pediatric and 3 adult departments. Participants were interviewed individually using a semistructured interview guide. Data were collected from January to March 2017 and analyzed using thematic analysis. Results A total of 5 themes were identified: (1) not feeling alone anymore (“we are in this together”); (2) gaining competence by sharing experiences and practical knowledge (“they know what they are talking about”); (3) feeling safer (“it’s just a click away”); (4) breaking the ice by starting to share thoughts and feelings and asking for help (“it is an outstretched hand”); and (5) lack of motivating factors (“done with the app”). Young people reported that YWD promoted self-management by peer-to-peer social support, exchanging messages with health care providers, and sharing YWD with parents. Participants recommended YWD as a supplement to self-management for newly diagnosed young people with T1DM and suggested improvements in app content and functionality. Conclusions The mHealth app YWD has the potential to support self-management. In particular, peer-to-peer support reduced feelings of loneliness and helped young people to gain knowledge and skills for managing T1DM. A need exists for alternative ways to train health care providers in using YWD and to support collaboration between young people and their parents to further improve young people’s self-management of T1DM.
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Affiliation(s)
- Gitte Reventlov Husted
- Pediatric and Adolescent Department, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Janne Weis
- Department of Neonatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Pediatric and Adolescent Department, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
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Castensøe-Seidenfaden P, Reventlov Husted G, Teilmann G, Hommel E, Olsen BS, Kensing F. Designing a Self-Management App for Young People With Type 1 Diabetes: Methodological Challenges, Experiences, and Recommendations. JMIR Mhealth Uhealth 2017; 5:e124. [PMID: 29061552 PMCID: PMC5673883 DOI: 10.2196/mhealth.8137] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 12/25/2022] Open
Abstract
Background Young people with type 1 diabetes often struggle to self-manage their disease. Mobile health (mHealth) apps show promise in supporting self-management of chronic conditions such as type 1 diabetes. Many health care providers become involved in app development. Unfortunately, limited information is available to guide their selection of appropriate methods, techniques, and tools for a participatory design (PD) project in health care. Objective The aim of our study was to develop an mHealth app to support young people in self-managing type 1 diabetes. This paper presents our methodological recommendations based on experiences and reflections from a 2-year research study. Methods A mixed methods design was used to identify user needs before designing the app and testing it in a randomized controlled trial. App design was based on qualitative, explorative, interventional, and experimental activities within an overall iterative PD approach. Several techniques and tools were used, including workshops, a mail panel, think-aloud tests, and a feasibility study. Results The final mHealth solution was “Young with Diabetes” (YWD). The iterative PD approach supported researchers and designers in understanding the needs of end users (ie, young people, parents, and health care providers) and their assessment of YWD, as well as how to improve app usability and feasibility. It is critical to include all end user groups during all phases of a PD project and to establish a multidisciplinary team to provide the wide range of expertise required to build a usable and useful mHealth app. Conclusions Future research is needed to develop and evaluate more efficient PD techniques. Health care providers need guidance on what tools and techniques to choose for which subgroups of users and guidance on how to introduce an app to colleagues to successfully implement an mHealth app in health care organizations. These steps are important for anyone who wants to design an mHealth app for any illness.
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Affiliation(s)
| | - Gitte Reventlov Husted
- Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød, University of Copenhagen, Hillerød, Denmark
| | - Grete Teilmann
- Pediatric and Adolescent Department, Nordsjællands Hospital, Hillerød, University of Copenhagen, Hillerød, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Gentofte, Denmark
| | - Birthe Susanne Olsen
- Pediatric and Adolescent Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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Castensøe-Seidenfaden P, Jensen AK, Smedegaard H, Hommel E, Husted GR, Pedersen-Bjergaard U, Teilmann G. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med 2017; 34:667-675. [PMID: 28099760 DOI: 10.1111/dme.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Abstract
AIMS To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control. METHODS Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS Among 126 participants, the mean HbA1c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS Glycaemic control improved significantly after transfer to adult care, but the mean HbA1c level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA1c levels and thereby reduce hospitalization rates.
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Affiliation(s)
| | - A K Jensen
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - H Smedegaard
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - E Hommel
- Steno Diabetes Centre, Gentofte, Denmark
| | - G R Husted
- Steno Diabetes Centre, Gentofte, Denmark
| | - U Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerød, Denmark
| | - G Teilmann
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
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Abstract
The purpose of this study was to investigate whether glycaemic control and diabetes self-management could be improved in patients with type-2 diabetes following education using the EMMA dialogue tools facilitated by a health care professional. Glycosylated haemoglobin (HbA1c) and Summary of Diabetes Self Care Activities (SDSCA) scores were collected at baseline and three months after the intervention from 22 participating patients. Participants significantly improved self-reported foot care (P<0.001) and exercise (P<0.001) whereas no significant changes were found in HbA1c (P=0.606) blood sugar measurements (P=0.213), and diet (P=0.061). In conclusion, the dialogue tools had a positive effect by improving diabetes self-management regarding foot care and exercise. The purpose of this study was to investigate whether glycaemic control and diabetes self-management could be improved in patients with type-2 diabetes following education using the EMMA dialogue tools facilitated by a health care professional. Glycosylated haemoglobin (HbA1c) and Summary of Diabetes Self Care Activities (SDSCA) scores were collected at baseline and three months after the intervention from 22 participating patients. Participants significantly improved self-reported foot care (P<0.001) and exercise (P<0.001) whereas no significant changes were found in HbA1c (P=0.606) blood sugar measurements (P=0.213), and diet (P=0.061). In conclusion, the dialogue tools had a positive effect by improving diabetes self-management regarding foot care and exercise.
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Castensøe-Seidenfaden P, Teilmann G, Kensing F, Hommel E, Olsen BS, Husted GR. Isolated thoughts and feelings and unsolved concerns: adolescents' and parents' perspectives on living with type 1 diabetes - a qualitative study using visual storytelling. J Clin Nurs 2017; 26:3018-3030. [PMID: 27865017 DOI: 10.1111/jocn.13649] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe the experiences of adolescents and their parents living with type 1 diabetes, to identify their needs for support to improve adolescents' self-management skills in the transition from child- to adulthood. BACKGROUND Adolescents with type 1 diabetes often experience deteriorating glycaemic control and distress. Parents are important in adolescents' ability to self-manage type 1 diabetes, but they report anxiety and frustrations. A better understanding of the challenges adolescents and parents face, in relation to the daily self-management of type 1 diabetes, is important to improve clinical practice. DESIGN A qualitative explorative study using visual storytelling as part of individual interviews. METHODS A purposive sample of nine adolescents and their parents (seven mothers, six fathers) took photographs illustrating their experiences living with type 1 diabetes. Subsequently, participants were interviewed individually guided by participants' photographs and a semistructured interview guide. Interviews were analysed using thematic analysis. RESULTS Four major themes were consistent across adolescents and their parents: (1) striving for safety, (2) striving for normality, (3) striving for independence and (4) worrying about future. Although adolescents and parents had same concerns and challenges living with type 1 diabetes, they were experienced differently. Their thoughts and feelings mostly remained isolated and their concerns and challenges unsolved. CONCLUSIONS The concerns and challenges adolescents and their parents face in the transition from child- to adulthood are still present despite new treatment modalities. Parents are fundamental in supporting the adolescents' self-management-work; however, the parties have unspoken concerns and challenges. RELEVANCE TO CLINICAL PRACTICE Healthcare providers should address the parties' challenges and concerns living with type 1 diabetes to diminish worries about future including fear of hypoglycaemia, the burden of type 1 diabetes and the feeling of being incompetent in diabetes self-management. It is important to focus on supporting both adolescents and their parents, and to provide a shared platform for communication.
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Affiliation(s)
| | - Grete Teilmann
- Pediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Eva Hommel
- Steno Diabetes Center, Gentofte, Denmark
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12
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Abstract
Aim of the database The aim of the Danish Adult Diabetes Registry (DADR) is to provide data from both the primary health care sector (general practice [GP]) and the secondary sector (specialized outpatient clinics) to assess the quality of treatment given to patients with diabetes. The indicators represent process and outcome indicators selected from the literature. Study population The total diabetes population in Denmark is estimated to be ~300,000 adult diabetes patients. Approximately 10% have type 1 diabetes, which is managed mainly in the secondary sector, and 90% have type 2 diabetes with the majority (80%) being treated in primary health care. In 2014, DADR included data from a total of 70,826 patients. Main variables The following variables are assessed: date of analysis as well as the outcome for hemoglobin A1c, blood pressure, lipids, urinary albumin–creatinine ratio, smoking status, glucose-, blood pressure-, and lipid-lowering treatment (yes/no), insulin pump treatment (yes/no), and date of last eye and foot examination. Descriptive data In 2014, the annual report included data regarding over 38,000 patients from outpatient clinics, which is assumed to have included almost all patients in this setting, and >32,000 from GPs, reflecting improved but still limited coverage from this setting. The annual results are published in a compiled report of Danish Diabetes Care, which included DADR, data from the pediatric diabetes database, and the national ophthalmological diabetes database. The annual report is published, which included data on national, regional, and local level (individual outpatient clinics and corresponding GPs). This allows a comprehensive overview of diabetes care in Denmark. Conclusion The database covers an increasing fraction of patients with diabetes in Denmark, and the structure for full coverage is in place. Annual reporting has helped to ensure focus on the quality of diabetes treatment in the primary and secondary health care. Furthermore, it is an important resource for Danish register-based diabetes research.
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Affiliation(s)
- Marit Eika Jørgensen
- Steno Diabetes Center, Gentofte; National Institute of Public Health, University of Southern Denmark, Odense
| | | | | | - Charlotte Cerqueira
- Registry Support Centre (East) - Epidemiology and Biostatistics, Research Centre for Prevention and Health, Capital Region of Denmark
| | - Peter Rossing
- Steno Diabetes Center, Gentofte; Aarhus University, Aarhus; University of Copenhagen, Copenhagen, Denmark
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Varming AR, Hansen UM, Andrésdóttir G, Husted GR, Willaing I. Empowerment, motivation, and medical adherence (EMMA): the feasibility of a program for patient-centered consultations to support medication adherence and blood glucose control in adults with type 2 diabetes. Patient Prefer Adherence 2015; 9:1243-53. [PMID: 26366060 PMCID: PMC4562751 DOI: 10.2147/ppa.s85528] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To explore the feasibility of a research-based program for patient-centered consultations to improve medical adherence and blood glucose control in patients with type 2 diabetes. PATIENTS AND METHODS The patient-centered empowerment, motivation, and medical adherence (EMMA) consultation program consisted of three individual consultations and one phone call with a single health care professional (HCP). Nineteen patients with type 2 diabetes completed the feasibility study. Feasibility was assessed by a questionnaire-based interview with patients 2 months after the final consultation and interviews with HCPs. Patient participation was measured by 10-second event coding based on digital recordings and observations of the consultations. RESULTS HCPs reported that EMMA supported patient-centered consultations by facilitating dialogue, reflection, and patient activity. Patients reported that they experienced valuable learning during the consultations, felt understood, and listened to and felt a trusting relationship with HCPs. Consultations became more person-specific, which helped patients and HCPs to discover inadequate diabetes self-management through shared decision-making. Compared with routine consultations, HCPs talked less and patients talked more. Seven of ten dialogue tools were used by all patients. It was difficult to complete the EMMA consultations within the scheduled time. CONCLUSION The EMMA program was feasible, usable, and acceptable to patients and HCPs. The use of tools elicited patients' perspectives and facilitated patient participation and shared decision-making.
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Affiliation(s)
- Annemarie Reinhardt Varming
- Patient Education Research, Steno Diabetes Center, Gentofte, Denmark
- Correspondence: Annemarie Reinhardt Varming Patient Education Research, Steno Diabetes Center, Niels Steensens Vej 6, 2820 Gentofte, Denmark, Tel +45 4443 5268, Fax +45 4443 8232, Email
| | | | | | | | - Ingrid Willaing
- Patient Education Research, Steno Diabetes Center, Gentofte, Denmark
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Husted GR, Rutkowski A, Retzik M. Variation in high purity water bacterial and endotoxin concentrations in response to spontaneous changes in total oxidizable carbon content. PDA J Pharm Sci Technol 1996; 50:16-23. [PMID: 8846049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The goal of this study is to determine the relationship between transient changes in total oxidizable carbon concentration (TOC), bacterial numbers, and endotoxin concentrations at several serial unit operations in a high purity water system. Bacteria are a dynamic component of any ambient temperature sections in a high purity water system; they are living and growing inhabitants. Their numerical variability over time poses challenging QA/QC problems for many industries using high purity waters for manufacturing, formulation, equipment rinsing, and medical device preparation. Preliminary data (Husted et al., 1994) suggested that a possible relationship existed between spontaneous transient elevations in TOC concentration and total planktonic (free floating) bacterial numbers in high purity waters: rising TOC produced sudden increases in bacterial concentration. If the results collected earlier are reproducible, real time monitoring of TOC stability may offer a gateway measurement permitting estimation of changes in endotoxin and bacterial cell concentration, analyses currently made off line in the laboratory. This correlation would also supply guidance for system operation to produce water with both an enhanced and a reproducible quality.
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Affiliation(s)
- G R Husted
- MicroAssays of Vermont, Incorporated, Montpelier, USA
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