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Davies MJ, Bodicoat DH, Brennan A, Dixon S, Eborall H, Glab A, Gray LJ, Hadjiconstantinou M, Huddlestone L, Hudson N, Keetharuth A, Khunti K, Martin G, Northern A, Pritchard R, Schreder S, Speight J, Sturt J, Turner J. Uptake of self-management education programmes for people with type 2 diabetes in primary care through the embedding package: a cluster randomised control trial and ethnographic study. BMC Prim Care 2024; 25:136. [PMID: 38664727 DOI: 10.1186/s12875-024-02372-x] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Self-management education programmes are cost-effective in helping people with type 2 diabetes manage their diabetes, but referral and attendance rates are low. This study reports on the effectiveness of the Embedding Package, a programme designed to increase type 2 diabetes self-management programme attendance in primary care. METHODS Using a cluster randomised design, 66 practices were randomised to: (1) a wait-list group that provided usual care for nine months before receiving the Embedding Package for nine months, or (2) an immediate group that received the Embedding Package for 18 months. 'Embedders' supported practices and self-management programme providers to embed programme referral into routine practice, and an online 'toolkit' contained embedding support resources. Patient-level HbA1c (primary outcome), programme referral and attendance data, and clinical data from 92,977 patients with type 2 diabetes were collected at baseline (months - 3-0), step one (months 1-9), step 2 (months 10-18), and 12 months post-intervention. An integrated ethnographic study including observations, interviews, and document analysis was conducted using interpretive thematic analysis and Normalisation Process Theory. RESULTS No significant difference was found in HbA1c between intervention and control conditions (adjusted mean difference [95% confidence interval]: -0.10 [-0.38, 0.18] mmol/mol; -0.01 [-0.03, 0.02] %). Statistically but not clinically significantly lower levels of HbA1c were found in people of ethnic minority groups compared with non-ethnic minority groups during the intervention condition (-0.64 [-1.08, -0.20] mmol/mol; -0.06% [-0.10, -0.02], p = 0.004), but not greater self-management programme attendance. Twelve months post-intervention data showed statistically but not clinically significantly lower HbA1c (-0.56 [95% confidence interval: -0.71, -0.42] mmol/mol; -0.05 [-0.06, -0.04] %; p < 0.001), and higher self-management programme attendance (adjusted odds ratio: 1.13; 95% confidence interval: 1.02, 1.25; p = 0.017) during intervention conditions. Themes identified through the ethnographic study included challenges for Embedders in making and sustaining contact with practices and providers, and around practices' interactions with the toolkit. CONCLUSIONS Barriers to implementing the Embedding Package may have compromised its effectiveness. Statistically but not clinically significantly improved HbA1c among ethnic minority groups and in longer-term follow-up suggest that future research exploring methods of embedding diabetes self-management programmes into routine care is warranted. TRIAL REGISTRATION ISRCTN23474120, registered 05/04/2018.
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Affiliation(s)
- Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
| | | | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Simon Dixon
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Helen Eborall
- Usher Institute, Old Medical School, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Agnieszka Glab
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Michelle Hadjiconstantinou
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, YO10 5DD, York, UK
| | - Nicky Hudson
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
| | - Anju Keetharuth
- School of Health and Related Research, University of Sheffield, Regent Court (ScHARR), 30 Regent Street, Sheffield, S1 4DA, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Graham Martin
- THIS Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical Campus, Cambridge, CB2 0AH, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Rebecca Pritchard
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
- Diabetes Research Centre, University of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- School of Psychology, Deakin University, Geelong VIC, 3220, Australia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Strand, London, WC2R 2LS, UK
| | - Jessica Turner
- School of Applied Health Sciences, De Montfort University, The Gateway, Leicester, LE1 9BH, UK
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Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschênes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol 2024; 12:61-82. [PMID: 38128969 DOI: 10.1016/s2213-8587(23)00347-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 12/23/2023]
Abstract
People with diabetes often encounter stigma (ie, negative social judgments, stereotypes, prejudice), which can adversely affect emotional, mental, and physical health; self-care, access to optimal health care; and social and professional opportunities. To accelerate an end to diabetes stigma and discrimination, an international multidisciplinary expert panel (n=51 members, from 18 countries) conducted rapid reviews and participated in a three-round Delphi survey process. We achieved consensus on 25 statements of evidence and 24 statements of recommendations. The consensus is that diabetes stigma is driven primarily by blame, perceptions of burden or sickness, invisibility, and fear or disgust. On average, four in five adults with diabetes experience diabetes stigma and one in five experience discrimination (ie, unfair and prejudicial treatment) due to diabetes, such as in health care, education, and employment. Diabetes stigma and discrimination are harmful, unacceptable, unethical, and counterproductive. Collective leadership is needed to proactively challenge, and bring an end to, diabetes stigma and discrimination. Consequently, we achieved unanimous consensus on a pledge to end diabetes stigma and discrimination.
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Affiliation(s)
- Jane Speight
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
| | - Elizabeth Holmes-Truscott
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Renza Scibilia
- Diabetogenic, Melbourne, VIC, Australia; JDRF International, New York, NY, USA
| | - Sabina Wagner
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Asuka Kato
- Department of Health and Social Behavior, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Victor Pedrero
- Faculty of Nursing, Universidad Andrés Bello, Santiago, Chile
| | - Sonya Deschênes
- School of Psychology, University College Dublin, Dublin, Ireland
| | | | - Kevin L Joiner
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ingrid Willaing
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Institute of Public Health, Department of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | - Katie M Babbott
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bryan Cleal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Jane K Dickinson
- Department of Health Studies & Applied Educational Psychology, Teachers College Columbia University, New York, NY, USA
| | - Jennifer A Halliday
- School of Psychology and Institute for Health Transformation, Deakin University, Geelong, VIC, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Eimear C Morrissey
- Health Behavior Change Research Group, School of Psychology, University of Galway, Galway, Ireland
| | - Giesje Nefs
- Department of Medical Psychology, Radboudumc, Nijmegen, Netherlands; Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands; Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Shane O'Donnell
- Birmingham Law School, University of Birmingham, Birmingham, UK
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, Netherlands
| | - Hamzah Alzubaidi
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Bustanul Arifin
- Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | | | | | - Emma Davidsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mary de Groot
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Karoline Kragelund Nielsen
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospitals, Navi Mumbai, India
| | | | | | - Diana Naranjo
- Department of Pediatrics, Division of Endocrinology, Stanford School of Medicine, Palo Alto, CA, USA
| | - Rebecca L Pearl
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Suman Prinjha
- Leicester Diabetes Centre, University of Leicester and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, College of Liberal Arts & Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Chitra Selvan
- Department of Endocrinology, Ramaiah Medical College, Bengaluru, India
| | - Jazz Sethi
- The Diabesties Foundation, Ahmedabad, India
| | - Mohammed Seyam
- Faculty of Medicine, Al-Quds University, Abu Dis, Palestine
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Mythily Subramaniam
- Institute of Mental Health Singapore, Singapore; Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Helle Terkildsen Maindal
- Department of Prevention, Health Promotions & Community Care, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Copenhagen, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; La Trobe Rural Health School, La Trobe University, Flora Hill, VIC, Australia; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Sturt J, Griffiths F, Ajisola M, Akinyemi JO, Chipwaza B, Fayehun O, Harris B, Owoaje E, Rogers R, Pemba S, Watson SI, Omigbodun A. Safety and upscaling of remote consulting for long-term conditions in primary health care in Nigeria and Tanzania (REaCH trials): stepped-wedge trials of training, mobile data allowance, and implementation. Lancet Glob Health 2023; 11:e1753-e1764. [PMID: 37858586 DOI: 10.1016/s2214-109x(23)00411-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND In-person health care poses risks to health workers and patients during pandemics. Remote consultations can mitigate these risks. The REaCH intervention comprised training and mobile data allowance provision for mobile phones to support remotely delivered primary care in Africa compared with no training and mobile data allowance. The aim of this study was to estimate the effects of REaCH among adults with non-communicable diseases on remote and face-to-face consultation rates, patient safety, and trustworthiness of consultations. METHODS In these two independent stepped-wedge cluster randomised controlled trials, we enrolled 20 primary care clusters in each of two settings (Oyo State, Nigeria, and Morogoro Region, Tanzania). Eligible clusters had 100 or more patients with diabetes, hypertension, and cardiovascular or pulmonary disease employing five health workers. Clusters were computer-randomised to one of ten (Nigeria) or one of seven (Tanzania) sequences to receive the REaCH intervention. Only outcome assessors were masked. Primary outcomes were consultation, prescription, and investigation rates, and trustworthiness collected monthly for 12 months (Nigeria) and 9 months (Tanzania) from open cohorts. Ten randomly sampled consulting patients per cluster-month completed patient reported outcome measures. This trial was registered with ISRCTN, ISRCTN17941313. FINDINGS Overall, 40 clusters comprising 8776 (Nigeria) and 3246 (Tanzania) patients' open cohort data were analysed (6377 [72·7%] of 8776 females in Nigeria, and 2235 [68·9%] of 3246 females in Tanzania). The mean age of the participants was 55·3 years (SD 13·9) in Nigeria and 59·2 years (14·2) in Tanzania. In Nigeria, no evidence of change in face-to-face consulting rate was observed (rate ratio [RR] 1·06, 95% CI 0·98 to 1·09; p=0·16); however, remote consultations increased four-fold (4·44, 1·34 to >10; p=0·01). In Tanzania, face-to-face (0·94, 0·61 to 1·67; p=0·99) and remote consulting rates (1·17, 0·56 to 5·57; p=0·39) were unchanged. There was no evidence of difference in prescribing rates (Nigeria: 1·05, 0·60 to 1·14; p=0·23; Tanzania: 0·92, 0·60 to 1·67; p=0·97), investigation rates (Nigeria: 1·06, 0·23 to 2·12; p=0·49; Tanzania: 1·15, 0·35 to 1·64; 0·58) or trustworthiness scores (Nigeria: mean difference 0·05, 95% CI -0·45 to 0·42; p=0·89; Tanzania: 0·07, -0·15 to 0·76; p=0·70). INTERPRETATION REaCH can be implemented and could improve intervention versus control health-care access. Remote consultations appear safe and trustworthy, supporting universal health coverage. FUNDING The UK Research and Innovation Collective Fund. TRANSLATIONS For the Swahili and Yoruba translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, UK; Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Joshua Odunayo Akinyemi
- College of Medicine, University of Ibadan Nigeria, Ibadan, Nigeria; Department of Epidemiology and Medical Statistics, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Beatrice Chipwaza
- School of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Olufunke Fayehun
- Department of Sociology, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Eme Owoaje
- Department of Community Medicine, University of Ibadan Nigeria, Ibadan, Nigeria
| | - Rebecca Rogers
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Senga Pemba
- School of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, Tanzania
| | - Samuel I Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Bozkurt D, Duaso M, Sturt J. Use of the 2021 UK Medical Research Council guidance to refine the Women's Wellness with Type 2 Diabetes Programme: a mixed-methods study. Lancet 2023; 402 Suppl 1:S27. [PMID: 37997067 DOI: 10.1016/s0140-6736(23)02135-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The Women's Wellness with Type 2 Diabetes Programme (WWDP) is an online behavioural intervention for midlife women living with type 2 diabetes. The gender-specific intervention fosters self-efficacy, encouraging positive wellbeing behaviours to enhance diabetes and menopause outcomes. In 2016, We co-led a feasibility trial and process evaluation with 70 women aged 45-50 years from the UK and Australia. The intervention comprised an e-book, a website, and nurse consultations. The WWDP seemed to improved diabetes distress, self-efficacy, and menopausal symptoms, but with impactful, costly, diabetes nurse input, compromising feasibility and delivery by the NHS. We report WWDP refinement using the 2021 Medical Research Council (MRC) framework for complex interventions to optimise future implementation. METHODS Intervention refinement was guided by six core MRC elements of context, programme theory, stakeholder engagement, key uncertainties, intervention refinement, and economic considerations. Critical analysis of quantitative and qualitative feasibility data, informed by self-efficacy theory, provided a deeper understanding of how the intervention was used. Eight PPI consultations took place between Sept 1, 2021, and Dec 31, 2022, with three women from diverse cultural and socioeconomic backgrounds and three female diabetes professionals to strengthen the e-book and methods of support for women undertaking the programme. FINDINGS Context was improved by the feasibility study and the PPI consultations, making the e-book relevant to UK health care. Understanding that self-efficacy was supported through primary use of peer group, and goal setting components supported the existing programme theory. Stakeholder engagement shaped the structure of the online peer support group. The feasibility study revealed uncertainties around goal settings. These uncertainties were addressed by introducing individualised goals focusing on aspects like medication adherence. The nurse support in the intervention was replaced with peer support, which might lead to greater economic feasibility of the programme. An optimised website and individualised goal setting underpin the WWDP. INTERPRETATION The MRC Framework provides intervention refinement structure, allowing adaptive adjustments based on emerging evidence, feedback, and contextual nuances. Limitations exist. Intervention refinements, including peer support, might affect adherence and unexpected interactions. New components could influence long-term efficacy. FUNDING Turkish Ministry of National Education.
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Affiliation(s)
- Deniz Bozkurt
- Division of Care in Long-Term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK.
| | - Maria Duaso
- Division of Care in Long-Term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
| | - Jackie Sturt
- Division of Care in Long-Term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
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Sturt J, Rogers R, Armour C, Cameron D, De Rijk L, Fiorentino F, Forbes T, Glen C, Grealish A, Kreft J, Meye de Souza I, Spikol E, Tzouvara V, Greenberg N. Reconsolidation of traumatic memories protocol compared to trauma-focussed cognitive behaviour therapy for post-traumatic stress disorder in UK military veterans: a randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:175. [PMID: 37833734 PMCID: PMC10571284 DOI: 10.1186/s40814-023-01396-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) occurs more commonly in military veterans than the general population. Whilst current therapies are effective, up to half of veterans commencing treatment do not complete it. Reconsolidation of Traumatic Memories (RTM) protocol is a novel, easy to train, talking therapy with promising findings. We examine the feasibility of undertaking an efficacy trial of RTM in veterans. METHODS A parallel group, single-centre randomised controlled feasibility trial with a post-completion qualitative interview study. Sixty military veterans were randomised 2:1 to RTM (n = 35) or Trauma Focussed Cognitive Behaviour Therapy (CBT) (n = 25). We aimed to determine the rate of recruitment and retention, understand reasons for attrition, determine data quality and size of efficacy signal. We explored veterans' perceptions of experiences of joining the trial, the research procedures and therapy, and design improvements for future veteran studies. Military veterans with a diagnosis of PTSD or complex PTSD, and clinically significant symptoms, were recruited between January 2020 and June 2021. Primary outcome was feasibility using pre-determined progression criteria alongside PTSD symptoms, with depression, recovery, and rehabilitation as secondary outcomes. Data were collected at baseline, 6, 12, and 20 weeks. Interviews (n = 15) were conducted after 20 weeks. Both therapies were delivered by trained charity sector provider therapists. RESULTS Participants' mean age was 53 years, the mean baseline PTSD symptoms score assessed by the Post-traumatic Stress Checklist (PCL-5) was 57 (range 0-80). Fifty had complex PTSD and 39 had experienced ≥ 4 traumas. Data were analysed at 20 weeks for feasibility outcomes (n = 60) and mental health outcomes (n = 45). Seven of eight progression criteria were met. The RTM group experienced a mean 18-point reduction on the PCL-5. TFCBT group participants experienced a mean reduction of eight points. Forty-eight percent of the RTM group no longer met diagnostic criteria for PTSD compared to 16% in the TFCBT group. All veterans reported largely positive experiences of the therapy and research procedures and ways to improve them. CONCLUSION RTM therapy remains a promising psychological intervention for the treatment of PTSD, including complex PTSD, in military veterans. With specific strengthening, the research protocol is fit for purpose in delivering an efficacy trial. TRIAL REGISTRATION ISRCTN registration no 10314773 on 01.10.2019. Full trial protocol: available on request or downloadable at ISRCTN reg. no. 10314773.
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Affiliation(s)
- J. Sturt
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - R. Rogers
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - C. Armour
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - D. Cameron
- Inspire Wellbeing, Lombard Street, Belfast, BT1 1RB Northern Ireland
| | - L. De Rijk
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - F. Fiorentino
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - T. Forbes
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - C. Glen
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - A. Grealish
- Faculty Of Education & Health Sciences, University of Limerick, Limerick, Ireland
| | - J. Kreft
- Military Veterans’ Service, Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - I. Meye de Souza
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - E. Spikol
- Research Centre for Stress, Trauma, and Related Conditions (STARC), School of Psychology, Queens University Belfast, Belfast, Northern Ireland
| | - V. Tzouvara
- Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - N. Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Collins S, Jones A, Woodward S, Sturt J. "It is like a pet in a way": The self-management experiences of people with cystic fibrosis diabetes. J Hum Nutr Diet 2023; 36:1621-1635. [PMID: 37158099 DOI: 10.1111/jhn.13181] [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: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cystic fibrosis diabetes (CFD) is a very common co-morbidity affecting the lives of people with cystic fibrosis. Surprisingly, minimal research has been undertaken to understand the experiences of people with CFD and how they self-mange this condition. METHODS Using interpretative phenomenological analysis, the present study examined the self-management experiences of people with CFD. In-depth semi-structure interviews were conducted with eight people who had CFD. RESULTS The following three superordinate themes were identified: forming a relationship with CFD, balancing the CFD self-management triad, and the unmet need for information and support. CONCLUSIONS The findings suggest that the management of CFD is challenging and, although people with CFD experience many adaptation and management processes similar to people with type 1 diabetes, they struggle with the additional complexity of balancing CF and CFD. The provision of appropriate education, support and person-centred care needs to be addressed.
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Affiliation(s)
| | - Andrew Jones
- Royal Brompton & Harefield Hospitals, London, UK
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Celik A, Sturt J, Temple A, Forbes A, Forde R. 'No one ever asks about something that actually is relevant to my life': A qualitative study of diabetes and diabetes care experiences of young women with type 2 diabetes during their reproductive years. Diabet Med 2023; 40:e15017. [PMID: 36448267 PMCID: PMC10107676 DOI: 10.1111/dme.15017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
AIM To understand the health needs, experiences, and views of women with type 2 diabetes in relation to diabetes, reproductive health experiences, and general wellbeing. METHOD A qualitative study using semi-structured interviews. Thirty-six women with type 2 diabetes (median age 37 years; age ranges 20-45 years; median diabetes duration 4.5 years), recruited through social media and charities in the UK (n = 23) and Turkey (n = 13). Video interviews (n = 28) were audio recorded and transcribed verbatim. Email interviews (n = 8) and transcribed video interviews were analysed using Framework Analysis. RESULTS Two overarching themes were identified: (1) Perception of self and identity, (2) type 2 diabetes care is not orientated to women's needs. These themes highlight that living with type 2 diabetes was negatively perceived by the women in terms of their self-identity and reproductive health. Women reported that the diabetes care provided was often not appropriate or relevant to their health needs, and neglected issues of relevance to them. The women voiced ideas for enhancing current care to reflect their health needs, in particular the need for more emotional and peer-based support. CONCLUSION Living with type 2 diabetes may negatively impact how women view themselves and how they relate to the roles they identify with such as, as a partner, mother, colleague. Current healthcare systems are not orientated to the specific needs of younger women with type 2 diabetes with limited opportunities to target their diabetes care around their health and wellbeing concerns and interests.
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Affiliation(s)
- Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Aya Temple
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Asaad M, Forde R, AlFares A, Bin Abbas B, Sturt J. Experiences and needs of Saudi mothers when a child or adolescent is diagnosed with type 1 diabetes mellitus: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2107151. [PMID: 35924381 PMCID: PMC9359183 DOI: 10.1080/17482631.2022.2107151] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim To explore the experiences of Saudi mothers with children or adolescents who have Type 1 diabetes mellitus at time of diagnosis. Background The Kingdom of Saudi Arabia (KSA) has one of the highest incidence rates of Type 1 diabetes mellitus in children and adolescents in the world. Few studies have considered the most appropriate methods of support for parents in the KSA and none report the experiences of Saudi mothers. Design Phenomenological inquiry. Method Qualitative interviews were conducted with 11 Saudi mothers and data were analysed following Giorgi’s 5-step method. Results The lived experiences of Saudi mothers coalesced around three overarching themes and eight subthemes: 1. In the dark (mother’s instinct, challenges of diagnosis phase, cultural reflections); 2. Empowerment (methods of support, mother’s health and wellbeing); 3. Coping and acceptance (stigma and cultural perceptions, coping strategies, transformation and adaptation). Conclusions Effective interventions delivered in other countries to support mothers may be effective in the KSA. However, the central role that Saudi mothers play in the management of their child’s condition, and the place of Islam in Saudi society, indicate the need for customized methods of support that take into account psychosociocultural needs of both mother and child.
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Affiliation(s)
- Mariam Asaad
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Abdullah AlFares
- Department of Pediatrics, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Bassam Bin Abbas
- Department of Pediatrics, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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Halliday JA, Russell-Green S, Hagger V, O E, Morris A, Sturt J, Speight J, Hendrieckx C. Feasibility and acceptability of e-learning to upskill diabetes educators in supporting people experiencing diabetes distress: a pilot randomised controlled trial. BMC Med Educ 2022; 22:768. [PMID: 36352377 PMCID: PMC9644574 DOI: 10.1186/s12909-022-03821-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/20/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Diabetes distress is a commonly experienced negative emotional response to the ongoing burden of diabetes. Holistic diabetes care, including attention to diabetes distress, is recommended in clinical guidelines, yet not routinely implemented. Diabetes health professionals have highlighted lack of training as a barrier to implementation of psychological care. Therefore, we developed an e-learning: 'Diabetes distress e-learning: A course for diabetes educators' to address this need. This pilot study aimed to examine the feasibility of evaluating the e-learning in a randomised controlled trial study, the acceptability of the e-learning to credentialled diabetes educators (CDEs); and preliminary evidence of its effect upon CDEs' diabetes distress-related knowledge, motivation, confidence, behavioural skills, and barriers to implementation. METHODS A pilot, unblinded, 2-armed, parallel group randomised controlled trial. Participants were recruited during a 4-month timeframe. Eligible participants were CDEs for ≥ 1 year providing care to ≥ 10 adults with type 1 or type 2 diabetes per week. Participants were randomly allocated (1:1 computer automated) to 1 of 2 learning activities: diabetes distress e-learning (intervention) or diabetes distress chapter (active control). They had 4 weeks to access the activity. They completed online surveys at baseline, 2-week and 12-week follow-up. RESULTS Seventy-four eligible CDEs (36 intervention, 38 active control) participated. At baseline, recognition of the clinical importance of diabetes distress was high but knowledge and confidence to provide support were low-to-moderate. Engagement with learning activities was high (intervention: 83%; active control: 92%). Fifty-five percent returned at least 1 follow-up survey. All 30 intervention participants who returned the 2-week follow-up survey deemed the e-learning high quality and relevant. Systemic barriers (e.g., financial limitations and access to mental health professionals) to supporting people with diabetes distress were common at baseline and follow-up. CONCLUSIONS: The e-learning was acceptable to CDEs. The study design was feasible but needs modification to improve follow-up survey return. The e-learning showed potential for improving diabetes distress-related knowledge, confidence and asking behaviours, but systemic barriers to implementation remained. Systemic barriers need to be addressed to facilitate implementation of support for diabetes distress in clinical practice. Future larger-scale evaluation of the e-learning is warranted.
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Affiliation(s)
- Jennifer A Halliday
- School of Psychology, Deakin University, Geelong, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia.
- Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Sienna Russell-Green
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Virginia Hagger
- Institute for Health Transformation, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Eric O
- Faculty of Health, Deakin University, Geelong, Australia
| | - Ann Morris
- AMCON Diabetes Management Service, Warrnambool, Australia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, London, UK
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Geelong, Australia
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Messina R, Berry E, Golinelli D, Donetto S, Reno C, Moscatiello S, Laffi G, Sturt J. Tackling diabetes as a team: co-designing healthcare interventions to engage couples living with type 1 diabetes. Acta Diabetol 2022; 59:1053-1061. [PMID: 35624322 PMCID: PMC9242905 DOI: 10.1007/s00592-022-01900-4] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022]
Abstract
AIMS Couples living with Type 1 diabetes: co-designing interventions to support them. METHODS This is a qualitative study comprising two phases. Phase I represents the exploratory phase, consisting of semi-structured interviews with persons with Type 1 diabetes (N = 16) and partners (N = 6). In the second phase, co-design principles guided workshops with healthcare professionals, persons with Type 1 diabetes, and partners (N = 7) to facilitate discussion of the key themes identified and solutions to engage couples living with Type 1 diabetes in diabetes care. RESULT The key themes identified from phase I as priorities to target in future interventions were: (i) Emotional impact of diabetes and (ii) Partners' involvement. Priority (i) captures the impact the emotional burden of diabetes management produces within couples' relationship. Priority (ii) captures the request from partners to be more involved in diabetes management. Characteristics of the interventions suggested during the co-design phase II focused on engaging patients and partners via a counseling point in healthcare settings and tailored help for couples' psychological support needs. CONCLUSIONS Couples value pro-active intervention and support from their diabetes team or primary care for both the partners to live well with Type 1 diabetes.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Emma Berry
- School of Psychology, Queen's University Belfast, Belfast, Ireland
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Sara Donetto
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Simona Moscatiello
- Unit of Endocrinology and Prevention and Care of Diabetes, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Gilberto Laffi
- Unit of Endocrinology and Prevention and Care of Diabetes, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Yeoh P, Czuber‐Dochan W, Aylwin S, Sturt J. Lived experience of people with adrenocortical carcinoma and associated adrenal insufficiency. Endocrinol Diabetes Metab 2022; 5:e341. [PMID: 35670031 PMCID: PMC9258998 DOI: 10.1002/edm2.341] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Adrenocortical carcinoma (ACC) is a rare cancer with an annual incidence of 0.7–2 cases per million population and 5‐year survival of 31.2%. Adrenal insufficiency (AI) is a common and life shortening complication of ACC, and little is understood about how it impacts on patients' experience. Objective To understand patients' lived experience of the condition, its treatment, care process, impact of AI on ACC wellbeing, self‐care needs and support. Methods Systematic review of MEDLINE, EMBASES, CINAHL, PsycINFO and Open Grey for studies published until February 2021. All research designs were included. The findings underwent a thematic analysis and narrative synthesis. Studies quality was assessed using mixed method assessment tools. Results A total of 2837 citations were identified; 15 titles with cohort, cross‐sectional, case series and case report study designs met the inclusion criteria involving 479 participants with adrenal insufficiency secondary to adrenocortical carcinoma (AI/ACC). Quantitative research identified impacts of disease and treatment on survivorship, the burden of living with AI/ACC, toxicity of therapies, supporting self‐care and AI management. These impact factors included adjuvant therapies involved and their toxicities, caregivers/family supports, healthcare and structure support in place, specialist skill and knowledge provided by healthcare professional on ACC management. No qualitative patient experiences evidence was identified. Conclusion ACC appears to have high impact on patients' wellbeing including the challenges with self‐care and managing AI. Evidence is needed to understand patient experience from a qualitative perspective.
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Affiliation(s)
- Phillip Yeoh
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care. King's College London London UK
- Department of Endocrinology & Diabetes The London Clinic London UK
| | - Wladyslawa Czuber‐Dochan
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care. King's College London London UK
| | - Simon Aylwin
- Department of Endocrinology King's College Hospital London UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing Midwifery & Palliative Care. King's College London London UK
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Downie A, Mashanya T, Chipwaza B, Griffiths F, Harris B, Kalolo A, Ndegese S, Sturt J, De Valliere N, Pemba S. Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic. JMIR Form Res 2022; 6:e32964. [PMID: 35507772 PMCID: PMC9200055 DOI: 10.2196/32964] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings.
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Affiliation(s)
- Andrew Downie
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Titus Mashanya
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Beatrice Chipwaza
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Bronwyn Harris
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Albino Kalolo
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Sylvester Ndegese
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Nicole De Valliere
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Senga Pemba
- Department of Public Health, Faculty of Medicine, St Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
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Temple A, Hamilton K, Bryce C, Griffiths F, Sturt J. Perspective on digital communication with health professions from close supporters of young people with long-term health conditions (The LYNC Study). Digit Health 2022; 8:20552076221092536. [PMID: 35433015 PMCID: PMC9005813 DOI: 10.1177/20552076221092536] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To understand the impact of digital communication using email and text between young people and their health care team on those in close supporting roles. Methods Twelve people (nine parents and three partners) of young people with long-term health conditions were interviewed between November 2014 and March 2016. Thematic analysis was performed followed Braun and Clarke's (2006) 6-phase method. Results Four main themes were identified. Close supporters felt that digital clinical communication was useful for young persons’ self-management. As well as young patients, close supporters would also like to have direct access to the clinicians, but it was necessary to build up a trusting relationship between close supporters and clinicians initially. Video appointments were suggested for future digital communication technology. Conclusions Close supporters were encouraging digital communication for their young person with diabetes. Clinicians should put an emphasis on establishing trusting relationships with both young people and close supporters which would be beneficial for their digital clinical communications.
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Affiliation(s)
- Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Kathryn Hamilton
- Department of Clinical, Educational and Health Psychology, Hunter Street Health Centre, London, UK
| | - Carol Bryce
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Frances Griffiths
- Warwick Medical School – Social Science and Systems in Health, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Suglo JN, Winkley K, Sturt J. Prevention and Management of Diabetes-Related Foot Ulcers through Informal Caregiver Involvement: A Systematic Review. J Diabetes Res 2022; 2022:9007813. [PMID: 35462785 PMCID: PMC9021995 DOI: 10.1155/2022/9007813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/28/2022] [Accepted: 03/22/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The literature remains unclear whether involving informal caregivers in diabetes self-care could lead to improved diabetic foot outcomes for persons at risk and/or with foot ulcer. In this review, we synthesized evidence of the impact of interventions involving informal caregivers in the prevention and/or management of diabetes-related foot ulcers. METHODS A systematic review based on PRISMA, and Synthesis Without Meta-analysis (SWiM) guidelines was conducted. MEDLINE (Ovid), Embase (Ovid), PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trial of the Cochrane Library databases were searched from inception to February 2021. The following MESH terms were used: diabetic foot, foot ulcer, foot disease, diabetes mellitus, caregiver, family caregiver ,and family. Experimental studies involving persons with diabetes, with or at risk of foot ulcers and their caregivers were included. Data were extracted from included studies and narrative synthesis of findings undertaken. RESULTS Following the search of databases, 9275 articles were screened and 10 met the inclusion criteria. Studies were RCTs (n = 5), non-RCTs (n = 1), and prepoststudies (n = 4). Informal caregivers through the intervention programmes were engaged in diverse roles that resulted in improved foot ulcer prevention and/or management outcomes such as improved foot care behaviors, increased diabetes knowledge, decreased HbA1c (mmol/mol or %), improved wound healing, and decreased limb amputations rates. Engaging both caregivers and the person with diabetes in education and hands-on skills training on wound care and foot checks were distinctive characteristics of interventions that consistently produced improved foot self-care behavior and clinically significant improvement in wound healing. CONCLUSION Informal caregivers play diverse and significant roles that seem to strengthen interventions and resulted in improved diabetes-related foot ulcer prevention and/or management outcomes. However, there are multiple intervention types and delivery strategies, and these may need to be considered by researchers and practitioners when planning programs for diabetes-related foot ulcers.
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Affiliation(s)
- Joseph Ngmenesegre Suglo
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
- Department of Nursing, Presbyterian University College Ghana, Ghana
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, UK
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Celik A, Forde R, Racaru S, Forbes A, Sturt J. The Impact of Type 2 Diabetes on Women's Health and Well-being During Their Reproductive Years: A Mixed-methods Systematic Review. Curr Diabetes Rev 2022; 18:e011821190403. [PMID: 33461469 DOI: 10.2174/1573399817666210118144743] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The incidence of Type 2 Diabetes (T2DM) among younger women now accounts for 40% of females with T2DM. Women of reproductive age with T2DM have additional health considerations and their needs may differ from older populations. OBJECTIVES The aims were (1) to identify the health issues encountered by women aged 16-45 years living with T2DM; (2) to determine the modifiable risk factors associated with living with diabetes; (3) to specify ideas for interventions to meet age and gender-specific diabetes-related healthcare needs. METHODS A systematic search was performed in the following databases; MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Maternity and Infant Care. Databases were searched without time and study design limits. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Data were narratively synthesised due to mixed methods evidence included. RESULTS A total of 32 papers were included in the review from which six domains were identified from the synthesis: (1) diabetes related modifiable risk factors: blood glucose, cardiovascular risk, neuropathy/nephropathy/retinopathy, diabetes self-management barriers (2) reproductive health: diabetes care before pregnancy, pre-pregnancy care barriers and expectations of women, contraceptive use (3) psychosocial wellbeing: depression symptoms and diabetes distress, perception of T2DM, emotional concerns about pregnancy (4) sexual function; (5) menopause; (6) sociocultural factors: social support, cultural norms. CONCLUSION This review highlighted specific health issues affecting women of reproductive age with T2DM and which represent an important focus for health services research and health care delivery. Future research needs to address identified health domains to improve women's health and well-being living with T2DM.
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Affiliation(s)
- Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Simona Racaru
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
- Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London SEI 8WA, UK
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Sturt J. Shame in younger adults with a type 2 diabetes diagnosis: Where might this be leading? Diabet Med 2022; 39:e14693. [PMID: 34545954 DOI: 10.1111/dme.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
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Silke L, Kirresh O, Sturt J, Lempp H. Development of the Rheumatoid Arthritis Distress Scale (RADS): a new tool to identify disease-specific distress in patients with Rheumatoid Arthritis. BMC Rheumatol 2021; 5:51. [PMID: 34782021 PMCID: PMC8594165 DOI: 10.1186/s41927-021-00220-4] [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: 12/01/2020] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Patients with Rheumatoid Arthritis (RA) may experience psychological distress (depression, anxiety) in addition to their physical symptoms. People with RA may also experience disease-specific distress (DSD), related to the specific burden of living with their life-long condition. DSD is a patient reported outcome in several long-term conditions, including type 1 and 2 diabetes. The aims of this study were to determine whether DSD is experienced by people with RA, and if so, develop a Patient Reported Outcome Measure (PROM) to assess for DSD in people with RA. Methods A five-phased qualitative study was conducted which consisted of a secondary data analysis of 61 interviews of people with rheumatological disease (Phase 1), validation of findings via a Patient and Public Involvement (PPI) group of people with RA (n = 4) (Phase 2), item generation for a PROM (Phase 3) and establishing face and content validity of the PROM via PPI group (n = 4) and individual cognitive interviews (n = 9) of people with RA respectively (Phase 4 and 5). The final PROM was presented at a Patient Education Evening for patients with long-term rheumatological conditions, including RA, and carers. Results Five themes of rheumatological disease distress emerged from Phase 1, which were validated in the Phase 2 PPI group. After Phases 3–5, the Rheumatoid Arthritis Distress Scale (RADS) was formed of 39 items and 3 supplementary questions. Overall participants reported the content of the RADS to be clear and relevant, and that DSD is a valid concept in RA, distinct from other entities like clinical depression or anxiety. Conclusions DSD appears to be an important concept in RA. The 39-item RADS demonstrates acceptable face and content validity in this patient group. Further psychometric testing is needed. The RADS may be a useful tool for healthcare professionals to identify RA distress.
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Affiliation(s)
- Linda Silke
- Outpatient Physiotherapy Department, Mile End Hospital, Bancroft Rd, London, E1 4DG, UK.
| | - Othman Kirresh
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, Waterloo, London, SE1 8WA, UK
| | - Heidi Lempp
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, Weston Education Centre, King's College London, 10, Cutcombe Road, London, SE5 9RJ, UK
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18
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Halliday JA, Speight J, Russell-Green S, O E, Hagger V, Morris A, Sturt J, Hendrieckx C. Developing a novel diabetes distress e-learning program for diabetes educators: an intervention mapping approach. Transl Behav Med 2021; 11:1264-1273. [PMID: 33677509 DOI: 10.1093/tbm/ibaa144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/07/2023] Open
Abstract
Diabetes distress is a common negative emotional response to the ongoing burden of living with diabetes. Elevated diabetes distress is associated with impaired diabetes self-management and quality of life yet rarely identified and addressed in clinical practice. Health professionals report numerous barriers to the provision of care for diabetes distress, including lack of skills and confidence, but few diabetes distress training opportunities exist. The purpose of this paper is to describe how we utilized Intervention Mapping to plan the development, implementation, and evaluation of a novel diabetes distress e-learning program for diabetes educators, to meet a well-documented need and significant gap in diabetes care. A multidisciplinary team (combining expertise in research, health and clinical psychology, diabetes education, nursing, tertiary education, and website architecture) developed a diabetes distress e-learning program. We followed a six-step process (logic model of the problem, program outcomes and objectives, program design, program production, program implementation plan, and evaluation plan) known as Intervention Mapping. The program is underpinned by educational and psychological theory, including Bloom's Taxonomy of Educational Objectives and social cognitive theory. We developed a short (estimated 4 h) e-learning program for diabetes educators, which draws on the content of the Diabetes and Emotional Health handbook and toolkit. It integrates a 7As model, which provides a stepwise approach to identifying and addressing diabetes distress. Our diabetes distress e-learning program has been developed systematically, guided by an Intervention Mapping approach. In the next phase of the project, we will trial the e-learning.
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Affiliation(s)
- Jennifer A Halliday
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Sienna Russell-Green
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Eric O
- Faculty of Health, Deakin University, Geelong, Australia
| | | | - Ann Morris
- AMCON Diabetes Management Service, Warrnambool, Australia
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia.,The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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19
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Scott DL, Ibrahim F, Hill H, Tom B, Prothero L, Baggott RR, Bosworth A, Galloway JB, Georgopoulou S, Martin N, Neatrour I, Nikiphorou E, Sturt J, Wailoo A, Williams FMK, Williams R, Lempp H. Intensive therapy for moderate established rheumatoid arthritis: the TITRATE research programme. Programme Grants Appl Res 2021. [DOI: 10.3310/pgfar09080] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Rheumatoid arthritis is a major inflammatory disorder and causes substantial disability. Treatment goals span minimising disease activity, achieving remission and decreasing disability. In active rheumatoid arthritis, intensive management achieves these goals. As many patients with established rheumatoid arthritis have moderate disease activity, the TITRATE (Treatment Intensities and Targets in Rheumatoid Arthritis ThErapy) programme assessed the benefits of intensive management.
Objectives
To (1) define how to deliver intensive therapy in moderate established rheumatoid arthritis; (2) establish its clinical effectiveness and cost-effectiveness in a trial; and (3) evaluate evidence supporting intensive management in observational studies and completed trials.
Design
Observational studies, secondary analyses of completed trials and systematic reviews assessed existing evidence about intensive management. Qualitative research, patient workshops and systematic reviews defined how to deliver it. The trial assessed its clinical effectiveness and cost-effectiveness in moderate established rheumatoid arthritis.
Setting
Observational studies (in three London centres) involved 3167 patients. These were supplemented by secondary analyses of three previously completed trials (in centres across all English regions), involving 668 patients. Qualitative studies assessed expectations (nine patients in four London centres) and experiences of intensive management (15 patients in 10 centres across England). The main clinical trial enrolled 335 patients with diverse socioeconomic deprivation and ethnicity (in 39 centres across all English regions).
Participants
Patients with established moderately active rheumatoid arthritis receiving conventional disease-modifying drugs.
Interventions
Intensive management used combinations of conventional disease-modifying drugs, biologics (particularly tumour necrosis factor inhibitors) and depot steroid injections; nurses saw patients monthly, adjusted treatment and provided supportive person-centred psychoeducation. Control patients received standard care.
Main outcome measures
Disease Activity Score for 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR)-categorised patients (active to remission). Remission (DAS28-ESR < 2.60) was the treatment target. Other outcomes included fatigue (measured on a 100-mm visual analogue scale), disability (as measured on the Health Assessment Questionnaire), harms and resource use for economic assessments.
Results
Evaluation of existing evidence for intensive rheumatoid arthritis management showed the following. First, in observational studies, DAS28-ESR scores decreased over 10–20 years, whereas remissions and treatment intensities increased. Second, in systematic reviews of published trials, all intensive management strategies increased remissions. Finally, patients with high disability scores had fewer remissions. Qualitative studies of rheumatoid arthritis patients, workshops and systematic reviews helped develop an intensive management pathway. A 2-day training session for rheumatology practitioners explained its use, including motivational interviewing techniques and patient handbooks. The trial screened 459 patients and randomised 335 patients (168 patients received intensive management and 167 patients received standard care). A total of 303 patients provided 12-month outcome data. Intention-to-treat analysis showed intensive management increased DAS28-ESR 12-month remissions, compared with standard care (32% vs. 18%, odds ratio 2.17, 95% confidence interval 1.28 to 3.68; p = 0.004), and reduced fatigue [mean difference –18, 95% confidence interval –24 to –11 (scale 0–100); p < 0.001]. Disability (as measured on the Health Assessment Questionnaire) decreased when intensive management patients achieved remission (difference –0.40, 95% confidence interval –0.57 to –0.22) and these differences were considered clinically relevant. However, in all intensive management patients reductions in the Health Assessment Questionnaire scores were less marked (difference –0.1, 95% confidence interval –0.2 to 0.0). The numbers of serious adverse events (intensive management n = 15 vs. standard care n = 11) and other adverse events (intensive management n = 114 vs. standard care n = 151) were similar. Economic analysis showed that the base-case incremental cost-effectiveness ratio was £43,972 from NHS and Personal Social Services cost perspectives. The probability of meeting a willingness-to-pay threshold of £30,000 was 17%. The incremental cost-effectiveness ratio decreased to £29,363 after including patients’ personal costs and lost working time, corresponding to a 50% probability that intensive management is cost-effective at English willingness-to-pay thresholds. Analysing trial baseline predictors showed that remission predictors comprised baseline DAS28-ESR, disability scores and body mass index. A 6-month extension study (involving 95 intensive management patients) showed fewer remissions by 18 months, although more sustained remissions were more likley to persist. Qualitative research in trial completers showed that intensive management was acceptable and treatment support from specialist nurses was beneficial.
Limitations
The main limitations comprised (1) using single time point remissions rather than sustained responses, (2) uncertainty about benefits of different aspects of intensive management and differences in its delivery across centres, (3) doubts about optimal treatment of patients unresponsive to intensive management and (4) the lack of formal international definitions of ‘intensive management’.
Conclusion
The benefits of intensive management need to be set against its additional costs. These were relatively high. Not all patients benefited. Patients with high pretreatment physical disability or who were substantially overweight usually did not achieve remission.
Future work
Further research should (1) identify the most effective components of the intervention, (2) consider its most cost-effective delivery and (3) identify alternative strategies for patients not responding to intensive management.
Trial registration
Current Controlled Trials ISRCTN70160382.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David L Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Harry Hill
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Louise Prothero
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Rhiannon R Baggott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | | | - James B Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Sofia Georgopoulou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Naomi Martin
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Isabel Neatrour
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Jackie Sturt
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
| | - Allan Wailoo
- ScHARR Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Frances MK Williams
- Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, St Thomas’ Hospital, London, UK
| | - Ruth Williams
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King’s College London, London, UK
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20
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Snoek FJ, Fisher L, Polonsky WH, Stuckey H, Hessler D, Tang T, Hermanns N, Mundet X, Silva M, Sturt J, Okazaki K, Hadjiyianni I, Desai U, Perez-Nieves M. Overcoming psychological insulin resistance: A practical guide for healthcare professionals. Prim Care Diabetes 2021; 15:619-621. [PMID: 33785288 DOI: 10.1016/j.pcd.2021.03.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
Despite the demonstrated benefits of using insulin, nearly a third of the patients with type 2 diabetes (T2D) are initially reluctant to initiate insulin therapy when it is first recommended by their healthcare provider (HCP). Several studies have documented the reasons for this phenomenon known as psychological insulin resistance (PIR) and also identified actionable strategies for HCPs to assist people with T2D to overcome their PIR. However, most strategies are based on the experiences of HCPs, rather than of patients. Based on findings from a study exploring real-world patient experience around HCP actions for mitigating PIR, we suggest that HCPs use collaborative strategies throughout the course of T2D treatment to 1) explore reasons for PIR, 2) help patients overcome PIR, and 3) follow-up regarding experience with insulin.
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Affiliation(s)
- Frank J Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, San Diego, CA, USA; University of California, San Diego, La Jolla, CA, USA
| | | | | | - Tricia Tang
- University of British Columbia, Vancouver, Canada
| | | | - Xavier Mundet
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Maria Silva
- Instituto Multidisciplinar de Medicina, Sao Paulo, Brazil
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21
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Anderson D, Sturt J, McDonald N, Sapkota D, Porter-Steele J, Rogers R, Temple A, Seib C, McGuire A, Tjondronegoro D, Walker R, Al-Khudairy L, White C. Women's Wellness with Type 2 Diabetes Program (WWDP): Qualitative findings from the UK and Australian feasibility study. Diabetes Res Clin Pract 2021; 172:108654. [PMID: 33422587 DOI: 10.1016/j.diabres.2021.108654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
AIMS To undertake a qualitative study of a multimodal behavioural intervention and research protocol developed to improve wellness in women with type 2 diabetes mellitus (T2DM), the Women's Wellness with Type 2 Diabetes program (WWDP). METHODS Semi-structured interviews were conducted with 15 participants who completed the WWDP. The interviews were transcribed verbatim and analysed thematically in an iterative process. RESULTS Themes developing from interviews were broadly grouped into three domains, 1) Hope for a better everyday life; 2) Reflection of the program and its contents; and 3) Impacts on health and wellbeing. Participants viewed the WWDP as a necessary and valuable approach that was crucial in helping them adopt strategies to improve their wellbeing and prevent complications associated with T2DM. Some participants expressed ambivalence towards their adherence to the program due to day-to-day life commitments. The most appreciated feature of the program were the individualised approach adopted by the consultation nurse via skype, convenient appointments, the provision of credible and factual information and the accessible website. CONCLUSIONS This study critically evaluated perceptions of participants towards the WWDP and provided important recommendations for improving the delivery and sustainability of the program in future. Participants perceived the program as an effective means of supporting their T2DM self-management and improving wellbeing.
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Affiliation(s)
- Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Faculty of Health, University of Technology Sydney, New South Wales, Australia.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Nicole McDonald
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Diksha Sapkota
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | | | - Rebecca Rogers
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Amanda McGuire
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Dian Tjondronegoro
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rosie Walker
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom; Successful Diabetes, Ipswich, United Kingdom
| | | | - Codi White
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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22
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Anderson D, Sturt J, McDonald N, White C, Porter-Steele J, Rogers R, Temple A, Seib C, McGuire A, Tjondronegoro D, Walker R, Sapkota D. International feasibility study for the Women's Wellness with Type 2 Diabetes Programme (WWDP): An eHealth enabled 12-week intervention programme for midlife women with type 2 diabetes. Diabetes Res Clin Pract 2021; 171:108541. [PMID: 33227358 DOI: 10.1016/j.diabres.2020.108541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
AIMS The current study aimed to examine feasibility of participant recruitment and retention rates for the Women's Wellness with Type 2 Diabetes program (WWDP), and to assess initial efficacy of the program in improving wellbeing outcomes. METHODS 70 midlife women with type 2 diabetes mellitus (T2DM) participated in a 12-week wellness-focused intervention, the WWDP. The WWDP involved a structured book (with participatory activities), an interactive website and nurse consultations. This study had an Australian and a UK arm. Analyses were conducted using chi-square, McNemar, paired t-test, and Wilcoxon signed-ranks tests. RESULTS The attrition rate for the sample was 22.2%. Overall, significant improvement was observed in diabetes distress (DD), diabetes self-efficacy, weight, BMI, menopausal symptoms and sleep symptoms from baseline to program completion at 12 weeks. Australian participants were also more likely to meet fruit recommendation guidelines and had significant waist- and hip-circumference reductions. CONCLUSIONS Good retention rates and initial efficacy findings indicated feasibility of the WWDP as a promising 12-week health and wellness program for women with T2DM. They also suggest incorporating a focus on self-efficacy and gendered information may be important in improving wellness and health outcomes related to distress and menopause.
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Affiliation(s)
- Debra Anderson
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Faculty of Health, University of Technology Sydney, New South Wales, Australia.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Nicole McDonald
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Codi White
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | | | - Rebecca Rogers
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Ayako Temple
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom
| | - Charrlotte Seib
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Amanda McGuire
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Dian Tjondronegoro
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rosie Walker
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, United Kingdom; Successful Diabetes, Ipswich, United Kingdom
| | - Diksha Sapkota
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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23
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Harris B, Ajisola M, Alam RM, Watkins JA, Arvanitis TN, Bakibinga P, Chipwaza B, Choudhury NN, Kibe P, Fayehun O, Omigbodun A, Owoaje E, Pemba S, Potter R, Rizvi N, Sturt J, Cave J, Iqbal R, Kabaria C, Kalolo A, Kyobutungi C, Lilford RJ, Mashanya T, Ndegese S, Rahman O, Sayani S, Yusuf R, Griffiths F. Mobile consulting as an option for delivering healthcare services in low-resource settings in low- and middle-income countries: A mixed-methods study. Digit Health 2021; 7:20552076211033425. [PMID: 34777849 PMCID: PMC8580492 DOI: 10.1177/20552076211033425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/05/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Remote or mobile consulting is being promoted to strengthen health systems, deliver universal health coverage and facilitate safe clinical communication during coronavirus disease 2019 and beyond. We explored whether mobile consulting is a viable option for communities with minimal resources in low- and middle-income countries. METHODS We reviewed evidence published since 2018 about mobile consulting in low- and middle-income countries and undertook a scoping study (pre-coronavirus disease) in two rural settings (Pakistan and Tanzania) and five urban slums (Kenya, Nigeria and Bangladesh), using policy/document review, secondary analysis of survey data (from the urban sites) and thematic analysis of interviews/workshops with community members, healthcare workers, digital/telecommunications experts, mobile consulting providers, and local and national decision-makers. Project advisory groups guided the study in each country. RESULTS We reviewed four empirical studies and seven reviews, analysed data from 5322 urban slum households and engaged with 424 stakeholders in rural and urban sites. Regulatory frameworks are available in each country. Mobile consulting services are operating through provider platforms (n = 5-17) and, at the community level, some direct experience of mobile consulting with healthcare workers using their own phones was reported - for emergencies, advice and care follow-up. Stakeholder willingness was high, provided challenges are addressed in technology, infrastructure, data security, confidentiality, acceptability and health system integration. Mobile consulting can reduce affordability barriers and facilitate care-seeking practices. CONCLUSIONS There are indications of readiness for mobile consulting in communities with minimal resources. However, wider system strengthening is needed to bolster referrals, specialist services, laboratories and supply chains to fully realise the continuity of care and responsiveness that mobile consulting services offer, particularly during/beyond coronavirus disease 2019.
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Affiliation(s)
| | - Motunrayo Ajisola
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Raisa Meher Alam
- Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh
| | | | | | | | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | - Peter Kibe
- African Population and Health Research Center, Kenya
| | - Olufunke Fayehun
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Nigeria
| | - Akinyinka Omigbodun
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria
| | - Eme Owoaje
- Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Senga Pemba
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Rachel Potter
- Clinical Trials Unit Warwick Medical School, University of Warwick, University of Warwick, UK
| | - Narjis Rizvi
- Community Health Sciences Department, Aga Khan University, Pakistan
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, UK
| | | | - Romaina Iqbal
- Community Health Sciences Department, Aga Khan University, Pakistan
| | | | - Albino Kalolo
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | - Richard J Lilford
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Titus Mashanya
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Sylvester Ndegese
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Omar Rahman
- University of Liberal Arts Bangladesh, Bangladesh
| | - Saleem Sayani
- Aga Khan Development Network Digital Health Resource Centre (Asia and Africa), Aga Khan University, Pakistan
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University Bangladesh, Bangladesh
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
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24
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Racaru S, Sturt J, Celik A. The Effects of Psychological Interventions on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Pain Manag Nurs 2020; 22:302-311. [PMID: 33317935 DOI: 10.1016/j.pmn.2020.11.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/22/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Psychological interventions are effective at ameliorating the experience of pain in conditions such as rheumatoid arthritis and chronic back pain. However, their effect on diabetic peripheral neuropathy (DPN) pain has yet to be established AIM: To assess the effectiveness of psychological interventions on pain and related outcomes in adults with DPN. DESIGN Systematic review. SETTINGS Community, hospital in-patient and out-patient. PARTICIPANTS/SUBJECTS Adults with diabetic peripheral neuropathy. METHODS Medline, Embase, PsychInfo, and CINAHL databases together with grey literature and trial registers were searched. A meta-analysis and narrative synthesis of included studies were undertaken. RESULTS Nine studies were selected from 1610 citations. At short-term follow-up psychological therapies showed a large effect on pain severity (SMD = -0.94, 95%CI [-1.50, -0.37], p = .001), a small effect on pain interference (SMD = -0.39, 95%CI [-0.73, -0.05], p = .02), and a moderate effect on depressive symptoms (SMD = -0.58, 95%CI [-0.95, -0.21], p = .002). Quality of life significantly improved in experimental subjects, (MD = -2.35, 95%CI [-3.99, -0.71], p = .005). At medium-term follow-up there was a large effect on pain severity (SMD = -1.26, 95%CI [-1.76, -0.77], p < .00001) and on pain interference (SMD = -0.91, 95%CI [-1.61, -0.21], p = .01) and a moderate effect on depressive symptoms (SMD = -0.76, 95%CI [-1.48, -0.05], p = .04). At long-term follow-up, improvements in pain interference, mood, and self-care behaviors were reported. CONCLUSIONS These findings demonstrate that the relationship between pain and perceived control identified in other groups who experience chronic pain may also be replicated in the DPN population. This is an important outcome that can guide further research and associated service developments.
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Affiliation(s)
- Simona Racaru
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK; St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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25
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Scott D, Ibrahim F, Hill H, Tom B, Prothero L, Baggott RR, Bosworth A, Galloway JB, Georgopoulou S, Martin N, Neatrour I, Nikiphorou E, Sturt J, Wailoo A, Williams FMK, Williams R, Lempp H. The clinical effectiveness of intensive management in moderate established rheumatoid arthritis: The titrate trial. Semin Arthritis Rheum 2020; 50:1182-1190. [PMID: 32931984 PMCID: PMC7390769 DOI: 10.1016/j.semarthrit.2020.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Many trials have shown that intensive management is effective in patients with early active rheumatoid arthritis (RA). But its benefits are unproven for the large number of RA patients seen in routine care who have established, moderately active RA and are already taking conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs). The TITRATE trial studied whether these patients also benefit from intensive management and, in particular, achieve more remissions. METHODS A 12-month multicentre individually randomised trial compared standard care with monthly intensive management appointments which was delivered by specially trained healthcare professionals and incorporated monthly clinical assessments, medication titration and psychosocial support. The primary outcome was 12-month remission assessed using the Disease Activity Score for 28 joints using ESR (DAS28-ESR). Secondary outcomes included fatigue, disability, harms and healthcare costs. Intention-to-treat multivariable logistic- and linear regression analyses compared treatment arms with multiple imputation used for missing data. RESULTS 459 patients were screened and 335 were randomised (168 intensive management; 167 standard care); 303 (90%) patients provided 12-month outcomes. Intensive management increased DAS28-ESR 12-month remissions compared to standard care (32% vs 18%, p = 0.004). Intensive management also significantly increased remissions using a range of alternative remission criteria and increased patients with DAS28-ESR low disease activity scores. (48% vs 32%, p = 0.005). In addition it substantially reduced fatigue (mean difference -18; 95% CI: -24, -11, p<0.001). There was no evidence that serious adverse events (intensive management =15 vs standard care =11) or other adverse events (114 vs 151) significantly increase with intensive management. INTERPRETATION The trial shows that intensive management incorporating psychosocial support delivered by specially trained healthcare professions is effective in moderately active established RA. More patients achieve remissions, there were greater improvements in fatigue, and there were no more harms.
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Affiliation(s)
- David Scott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Fowzia Ibrahim
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom.
| | - Harry Hill
- ScHARR Health Economics and Decision Science, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom
| | - Brian Tom
- MRC Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom
| | - Louise Prothero
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Rhiannon R Baggott
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Ailsa Bosworth
- National Rheumatoid Arthritis Society (NRAS), Switchback Office Park, Gardner Rd, Maidenhead, SL6 7RJ, United Kingdom
| | - James B Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Sofia Georgopoulou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Naomi Martin
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Isabel Neatrour
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Jackie Sturt
- Department Of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom
| | - Allan Wailoo
- ScHARR Health Economics and Decision Science, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom
| | - Frances M K Williams
- Twin Research & Genetic Epidemiology, School of Life Course Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Ruth Williams
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London Cutcombe Road, London, SE5 9RJ, United Kingdom
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Sturt J, Huxley C, Ajana B, Gainty C, Gibbons C, Graham T, Khadjesari Z, Lucivero F, Rogers R, Smol A, Watkins JA, Griffiths F. How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study. Digit Health 2020; 6:2055207620942359. [PMID: 32742716 PMCID: PMC7375714 DOI: 10.1177/2055207620942359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/21/2019] [Accepted: 06/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background While studies have examined the impact of digital communication technology on healthcare, there is little exploration of how new models of digital care change the roles and identities of the health professional and patient. The purpose of the current study is to generate multidisciplinary reflections and questions around the use of digital consulting and the way it changes the meaning of being a patient and/or a health professional. Method We used a large pre-existing qualitative dataset from the Long-term Conditions Young People Networked Communication (LYNC) study which involved interviews with healthcare professionals and a group of 16-24 years patients with long-term physical and mental health conditions. We conducted a three-stage mixed methods analysis. First, using a small sample of interview data from the LYNC study, we identified three key themes to explore in the data and relevant academic literature. Second, in small groups we conducted secondary analysis of samples of patient and health professional LYNC interview data. Third, we ran a series of rapid evidence reviews. Findings We identified three key themes: workload/flow, impact of increased access to healthcare and vulnerabilities. Both health professionals and patients were 'on duty' in their role more often. Increased access to healthcare introduced more responsibilities to both patients and health professionals. Traditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting. Conclusions Our collaboration identified conflicts and constraints in the construction of digital patients and digital clinicians. There is evidence that digital technologies change the nature of a medical consultation and with it the identities and the roles of clinicians and patients which, in turn, calls for a redefinition of traditional concepts of medical ethics. Overall, digital consulting has the potential to significantly reduce costs while maintaining or improving patient care and clinical outcomes. Timely study of digital engagement in the National Health Service is a matter of critical importance.
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Affiliation(s)
- Jackie Sturt
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Caroline Huxley
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Btihaj Ajana
- Department of Digital Humanities, King's College London, UK
| | | | | | - Tanya Graham
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | | | | | - Rebecca Rogers
- The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | | | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
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Prothero L, Barley E, Galloway J, Georgopoulou S, Sturt J. Corrigendum to ``The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews'' [International Journal of Nursing Studies Volume 82, June 2018, Pages 20-29]. Int J Nurs Stud 2020; 107:103581. [DOI: 10.1016/j.ijnurstu.2020.103581] [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: 11/24/2022]
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Collins S, Jones A, Woodward S, Sturt J. P254 Establishing face validity of the MAGIC programme for people with cystic fibrosis diabetes (CFD). J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30586-5] [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: 10/24/2022]
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Abstract
Background Inaccessible services and poor communication are barriers to successful transitions between adolescent and adult mental health services, for which digital communications (DC) offer a possible solution. Aims To investigate the role of DC, including smartphone apps, email and text, given the known barriers and facilitators of mental health service transitions reported in the literature. Methods Use of Neale's (2016) iterative categorisation technique to undertake a secondary analysis of qualitative data collected for the Long-term conditions Young people Networked Communication (LYNC) study. Results DC were used successfully by young people and staff in ways that ameliorated known barriers to service transitions. They engendered responsibility in young people, promoted service access and contributed to client safety, particularly in times of crisis. DC risks included over-familiarity between young people and staff, and the possibility that messages could go unread. Conclusions DC have the potential to facilitate trust and familiarity during and after transition to adult mental health services. They can strengthen young people's perceptions of adult services as supportive, empowering and available. DC can be used for frequent 'check-ins' and remote digital support for social and personal problems. They provide an additional safety net for at-risk individuals, but require careful boundary setting.
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Affiliation(s)
- Rosie Martin
- Intensive Care, Wellington Hospital, New Zealand
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Griffiths F, Watkins JA, Huxley C, Harris B, Cave J, Pemba S, Chipwaza B, Lilford R, Ajisola M, Arvanitis TN, Bakibinga P, Billah M, Choudhury N, Davies D, Fayehun O, Kabaria C, Iqbal R, Omigbodun A, Owoaje E, Rahman O, Sartori J, Sayani S, Tabani K, Yusuf R, Sturt J. Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries. Digit Health 2020; 6:2055207620919594. [PMID: 32341793 PMCID: PMC7175047 DOI: 10.1177/2055207620919594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/01/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up. Methods We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue. Results We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system. Conclusions For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.
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Affiliation(s)
- Frances Griffiths
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, UK.,Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | - Senga Pemba
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | | | | | | | | | | | - David Davies
- Warwick Medical School, University of Warwick, UK
| | | | | | | | | | | | - Omar Rahman
- Independent University Bangladesh, Bangladesh
| | - Jo Sartori
- Warwick Medical School, University of Warwick, UK
| | | | | | - Rita Yusuf
- Independent University Bangladesh, Bangladesh
| | - Jackie Sturt
- The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK
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Celik A, Forde R, Sturt J. The impact of online self-management interventions on midlife adults with type 2 diabetes: a systematic review. ACTA ACUST UNITED AC 2020; 29:266-272. [DOI: 10.12968/bjon.2020.29.5.266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Online self-management education programmes are now recommended for people with type 2 diabetes to improve self-management capacities. There is limited evidence to determine whether such programmes improve the health outcomes for midlife adults with diabetes. Aims: The purpose of this systematic review was to assess the impact of online self-management interventions with digital consulting on glycated haemoglobin (HbA1c), total cholesterol, blood pressure, diabetes distress, self-efficacy, and depression in midlife adults. Methods: A systematic review was undertaken searching Medline, Embase and CINAHL. Studies were appraised using the Cochrane Collaboration's tool. Results: Eight studies were included. Online interventions resulted in the improvement of HbA1c (pooled mean difference on HbA1c: -0.35%, 95% CI (-0.52, -0.18), P<0.001). A narrative synthesis was conducted for all secondary outcomes. No conclusions could be drawn on the impact of these outcomes. Conclusion: Online interventions improve HbA1c. Further research is needed for secondary outcomes.
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Affiliation(s)
- Aycan Celik
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Rita Forde
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
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Artom M, Czuber-Dochan W, Sturt J, Proudfoot H, Roberts D, Norton C. Cognitive-behavioural therapy for the management of inflammatory bowel disease-fatigue: a feasibility randomised controlled trial. Pilot Feasibility Stud 2019; 5:145. [PMID: 31890258 PMCID: PMC6905023 DOI: 10.1186/s40814-019-0538-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 11/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background Fatigue is the third most prevalent symptom for patients with inflammatory bowel disease (IBD), yet optimal strategies for its management are unclear. Treatment protocols for fatigue in other conditions have been based on cognitive-behavioural models. Targeting cognitions, emotions and behaviour related to fatigue through cognitive-behavioural therapy (CBT) may be a viable option to improve fatigue and quality of life (QoL) in IBD. Methods This single centre, two-arm, feasibility randomised controlled trial (RCT) aimed to assess the feasibility and initial estimates of potential efficacy of a CBT intervention for the management of IBD-fatigue. Feasibility, acceptability and initial estimates of potential efficacy outcomes were collected through self-report measures and semi-structured interviews. Participants were recruited from one tertiary referral centre. Intervention Group 1 received a CBT manual for fatigue, one 60-min and seven 30-min telephone sessions with a therapist over 8-weeks. Control Group 2 received a fatigue information sheet without therapist support. A nested qualitative study evaluated patients’ and therapists’ experiences, and IBD-healthcare professionals’ (HCPs) perceptions of the intervention. Results Eighty-nine participants were assessed for eligibility. Of these, 31 of the 70 eligible participants consented to participate (recruitment rate of 44%). Of the 15 participants randomised to the intervention group, 13 (87%) started it and 10 (77% of those who started) completed all 8 sessions. Follow-up questionnaires were completed by 22 (71%) participants at 3 months, 14 (45%) at 6 months and 12 (39%) at 12 months’ follow-up. The intervention was acceptable to participants and feasible for therapists to deliver. HCPs reported that the intervention would be applicable, but time, finance and training constraints limit its implementation. Initial estimates of potential efficacy with complete case analysis showed a reduction in fatigue and an increase in QoL at 3, 6 and 12 months post-randomisation. Conclusions A full-scale effectiveness RCT testing CBT for IBD-fatigue is feasible and is potentially worthwhile with some changes to the protocol. However, given the small numbers, further pilot work is warranted before a full-scale RCT. Trial registration Registration Trial ISRCTN 17917944, Registered 2 September 2016
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Affiliation(s)
- Micol Artom
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Wladyslawa Czuber-Dochan
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Hannah Proudfoot
- 2Tobacco & Alcohol Research Group, University College London, London, UK
| | - Danniella Roberts
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
| | - Christine Norton
- 1Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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Skinner T, Byrne M, Dickinson JK, Fisher L, Funnell M, Guzman S, Hendrieckx C, Hermanns N, Kanc K, Lloyd C, Mocan A, Nouwen A, Pouwer F, Saleh-Stattin N, Snoek F, Speight J, Sturt J, Vallis M, Wagner J, Willaing I, Young-Hyman D, Zoffmann V. Comment on the consensus report on the management of hyperglycaemia in Type 2 diabetes by the American Diabetes Association and the European Association for the Study of Diabetes. Diabet Med 2019; 36:911-912. [PMID: 30785642 DOI: 10.1111/dme.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T Skinner
- University of Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Denmark
| | - M Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
| | - J K Dickinson
- Diabetes Education and Management, Teachers College Columbia University, New York, NY, USA
| | - L Fisher
- Family and Community Medicine, University of California San Francisco, San Francisco, LA, USA
| | - M Funnell
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Guzman
- Behavioural Diabetes Institute, San Diego, CA, USA
| | - C Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - N Hermanns
- Jazindiabetes, (Diabetes & Me), Slovenia
| | - K Kanc
- Forschungsinstitut Diabetes-Akademie, Bad Mergentheim, Germany
| | - C Lloyd
- Open University, Milton Keynes, UK
| | - A Mocan
- Emergency Clinical County Hospital, Cluj-Napoca, Romania
| | - A Nouwen
- Middlesex University, London, UK
| | - F Pouwer
- University of Southern Denmark, Odense, Denmark
| | | | - F Snoek
- Amsterdam UMC, Amsterdam, Netherlands
| | - J Speight
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Australia
| | - J Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, UK
| | - M Vallis
- Dalhousie University, Halifax, Canada
| | - J Wagner
- Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Denmark
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Collins S, Jones A, Woodward S, Sturt J. P302 “If I could be off them, I would” - adults with Cystic Fibrosis-Related Diabetes experiences of corticosteroid therapy. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30595-8] [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: 11/25/2022]
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Ignatowicz A, Atherton H, Bernstein CJ, Bryce C, Court R, Sturt J, Griffiths F. Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digit Health 2019; 5:2055207619845831. [PMID: 31069105 PMCID: PMC6495459 DOI: 10.1177/2055207619845831] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [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: 08/29/2018] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background The use of internet videoconferencing in healthcare settings is widespread,
reflecting the normalisation of this mode of communication in society and
current healthcare policy. As the use of internet videoconferencing is
growing, increasing numbers of reviews of literature are published. Methods The authors conducted a review of the existing reviews of literature relating
to the use of internet videoconferencing for consultations between
healthcare professionals and patients with long-term conditions in their own
home. The review was followed with an assessment of United Kingdom National
Institute for Health and Clinical Excellence guidelines for patient care in
the context of common long-term illnesses to examine where videoconferencing
could be implemented in line with these recommendations. Results The review of reviews found no formal evidence in favour of or against the
use of internet videoconferencing. Patients were satisfied with the use of
videoconferencing but there was limited evidence that it led to a change in
health outcomes. Evidence of healthcare professional satisfaction when using
this mode of communication with patients was limited. The review of
guidelines suggested a number of opportunities for adoption and expansion of
internet videoconferencing. Implementing videoconferencing in line with
current evidence for patient care could offer support and provide
information on using a communication channel that suits individual patient
needs and circumstances. The evidence base for videoconferencing is growing,
but there is still a lack of data relating to cost, ethics and safety. Conclusions While the current evidence base for internet videoconferencing is equivocal,
it is likely to change as more research is undertaken and evidence
published. With more videoconferencing services added in more contexts,
research needs to explore how internet videoconferencing can be implemented
in ways that it is valued by patients and clinicians, and how it can fit
within organisational and technical infrastructure of the healthcare
services.
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Affiliation(s)
- Agnieszka Ignatowicz
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Helen Atherton
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | | | - Carol Bryce
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Rachel Court
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, The University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Baggott R, Scott D, Sturt J, Bosworth A, Parker L, Georgopoulou S, Lempp H. 150 What is the value, impact and role of nurses in rheumatology outpatient care? Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez108.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rhiannon Baggott
- Department of Inflammation Biology, King’s College London, London, UNITED KINGDOM
| | - David Scott
- Department of Inflammation Biology, King’s College London, London, UNITED KINGDOM
| | - Jackie Sturt
- Nursing, Midwifery and Palliative Care, King’s College London, London, UNITED KINGDOM
| | - Ailsa Bosworth
- CEO, National Rheumatoid Arthritis Society, Maidenhead, UNITED KINGDOM
| | - Louise Parker
- Rheumatology Department, Royal Free London NHSFT, London, UNITED KINGDOM
| | - Sofia Georgopoulou
- Applied Health Research, The Royal Marsden Hospital, London, UNITED KINGDOM
| | - Heidi Lempp
- Department of Inflammation Biology, King’s College London, London, UNITED KINGDOM
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Silke L, Sturt J, Lempp H. 056 Development of the rheumatoid arthritis distress scale: a new tool to identify disease-specific distress in patients with rheumatoid arthritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez106.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Linda Silke
- Academic Department of Physiotherapy, Faculty of Life Sciences & Medicine, King’s College London, London, UNITED KINGDOM
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, London, UNITED KINGDOM
| | - Heidi Lempp
- Department of Inflammation Biology, Faculty of Life Sciences & Medicine, King’s College London, London, UNITED KINGDOM
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Polonsky WH, Fisher L, Hessler D, Stuckey H, Snoek FJ, Tang T, Hermanns N, Mundet X, Silva M, Sturt J, Okazaki K, Hadjiyianni I, Cao D, Ivanova J, Desai U, Perez-Nieves M. Identifying solutions to psychological insulin resistance: An international study. J Diabetes Complications 2019; 33:307-314. [PMID: 30709604 DOI: 10.1016/j.jdiacomp.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/16/2018] [Accepted: 01/08/2019] [Indexed: 02/06/2023]
Abstract
AIMS To identify actions of healthcare professionals (HCPs) that facilitate the transition to insulin therapy (IT) in type 2 diabetes (T2D) adults. METHODS Included were T2Ds in seven countries (n = 594) who reported initial IT reluctance but eventually began IT. An online survey included 38 possible HCP actions: T2Ds indicated which may have occurred and their helpfulness. Also reported were delays in IT start after initial recommendation and any period of IT discontinuation. RESULTS Exploratory factor analysis of HCP actions yielded five factors: "Explained Insulin Benefits" (EIB), "Dispelled Insulin Myths" (DIM), "Demonstrated the Injection Process" (DIP), "Collaborative Style" (CS) and "Authoritarian Style" (AS). Highest levels of helpfulness occurred for DIP, EIB and CS; lowest for AS. Participants who rated DIP as helpful were less likely to delay IT than those who rated DIP as less helpful (OR = 0.75, p = 0.01); participants who rated CS and EIB as helpful were less likely to interrupt IT than those who rated these as less helpful (OR = 0.55, p < 0.01; OR = 0.51, p = 0.01, respectively). CONCLUSIONS Three key HCP actions to facilitate IT initiation were identified as helpful and were associated with more successful initiation and persistence. These findings may aid the development of interventions to address reluctance to initiating IT.
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Affiliation(s)
- William H Polonsky
- University of California, San Diego, La Jolla, CA, USA; Behavioral Diabetes Institute, San Diego, CA, USA.
| | - Lawrence Fisher
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Frank J Snoek
- Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands
| | - Tricia Tang
- University of British Columbia, Vancouver, Canada
| | | | - Xavier Mundet
- Universitat Autonoma de Barcelona, Bellaterra, Spain
| | - Maria Silva
- Instituto Multidisciplinar de Medicina, Sao Paulo, Brazil
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Prothero L, Sturt J, de Souza S, Lempp H. Intensive management for moderate rheumatoid arthritis: a qualitative study of patients' and practitioners' views. BMC Rheumatol 2019; 3:12. [PMID: 30976751 PMCID: PMC6437952 DOI: 10.1186/s41927-019-0057-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The TITRATE trial seeks to test whether intensive management is valuable in achieving disease remission in moderately active rheumatoid arthritis. Intensive management is a complex intervention consisting of: 1) 12 x monthly appointments, 2) tailored 'treatment support' based on motivational interviewing techniques, 3) optimised medication (including the opportunity for biologics), 4) provision of a Patient Handbook, and 5) shared treatment planning. This study aims to understand: a) patients' and practitioners' views on the feasibility and acceptability of intensive management, and b) patients' and practitioners' experience of receiving/providing intensive management. METHODS A qualitative study, nested within a randomised controlled trial. Participants were patients (n = 15) in the intensive management arm of the trial and rheumatology practitioners (n = 16) providing the intensive management intervention, from 18/42 clinics across England. Data were collected via semi-structured interviews and analysed using thematic analysis and iterative categorization. RESULTS Monthly appointments were largely acceptable to both groups who cited several treatment benefits (e.g. regular review of medication, practitioners built close relationships with patients). Practitioners were 'fairly confident' using the motivational interviewing techniques. Learning to pace was the most commonly reported self-management technique that patients and healthcare professionals worked on together, followed by gaining control over pain and fatigue. Practitioners liked having the option to offer biologics to patients with moderate RA. Most patients found the optimised medication (following monthly joint assessment) helpful and side-effects experienced were resolved. Variation existed in the extent to which patients engaged with the Patient Handbook and shared treatment planning, with those who did engage doing so in the early stages. CONCLUSIONS Feedback from patient participants about the intensive management intervention was positive. They found increased medication helpful. Continuity of care with the same healthcare professional at regular intensive management sessions, and the treatment support provided, were highly rated. Feedback from practitioners indicated that intensive management training is feasible. Evidence from the interviews showed that some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients.
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Affiliation(s)
- Louise Prothero
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Savia de Souza
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
| | - Heidi Lempp
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
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Keller-Senn A, Lee G, Imhof L, Sturt J. Characteristics of patients treated for severe hypoglycaemia in emergency care settings – Analysis of routinely collected data. Int Emerg Nurs 2019; 43:74-78. [DOI: 10.1016/j.ienj.2018.10.005] [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] [Received: 01/18/2018] [Revised: 09/27/2018] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
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Stuckey H, Fisher L, Polonsky WH, Hessler D, Snoek FJ, Tang TS, Hermanns N, Mundet-Tuduri X, da Silva MER, Sturt J, Okazaki K, Cao D, Hadjiyianni I, Ivanova JI, Desai U, Perez-Nieves M. Key factors for overcoming psychological insulin resistance: an examination of patient perspectives through content analysis. BMJ Open Diabetes Res Care 2019; 7:e000723. [PMID: 31908792 PMCID: PMC6936574 DOI: 10.1136/bmjdrc-2019-000723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to start insulin treatment. RESEARCH DESIGN AND METHODS Telephone interviews were conducted with a subset of participants from an international investigation of adults with T2D who were reluctant to start insulin (EMOTION). Questions related to: (a) participants' thoughts about insulin before and after initiation; (b) reasons behind responses on the survey that were either 'not helpful at all' or 'helped a lot'; (c) actions their HCP may have taken to help start insulin treatment; and (d) advice they would give to others in a similar situation of starting insulin. Responses were coded by two independent reviewers (kappa 0.992). RESULTS Starting insulin treatment was perceived as a negative experience that would be painful and would lead down a 'slippery slope' to complications. HCPs engaged in four primary behaviors that helped with insulin acceptance: (1) showed the insulin pen/needle and demonstrated the injection process; (2) explained how insulin could help with diabetes control and reduce risk of complications; (3) used collaborative communication style; and (4) offered support and willingness to answer questions so that participants would not be 'on their own'. Following initiation, most participants noted that insulin was not 'as bad as they thought' and recommended insulin to other adults with T2D. CONCLUSIONS Based on these themes, two actionable strategies are suggested for HCPs to help people with psychological insulin resistance: (1) demonstrate the injection process and discuss negative perceptions of insulin as well as potential benefits; (2) offer autonomy in a person-centred collaborative approach, but provide support and accessibility to address concerns. These findings help HCPs to better understand ways in which they can engage reluctant people with T2D with specific strategies.
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Affiliation(s)
| | - Lawrence Fisher
- University of California San Francisco, San Francisco, California, USA
| | - William H Polonsky
- Behavioral Diabetes Institute, University of California, San Diego, Del Mar, California, USA
| | - Danielle Hessler
- University of California San Francisco, San Francisco, California, USA
| | - Frank J Snoek
- Amsterdam University Medical Centre Vrije Universiteit, Amsterdam, The Netherlands
| | - Tricia S Tang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Kentaro Okazaki
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dachuang Cao
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | - Urvi Desai
- Analysis Group Inc Boston, Boston, Massachusetts, USA
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Messina R, Due-Christensen M, Keller-Senn A, Polek E, Fantini MP, Sturt J. Couples living with type 1 diabetes: An integrative review of the impacts on health and wellbeing. J Health Psychol 2018; 26:412-437. [PMID: 30574793 DOI: 10.1177/1359105318817356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Impacts of type 1 diabetes and relationship factors on health and wellbeing of both persons with diabetes and partners (T1D partners) have not been investigated. Integrative review methods evaluated the evidence. From 323 titles, we included 24 studies involving 16,083 persons with diabetes and 1020 T1D partners. Studies were quantitative (n = 13), qualitative (n = 9) and mixed methods (n = 2). Maintaining resilient, good quality, intimate relationships optimises physical and psychological outcomes for persons with diabetes. Partners experience disturbed sleep and while general psychological health is maintained, distress surrounding hypoglycaemia is overwhelming for over a third of partners. Nurturing quality relationships could reap significant health benefits.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Italy
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
| | - Mette Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
- Steno Diabetes Centre Copenhagen, Denmark
| | - Anita Keller-Senn
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
- Cantonal Hospital Winterthur, Switzerland
- Zurich University of Applied Sciences, Switzerland
| | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK
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Affiliation(s)
- Micol Artom
- King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK
| | | | - Jackie Sturt
- King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Christine Norton
- King's College London, Florence Nightingale Faculty of Nursing & Midwifery, London, UK.,Imperial College Healthcare NHS Trust, London, UK
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Kim SW, Madan J, Dritsaki M, Bryce C, Forjaz V, Fraser J, Griffiths F, Hamilton K, Huxley C, Sturt J. Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach. JMIR Med Inform 2018; 6:e48. [PMID: 30377145 PMCID: PMC6234335 DOI: 10.2196/medinform.9577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/09/2018] [Revised: 06/28/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. OBJECTIVE This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. METHODS This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. RESULTS When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. CONCLUSIONS Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting.
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Affiliation(s)
- Sung Wook Kim
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Jason Madan
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Carol Bryce
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Vera Forjaz
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Joe Fraser
- Joe's Diabetes Ltd, Coventry, United Kingdom
| | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Kathryn Hamilton
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Caroline Huxley
- Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Sturt J, Dliwayo TR, Forjaz V, Hamilton K, Bryce C, Fraser J, Griffiths F. Eliciting the Impact of Digital Consulting for Young People Living With Long-Term Conditions (LYNC Study): Cognitive Interviews to Assess the Face and Content Validity of Two Patient-Reported Outcome Measures. J Med Internet Res 2018; 20:e268. [PMID: 30309832 PMCID: PMC6231804 DOI: 10.2196/jmir.9786] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/30/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Digital consulting, using email, text, and Skype, is increasingly offered to young people accessing specialist care for long-term conditions. No patient-reported outcome measures (PROMs) have been evaluated for assessing outcomes of digital consulting. Systematic and scoping reviews, alongside patient involvement, revealed 2 candidate PROMs for this purpose: the patient activation measure (PAM) and the physician's humanistic behaviors questionnaire (PHBQ). PAM measures knowledge, beliefs, and skills that enable people to manage their long-term conditions. PHBQ assesses the presence of behaviors that are important to patients in their physician-patient interactions. OBJECTIVE This study aimed to assess the face and content validity of PAM and PHBQ to explore whether they elicit important outcomes of digital consulting and whether the PROMs can isolate the digital consultation component of care. METHODS Participants were drawn from 5 clinics providing specialist National Health Service care to 16- to 24-year-olds with long-term health conditions participating in the wider LYNC (Long-Term Conditions, Young People, Networked Communications) study. Overall, 14 people undertook a cognitive interview in this substudy. Of these, 7 participants were young people with either inflammatory bowel disease, cystic fibrosis, or cancer. The remaining 7 participants were clinicians who were convenience sampled. These included a clinical psychologist, 2 nurses, 3 consultant physicians, and a community youth worker practicing in cancer, diabetes, cystic fibrosis, and liver disease. Cognitive interviews were transcribed and analyzed, and a spreadsheet recorded the participants' PROM item appraisals. Illustrative quotes were extracted verbatim from the interviews for all participants. RESULTS Young people found 11 of the PAM 13 items and 7 of the additional 8 PAM 22 items to be relevant to digital consulting. They were only able to provide spontaneous examples of digital consulting for 50% (11/22) of the items. Of the 7 clinicians, 4 appraised all PAM 13 items and 20 of the PAM 22 items to be relevant to evaluating digital consulting and articulated operationalization of the items with reference to their own digital consulting practice with greater ease than the young people. Appraising the PHBQ, in 14 of the 25 items, two-thirds of the young people's appraisals offered digital consulting examples with ease, suggesting that young people can detect and discern humanistic clinician behaviors via digital as well as face-to-face communication channels. Moreover, 17 of the 25 items were appraised as relevant by the young people. This finding was mirrored in the clinician appraisals. Both young people and the clinicians found the research task complex. Young participants required considerably more researcher prompting to elicit examples related to digital consulting rather than their face-to-face care. CONCLUSIONS PAM and PHBQ have satisfactory face and content validity for evaluating digital consulting to warrant proceeding to psychometric evaluation. Completion instructions require revision to differentiate between digital and face-to-face consultations.
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Affiliation(s)
- Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | | | - Vera Forjaz
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Kathryn Hamilton
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
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Abu Ghazaleh H, Hashem R, Forbes A, Dilwayo TR, Duaso M, Sturt J, Halson-Brown S, Mulnier H. A Systematic Review of Ultrasound-Detected Lipohypertrophy in Insulin-Exposed People with Diabetes. Diabetes Ther 2018; 9:1741-1756. [PMID: 30014243 PMCID: PMC6167307 DOI: 10.1007/s13300-018-0472-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 05/18/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Lipohypertrophy (LH) is a common complication occurring in diabetes individuals. The most common methods used include palpation, visual examination and/or ultrasound (US). To date, there is limited information on the detection sensitivity among the different techniques used to identify LH. This systematic review aimed to identify studies that examined insulin-related LH using US detection to identify the prevalence, characteristics and morphology of LH, and to compare US and clinical palpation methods for detecting LH. METHODS Three electronic databases were systematically searched for studies detecting LH using US in insulin users. Articles were screened for eligibility and included studies were appraised using quality assessment tools. The quality of the evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation, and the extracted data was synthesised narratively. RESULTS Sixteen articles were included in the review providing data on 1722 patients. The prevalence of LH prevalence varied from 14.5% to 88% (median 56.6%). Identified risk factors for the development of included insulin injection behaviour such as a lack of injection site rotation and social factors such as low education level. Four studies compared LH detection by US to palpation, providing inconsistent results. One study showed that palpation detected 64% more LH, whilst two studies demonstrated that US identified 50% more sites and extended areas of LH (additional ~ 5 cm2). Another study provided comparable estimates between palpation and US in clinicians trained to detect LH (97%). CONCLUSION The evidence highlights a lack of congruence in results pertaining to the detection sensitivity of US and palpation for LH sites. More research with robust study design is needed to verify whether clinically palpation is sufficient to detect LH, or whether US would increase the precision of LH assessment to help address this common clinically significant problem.
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Affiliation(s)
- Haya Abu Ghazaleh
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
| | - Rabab Hashem
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | | | - Maria Duaso
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Susan Halson-Brown
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Henrietta Mulnier
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Dibley L, Czuber-Dochan W, Woodward S, Wade T, Bassett P, Sturt J, Norton C. Development and Psychometric Properties of the Inflammatory Bowel Disease Distress Scale (IBD-DS): A New Tool to Measure Disease-Specific Distress. Inflamm Bowel Dis 2018; 24:2068-2077. [PMID: 29788323 DOI: 10.1093/ibd/izy108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) imposes a heavy psychosocial burden, with many patients reporting anxiety, depression, and distress. In diseases such as diabetes, disease-specific distress is associated with concordance with treatments and disease control. IBD distress, distinct from anxiety and depression, is evident in people with IBD. We aimed to develop a questionnaire for assessing IBD-specific distress, validate this against a gold standard distress measure for diabetes, and demonstrate the difference between anxiety, depression, and distress. METHODS The 94-item IBD Distress Scale (IBD-DS) was developed through secondary analysis of 3 qualitative data sets from previous IBD studies. Items were then refined through cognitive interviews in 2 stages (n = 15, n = 3). Three supplementary unscored questions were added to enable patients to identify their overall level of distress, their perceived level of disease activity, and their 3 most distressing issues. Subsequently, the 55-item IBD Distress Scale was subjected to test-retest. Two hundred seventy-five people received the test draft IBD-DS, and 168 responded (60.4%). Of these, 136 (82%) returned the retest draft of IBD-DS 3 weeks later. After analysis, further item reduction was informed by response rates, kappa values, and correlation coefficients, and test-retest was repeated. One hundred fifty-four people received the test final 28-item IBD-DS, and 123 people responded (58.8%). Of these, 95 (77%) returned the retest final IBD-DS. RESULTS The 94 items were reduced to 28 items. Good intraclass correlation (ICC) was found between test-retest scores on 72 complete data sets with unchanged disease status (ICC, 0.92; 95% confidence interval, 0.88-0.95). Cronbach's alpha was 0.95, indicating excellent internal consistency. Factor analysis indicated scoring the items as a single domain (score range, 0-168). CONCLUSION The final IBD-DS performs well and offers a tool for assessing IBD-specific distress.
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Affiliation(s)
- Lesley Dibley
- Faculty of Education and Health, University of Greenwich, London, United Kingdom.,Bart's Health NHS Trust, London, United Kingdom
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Sue Woodward
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Tiffany Wade
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Paul Bassett
- Independent Statistician, Amersham, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Verran A, Uddin A, Court R, Taggart F, Sutcliffe P, Sturt J, Griffiths F, Atherton H. Effectiveness and impact of networked communication interventions in young people with mental health conditions: A rapid review. Digit Health 2018; 4:2055207618762209. [PMID: 29942626 PMCID: PMC6005403 DOI: 10.1177/2055207618762209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/27/2017] [Accepted: 01/18/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the latest evidence of effectiveness and impact of networked communication interventions for young people with mental health conditions. Methods Searching five databases from 2009 onwards, we included studies of any design investigating two-way communication interventions for the treatment of young people (mean age 12–25) with a chronic mental health disorder. The data were synthesised using narrative summary. Results Six studies met the inclusion criteria, covering a range of mental health conditions (depression, psychosis, OCD). Interventions included an online chat room (n = 2), videoconferencing (n = 3) and telephone (n = 1). Where studies compared two groups, equivalence or a statistically significant improvement in symptoms was observed compared to control. Views of patients and clinicians included impact on the patient-clinician interaction. Clinicians did not feel it hindered their diagnostic ability. Conclusion Networked communication technologies show promise in the treatment of young people with mental health problems but the current available evidence remains limited and the evidence base has not advanced much since the previous inception of this review in 2011. Practice implications Although the available research is generally positive, robust evidence relating to the provision of care for young persons via these technologies is lacking and healthcare providers should be mindful of this.
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Affiliation(s)
- Alice Verran
- 1Warwick Medical School, University of Warwick, UK
| | - Ayesha Uddin
- 1Warwick Medical School, University of Warwick, UK
| | - Rachel Court
- 1Warwick Medical School, University of Warwick, UK
| | | | | | - Jackie Sturt
- The Florence Nightingale Faculty of Nursing & Midwifery, King's College London, UK
| | - Frances Griffiths
- 1Warwick Medical School, University of Warwick, UK.,University of the Witwatersrand, South Africa
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Collins S, Jones A, Woodward S, Sturt J. P160 Striking the balance between cystic fibrosis and Cystic Fibrosis-Related Diabetes (CFRD) - a meta-ethnography. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30455-7] [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: 10/14/2022]
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Messina R, Rucci P, Sturt J, Mancini T, Fantini MP. Assessing self-efficacy in type 2 diabetes management: validation of the Italian version of the Diabetes Management Self-Efficacy Scale (IT-DMSES). Health Qual Life Outcomes 2018; 16:71. [PMID: 29685153 PMCID: PMC5914030 DOI: 10.1186/s12955-018-0901-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/16/2018] [Indexed: 11/24/2022] Open
Abstract
Background Being highly self-efficacious is a key factor in successful chronic disease self-management. In the context of measuring self-efficacy in type 2 diabetes management, the Diabetes Management Self-Efficacy Scale (DMSES) is the most widely used scale. The aim of this study was to adapt the English version of the scale to Italian and to evaluate the psychometric properties of the Italian version of DMSES in type 2 diabetes (IT-DMSES). Methods We conducted a cross-sectional study of people with type 2 diabetes attending the Endocrine-Metabolic Disease Care Unit of the Internal Medicine Department of San Marino State Hospital between October 2016 and February 2017. Patients completed a socio-demographic and clinical data form, the IT-DMSES and 3 self-report questionnaires measuring diabetes distress (PAID-5), psychological well-being (WHO-5) and depression (PHQ-9). Psychometric testing included construct validity (principal component analysis), internal consistency (Cronbach’s α coefficient) and convergent/discriminant validity (Spearman’s correlation coefficient). Decision tree analysis was performed to classify patients into homogeneous subgroups of self-efficacy based on their demographic and clinical characteristics. Results Participants were 110 males and 55 females, mean age of 65.2 years (SD ± 9), 56.9% had been diagnosed for 1–15 years, 63% had HbA1c level > 53 mmol/mol. Two main factors underlain the construct of self-efficacy in diabetes management: ‘Disease Management’ and “Lifestyles Management”. Disease Management had a good reliability (α = .849) and Lifestyle Management had an excellent reliability (α = .902) indicating that the instrument is internally consistent. A negative and weak correlation was found between Lifestyle management, PAID-5 (r = − 0.258, p = < 0.01) and PHQ-9 (r = − 0.274, p = < 0.01) and a positive one with WHO-5 (r = 0.325, p < 0.01) supporting convergent validity. Disease management was uncorrelated with PAID-5 (r = − 0.142, p = 0.083), PHQ-9 (r = − 0.145, p = 0.076) and weekly correlated with WHO-5 (r = 0.170, p = 0.037) confirming discriminant validity. Higher levels of self-efficacy in lifestyle management were found in patients diagnosed for at least 1 year up to 15 years and aged > 65 years and the poorest self-efficacy was found in males < 65 years. Conclusions Results support the validity and reliability of IT-DMSES. The scale can be used in research and clinical practice to monitor type 2 diabetes self-management over time. Electronic supplementary material The online version of this article (10.1186/s12955-018-0901-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
| | - Tatiana Mancini
- Endocrine-Metabolic Disease Care Unit, Department of Internal Medicine, Istituto Sicurezza Sociale, Cailungo, San Marino
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Section of Hygiene and Biostatistics, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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