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Josefsson C, Liljeroos T, Hellgren M, Pöder U, Hedström M, Olsson EMG. The Sukaribit Smartphone App for Better Self-Management of Type 2 Diabetes: Randomized Controlled Feasibility Study. JMIR Form Res 2024; 8:e46222. [PMID: 38198200 PMCID: PMC10809162 DOI: 10.2196/46222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 09/15/2023] [Accepted: 11/24/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND A new app, Sukaribit, was designed to enable contact between the caregiver and the patient with the intent to improve self-care and glycemic control (hemoglobin A1c [HbA1c]). OBJECTIVE This study investigated the feasibility of the study methodology and the intervention in preparation for a larger effectiveness study. METHODS Adults with type 2 diabetes were recruited in this randomized controlled feasibility study with a mixed methods design. The intervention group (n=28) tried Sukaribit for 2 months. They were encouraged to report blood glucose levels and medications, and they received feedback from a physician. The control group (n=31) received standard care. Both groups were evaluated with pre and postmeasurements of glycemic control (HbA1c), diabetes distress, physical activity, and self-care. Feasibility was evaluated against 5 progression criteria regarding recruitment, study methods, and active participation. RESULTS Of the 5 progression criteria, only 2 were met or partially met. The recruitment process exceeded expectations, and data collection worked well for self-reported data but not for HbA1c measured with a home testing kit. The participants were less active than anticipated, and the effect sizes were small. Only the number of blood glucose tests per day was positively affected by the intervention, with 0.6 more tests per day in the intervention group. CONCLUSIONS Recruitment of participants to a future fully powered study may work with minor adjustments. The collection of HbA1c using home testing constituted a major problem, and an alternative strategy is warranted. Finally, the app was not used as intended. In order to proceed with a larger study, the app and study procedures need improvement.
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Affiliation(s)
- Cecilia Josefsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Thea Liljeroos
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Ulrika Pöder
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mariann Hedström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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2
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Aydin C, Ceyhan Y. Moderating Effect of Dyspnea in the Relationship Between Death Anxiety and Self-Management in COPD: A Structural Equation Modeling Analysis. Omega (Westport) 2023:302228231224572. [PMID: 38135283 DOI: 10.1177/00302228231224572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
The study was conducted to examine the moderating effect of dyspnea (according to Modified Medical Research Council-mMRC scale) on the relationship between death anxiety (DA) and self-management (SM) levels in patients suffering from chronic obstructive pulmonary disease (COPD) (n = 313). Model fit indices are within appropriate limits (χ2/DF = 2.284, GFI = .855, CFI = .796, RMSEA = .064). In mMRC 2, females had 33 times more DA than males. In mMRC 3, DA increased 36 times with increasing age and 14 times with comorbidity. It decreased 15-fold in those with past exacerbation experience. The second model explained DA by 18% while the moderating effect of severe dyspnea contributed 28% to this association. In this group of patients, a one unit increase in DA led to a 53-fold increase in SM. Age, gender, comorbidity and previous exacerbation history affect DA in patients with COPD. Increased DA decreases self-management. Severe dyspnea has a moderating effect between DA and SM.
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Affiliation(s)
- Cihan Aydin
- Department of Chest Diseases, Clinic of Pulmonology, Kirsehir Ahi Evran University Training and Research Hospital, Kirsehir, Turkey
| | - Yasemin Ceyhan
- Department of Internal Medicine Nursing, Kirsehir Ahi Evran University Faculty of Health Sciences, Kirsehir, Turkey
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Hong S, Lee H, Kim B. Editorial: Self-presentation during self quarantine era. Front Psychol 2023; 14:1194898. [PMID: 37384175 PMCID: PMC10295727 DOI: 10.3389/fpsyg.2023.1194898] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Seoyeon Hong
- Department of Public Relations & Advertising, Ric Edelman College of Communication and Creative Arts, Rowan University, Glassboro, NJ, United States
| | - Hyunmin Lee
- Department of Communication, Drexel University, Philadelphia, PA, United States
| | - Bokyung Kim
- Department of Public Relations & Advertising, Ric Edelman College of Communication and Creative Arts, Rowan University, Glassboro, NJ, United States
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Kolivas D, Fraser L, Schweitzer R, Brukner P, Moschonis G. Effectiveness of a Digitally Delivered Continuous Care Intervention (Defeat Diabetes) on Type 2 Diabetes Outcomes: A 12-Month Single-Arm, Pre-Post Intervention Study. Nutrients 2023; 15:2153. [PMID: 37417727 DOI: 10.3390/nu15092153] [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: 03/29/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023] Open
Abstract
Low-carbohydrate dietary approaches can lead to improvements in blood glucose levels and weight loss, as well as a reduction and/or cessation in medication use in people with type 2 diabetes (T2D). Recent technological advances have led to the development of health-related applications (apps), including a high proportion dedicated to the management of diabetes. The Defeat Diabetes Program is a smartphone- and web-based app that provides guidance on a low-carbohydrate dietary approach for T2D and was designed to be used in conjunction with standard care in the medical management of T2D. The primary aim of this protocol is to provide the rationale and design of a single-arm 12-month pre-post intervention clinical trial using the Defeat Diabetes Program in an Australian community-based cohort of people with T2D who were referred by their general practitioner (GP). The study seeks to engage the GP community to help demonstrate whether the results of using a low-carbohydrate dietary approach for T2D can be achieved by the Defeat Diabetes Program in their patients. This protocol describes (1) the rationale for the selection of primary and secondary outcome measures, (2) the sampling procedures and methodological steps used to identify eligible participants and collect data, and (3) the approach followed to involve and educate GPs to support the trial.
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Affiliation(s)
- Despina Kolivas
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
| | - Liz Fraser
- Watson General Practice, Watson 2602, Australia
| | - Ronald Schweitzer
- East Bentleigh Medical Group, Bentleigh East 3165, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton 3800, Australia
| | - Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
| | - George Moschonis
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
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Shields C, Conway NT, Allardice B, Wake DJ, Cunningham SG. Continuing the quality improvement of an electronic personal health record and interactive website for people with diabetes in Scotland (My Diabetes My Way). Diabet Med 2023:e15085. [PMID: 36924001 DOI: 10.1111/dme.15085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
AIMS eHealth applications have the potential to enable patients to take more control over managing their own health, helping to delay and prevent complications. My Diabetes My Way (MDMW) is an electronic personal health record/educational platform available to people with diabetes in Scotland. This study aims to assess user experience with respect to demographic subgroups, examine effectiveness of previous improvements made to the platform and inform its ongoing development. METHODS All active MDMW users (22,665) were invited to take part in a questionnaire combining Likert scale and free-response items relating to system utility. Likert responses were used to generate a 'utility score'. This was used in regression analyses to determine predictors of system utility scoring. Free-response answers were analysed thematically and themes were generated. RESULTS A total of 4713 (21%) MDMW users responded to the questionnaire. Most agreed that MDMW helps them to track changes over time, prepare for face-to-face consultations, remember information discussed in consultations and reduced the need to contact their general practitioner. Free-response answers showed that users valued earlier enhancements made to the site (e.g. linking Fitbit data), and highlighted areas needing further improvement. Evidence of the 'digital divide' was seen in respondent demographics, and some users mentioned 'lack of digital skills' as a barrier to engaging with the platform. CONCLUSIONS User experience of MDMW was positive. Users agreed with statements that MDMW facilitates diabetes self management. Several areas of potential improvement were identified, including linking more wearable device data, and assisting/directing users to gain the digital skills required to engage fully with MDMW.
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Affiliation(s)
- Cathy Shields
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Nicholas T Conway
- Tayside Children's Hospital, Ninewells hospital, MACHS Building, Dundee, DD1 9SY, UK
| | - Brian Allardice
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
| | - Deborah J Wake
- Usher Institute, University of Edinburgh, NINE, 9 Little France Road, Edinburgh BioQuarter, Edinburgh, EH16 4UX, UK
| | - Scott G Cunningham
- Division of Population Health and Genomics, School of Medicine, Ninewells Hospital, University of Dundee, Dundee, DD1 9SY, UK
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Mavragani A, Löf M, Maddison R, Nourse R. Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study. JMIR Form Res 2023; 7:e40536. [PMID: 36800215 PMCID: PMC9984995 DOI: 10.2196/40536] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. OBJECTIVE The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. METHODS A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. RESULTS The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. CONCLUSIONS Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care.
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Affiliation(s)
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Rebecca Nourse
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Norberg H, Håkansson Lindqvist M, Gustafsson M. Older Individuals' Experiences of Medication Management and Care After Discharge from Hospital: An Interview Study. Patient Prefer Adherence 2023; 17:781-792. [PMID: 36987497 PMCID: PMC10040160 DOI: 10.2147/ppa.s400039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To develop an in-depth understanding of older individuals' attitudes and perceptions of medication management and care after discharge from hospital-to-home. PATIENTS AND METHODS A qualitative study using semi-structured interviews with selected individuals 75 years and older, discharged from hospital within the last 6-12 months, living at home, and managing their own medications. Face-to-face interviews were audio-recorded, transcribed and analyzed with thematic analysis. RESULTS Among the 15 respondents, mean age was 83.5 years (range 75-95 years), 67% were women, and 60% lived alone. The majority (80%) managed their medications with a pill organizer or directly from the pill boxes, while 20% used dose dispensed medications. The analysis of the data led to six themes: Medication adherence, Personal responsibility, Transitions of care, Beliefs about medications, Participation (experience of participation, willingness to participate) and Accessibility (easier to reach hospital than primary care, navigating in the care system, continuity, personal chemistry). CONCLUSION The included respondents who were older individuals, living at home and managing their own medications, expressed that they were medical adherent and self-managing. Two important aspects which were seen were difficulties to reach primary care on their own initiative and the lack of continuity with the same physician over a longer period of time.
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Affiliation(s)
- Helena Norberg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Correspondence: Helena Norberg, Department of Integrative Medical Biology, Umeå University, Umeå, S-901 87, Sweden, Tel +46 90 786 68 21, Email
| | | | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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Selen F, Polat Ü. The effect of web based type 2 diabetes education on diabetes self management. Digit Health 2023; 9:20552076231205739. [PMID: 37822962 PMCID: PMC10563455 DOI: 10.1177/20552076231205739] [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: 03/22/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Objective This study is a control group intervention study to determine the effect of web-based education on diabetes self-management in individuals with type 2 diabetes. Methods The study was conducted in the Training and Research Hospital Diabetes Education Unit of Hitit University. The study was completed with 75 people (intervention 38, control 37). The data were obtained in the web site through patient identification form, self-management perception scale in diabetes, diabetes attitude, self-care scale and HbA1c, HDL, LDL values were followed by providing training and counseling. The values followed were viewed at the third and sixth months. Written permission was obtained from ethics committee and participants. The data of the study were evaluated with number, percentage, mean, pearson chi-square, independent t-test, repetitive analysis and variance analysis. Results Statistically significant decrease in HbA1c and LDL values, diabetes self-management scale, diabetes attitude scale and self-care scale scores were found to be significantly different between the intervention and control groups. Conclusion Web-based education and follow-up studies are effective in decreasing HbA1c values in increasing diabetes self-management skills of individuals with type 2 diabetes. It is recommended to use as a complementary tool in health care services for type 2 diabetes management.
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Affiliation(s)
- Filiz Selen
- Department of Internal Medicine Nursing, Hitit University Faculty of Health Sciences, Corum, Turkey
| | - Ülkü Polat
- Department of Internal Medicine Nursing, Gazi University, Faculty of Health Sciences, Ankara, Turkey
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Leung T, Nahar van Venrooij LMW, Verdaasdonk EGG. Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study. JMIR Perioper Med 2022; 5:e40352. [PMID: 36512385 PMCID: PMC9795396 DOI: 10.2196/40352] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. OBJECTIVE This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. METHODS This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range -100 to +100). RESULTS In total, 28 persons were included (n=16, 57% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and-7 (postoperative). CONCLUSIONS The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased.
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Korenhof SA, Rouwet EV, Elstgeest LEM, Tan SS, Macchione S, Vasiljev V, Rukavina T, Alhambra-Borrás T, Fierloos IN, Raat H. Evaluation of an Intervention to Promote Self-Management Regarding Cardiovascular Disease: The Social Engagement Framework for Addressing the Chronic-Disease-Challenge (SEFAC). Int J Environ Res Public Health 2022; 19:ijerph192013145. [PMID: 36293726 PMCID: PMC9603702 DOI: 10.3390/ijerph192013145] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVD) are predominantly lifestyle related. Mental health issues also influence CVD progression and quality of life. Self-management of lifestyle behaviors and mental well-being may play a significant role in reducing the CVD burden. Previous studies have shown that mindfulness practices are associated with psychological well-being, but their effects on CVD self-management are mainly unknown. METHODS The study had a before-after design and included adults over 50 years with CVD and/or one or more risk factors from three European countries. Follow-up was six months. The intervention was a 7-week mindfulness-based intervention (MBI) in a group setting focusing on chronic disease self-management. Outcomes were measured with validated self-report questionnaires at baseline and follow-up: self-efficacy, physical activity, nutrition, smoking, alcohol use, sleep and fatigue, social support, stress, depression, medication adherence, and self-rated health. RESULTS Among 352 participants, 324 (92%) attended ≥4 of the 7 group sessions and completed follow-up. During follow-up, self-efficacy, stress, social support, depressive symptoms, and self-rated health significantly improved. No significant changes were detected for other outcomes. CONCLUSIONS A 7-week MBI focusing on chronic disease self-management was conducive to improved self-efficacy, emotional well-being, social support, and self-rated overall health during six months. These findings support the use of MBIs for improving self-management in cardiovascular care. ISRCTN registry-number ISRCTN11248135.
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Affiliation(s)
- Sophie A. Korenhof
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Ellen V. Rouwet
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Liset E. M. Elstgeest
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Reinier Academy, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Siok Swan Tan
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Research Group City Dynamics, InHolland University of Applied Sciences, 3072 AG Rotterdam, The Netherlands
| | - Stefania Macchione
- European Project Office Department, Istituto per Servizi di Ricovero e Assistenza agli Anziani (Institute for Hospitalization and Care for the Elderly), 31100 Treviso, Italy
| | - Vanja Vasiljev
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Tomislav Rukavina
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | | | - Irene N. Fierloos
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
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Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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Sakamoto R, Kazawa K, Jahan Y, Takeyama N, Moriyama M. Can a sleep disorder intervention-embedded self-management programme contribute to improve management of diabetes? A pilot single-arm pretest and post-test study. BMJ Open 2021; 11:e045783. [PMID: 34548342 PMCID: PMC8458311 DOI: 10.1136/bmjopen-2020-045783] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and feasibility of a self-management programme incorporating a sleep intervention for improving diabetes outcomes. DESIGN A single-arm pre-test and post-test study was conducted within a community setting in Hiroshima, Japan. PARTICIPANTS Participants were aged 52-74 years and diagnosed with type 2 diabetic nephropathy stages 1-3. INTERVENTIONS Participants received self-management education from nurses for 6 months. First, the nurses assessed their sleep conditions using insomnia scales and a sleep metre. Then, the participants learnt self-management to increase their physical activity and improve their sleep condition. They also implemented diet therapy and medication adherence. OUTCOME MEASURES Physiological indicators, subjective and objective indicators of sleep quality, self-management indicators, quality of life (QOL) and feasibility were evaluated. To confirm the efficacy of intervention, Freidman tests, analysis of variance, Wilcoxon signed-rank test and t-test were performed. Pearson's correlations were analysed between activities and sleep condition. RESULTS Of the 26 enrolled participants, 24 completed the programme and were analysed. Among them, 15 participants (62.5%) had sleep disorders caused by multiple factors, such as an inappropriate lifestyle and physical factors that interfere with good sleep. Although insomnia scales did not change for the sleep disorders, their subjective health status improved. Regarding indicators related to diabetes management, lifestyles improved significantly. Haemoglobin A1c, body mass index, systolic blood pressure, non-high-density lipoprotein-cholesterol and QOL also improved. All participants except one were satisfied with the programme. However, use of the sleep metre and nurses' consultation about sleep disturbance were not well evaluated. CONCLUSIONS This programme was effective in improving diabetes status, lifestyle and behaviour changes. However, its effect on sleep condition was limited because of its complexity. A simple and novel approach is needed to strengthen the motivation for sleep behaviour change and to increase programme efficacy and feasibility. TRIAL REGISTRATION NUMBER UMIN000025906.
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Affiliation(s)
- Ritsuko Sakamoto
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School, Hiroshima, Japan
| | - Kana Kazawa
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School, Hiroshima, Japan
| | - Yasmin Jahan
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School, Hiroshima, Japan
| | - Naoko Takeyama
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School, Hiroshima, Japan
| | - Michiko Moriyama
- Chronic Care and Family Nursing, Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School, Hiroshima, Japan
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Bellass S, Lister J, Kitchen CEW, Kramer L, Alderson SL, Doran T, Gilbody S, Han L, Hewitt C, Holt RIG, Jacobs R, Prady SL, Shiers D, Siddiqi N, Taylor J. Living with diabetes alongside a severe mental illness: A qualitative exploration with people with severe mental illness, family members and healthcare staff. Diabet Med 2021; 38:e14562. [PMID: 33772867 DOI: 10.1111/dme.14562] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 09/09/2020] [Revised: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
AIMS Diabetes is two to three times more prevalent in people with severe mental illness, yet little is known about the challenges of managing both conditions from the perspectives of people living with the co-morbidity, their family members or healthcare staff. Our aim was to understand these challenges and to explore the circumstances that influence access to and receipt of diabetes care for people with severe mental illness. METHODS Framework analysis of qualitative semi-structured interviews with people with severe mental illness and diabetes, family members, and staff from UK primary care, mental health and diabetes services, selected using a maximum variation sampling strategy between April and December 2018. RESULTS In all, 39 adults with severe mental illness and diabetes (3 with type 1 diabetes and 36 with type 2 diabetes), nine family members and 30 healthcare staff participated. Five themes were identified: (a) Severe mental illness governs everyday life including diabetes management; (b) mood influences capacity and motivation for diabetes self-management; (c) cumulative burden of managing multiple physical conditions; (d) interacting conditions and overlapping symptoms and (e) support for everyday challenges. People living with the co-morbidity and their family members emphasised the importance of receiving support for the everyday challenges that impact diabetes management, and identified barriers to accessing this from healthcare providers. CONCLUSIONS More intensive support for diabetes management is needed when people's severe mental illness (including symptoms of depression) or physical health deteriorates. Interventions that help people, including healthcare staff, distinguish between symptoms of diabetes and severe mental illness are also needed.
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Affiliation(s)
- Sue Bellass
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Jennie Lister
- Department of Health Sciences, University of York, Heslington, York, UK
| | | | - Lyndsey Kramer
- Department of Sociology, Wentworth College, University of York, Heslington, York, UK
| | | | - Tim Doran
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Catherine Hewitt
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Richard Ian Gregory Holt
- Faculty of Medicine/Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | - David Shiers
- Division of Psychology and Mental Health/Greater, Manchester Mental Health NHS Trust/Primary Care and Health Sciences (Keele University), University of Manchester, Manchester, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
- Bradford District Care NHS Foundation Trust, Shipley, Bradford, UK
- Hull York Medical School, University of York, Heslington, York, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, Heslington, York, UK
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Alruhaim HY, Almigbal TH, Almutairi JS, Mujammami MH, AlMogbel TA, Alrasheed AA, Al Zahrani AM, Batais MA. The association between diabetes numeracy and diabetes self-management among Saudi adults with insulin-treated diabetes. Saudi Med J 2021; 42:517-525. [PMID: 33896781 PMCID: PMC9149690 DOI: 10.15537/smj.2021.42.5.20200422] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To describe the association between diabetes numeracy and diabetes self-management among Saudi adults with insulin-treated diabetes. METHODS From August 2018 to January 2019, a cross-sectional study was conducted in 3 diabetes centers in Riyadh, Buraydah, and Jeddah, Saudi Arabia. Systematic random sampling was used to include 290 Saudi adults with insulin-treated diabetes. The levels of diabetes numeracy and diabetes self-management were measured by using the Diabetes Numeracy Test tool (DNT-15) and Diabetes Self-Management Questionnaire tool (DSMQ). RESULTS The final analysis included 279 completed surveys. The mean total score of DSMQ was 6.47. The total DSMQ score was higher among patients who had a lower level of education (p=0.02), and patients who had a higher level of diabetes knowledge (p=0.01). The mean total score of DNT-15 was 41.3%. Patients who had lower diabetes numeracy scores tended to be younger, married, have fewer years of education, have a lower monthly income(p<0.001), use insulin only, and have type 1 diabetes. Patients who achieved a total score of 82%, and higher in DNT-15 have also achieved the highest score in DSMQ (p=0.17). A linear regression analysis adjusted for level of education, diabetes knowledge, and other variables found a modest association between low diabetes numeracy and low diabetes self-management (p=0.08). CONCLUSION Lower level of diabetes numeracy was associated with lower level of diabetes self-management.
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Affiliation(s)
- Hiba Y. Alruhaim
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Turky H. Almigbal
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Joud S. Almutairi
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Muhammad H. Mujammami
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Turki A. AlMogbel
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Abdullah A. Alrasheed
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Abdullah M. Al Zahrani
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
| | - Mohammed A. Batais
- From the Department of Family and Community Medicine (Alruhaim, Almigbal, Almutairi, Alrasheed, Batais), from the Endocrinology and Metabolism Unit (Mujammami), College of Medicine, King Saud University; from the Vision College of Medicine, Vision Colleges (Almigbal); from the King Saud University Medical City (Almigbal, Mujammami, Alrasheed, Batais), Riyadh; from the Department of Family Medicine (Al Zahrani), King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah; and from the Buraydah Diabetes Centre (AlMogbel), King Fahd Specialist Hospital, Buraydah, Kingdom of Saudi Arabia.
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Zaeh SE, Lu MA, Blake KV, Ruvalcaba E, Ayensu-Asiedu C, Wise RA, Holbrook JT, Eakin MN. "It is kind of like a responsibility thing": transitional challenges in asthma medication adherence among adolescents and young adults. J Asthma 2021; 59:956-966. [PMID: 33653199 DOI: 10.1080/02770903.2021.1897836] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Nonadherence to asthma medications is prevalent among adolescents and young adults (AYAs) with asthma, leading to worsened control of asthma symptoms and more frequent exacerbations. AYAs have unique developmental transitional challenges that may alter medication adherence. We aimed to use a socio-ecological framework to explore the effect of transitional challenges from adolescence to young adulthood on asthma controller medication adherence and to identify possible strategies to promote medication adherence. METHODS We conducted qualitative semi-structured interviews by phone with 7 adolescents (14 to 17 years), their respective caregivers, and 7 young adults (18 to 30 years). Participants were recruited from a respiratory clinical trial network and pulmonary clinics in 4 states at 6 different sites through convenience sampling. Interviews were audio recorded, transcribed and coded using thematic analyses. RESULTS Participants identified personal challenges affecting adherence to asthma medications during the transition from adolescence to young adulthood including responsibility for asthma self-management, understanding of asthma condition and severity, embarrassment, and life demands. Health systems factors including medication cost, challenges with insurance, difficulties obtaining refills, and difficulty with access to medications at school also impacted asthma medication adherence. Participants recommended adherence strategies including improved access to inhalers, incorporating asthma medications into daily routines, and using reminders. CONCLUSIONS Focusing on the transitional challenges of AYAs during the time period from adolescence to young adulthood is necessary for supporting their asthma medication adherence and creating future interventions. Socio-ecological and systems factors should also be targeted for improved asthma medication adherence. Supplemental data for this article can be accessed online at https://doi.org/10.1080/02770903.2021.1897836.
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Affiliation(s)
- Sandra E Zaeh
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Monica A Lu
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kathryn V Blake
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, FL, USA
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christabelle Ayensu-Asiedu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Janet T Holbrook
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Payne H, Brooks SDM. A Qualitative Study of the Views of Patients With Medically Unexplained Symptoms on The BodyMind Approach ®: Employing Embodied Methods and Arts Practices for Self-Management. Front Psychol 2020; 11:554566. [PMID: 33364994 PMCID: PMC7750328 DOI: 10.3389/fpsyg.2020.554566] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/28/2020] [Indexed: 12/28/2022] Open
Abstract
The arts provide openings for symbolic expression by engaging the sensory experience in the body they become a source of insight through embodied cognition and emotion, enabling meaning-making, and acting as a catalyst for change. This synthesis of sensation and enactive, embodied expression through movement and the arts is capitalized on in The BodyMind Approach® (TBMA). It is integral to this biopsychosocial, innovative, unique intervention for people suffering medically unexplained symptoms (MUS) applied in primary healthcare. The relevance of embodiment and arts practices in TBMA are discussed in relation to the views of participants in the pursuit of self-management. If widely employed TBMA could have an enormous impact, reach, and significance for patients and global health services. This original pre-clinical trial of qualitative research reports on the perceptions of participant patients with generic MUS, a world-wide issue usually treated by either psychological therapy or physiotherapy. TBMA is not a therapy but a health education program founded upon the concept of an integration of psychological elements with physiological, bodily, and sensory experiences. Thematic analysis of qualitative data sets from open-ended questions in semi-structured interviews and a written questionnaire post intervention is presented. Five aspects which appear to be key to learning self-management were derived from analyzing the data: (1) body with mind connections; (2) importance of facilitation; (3) potential benefits; (4) preparedness for change; (5) self-acceptance/compassion. This article advances the discourse on the nature of self-management for MUS through changing the mind-set and the relationship participants have with their bodily symptom/s through employing embodied methods and arts practices, challenging current, and solely verbal, psychological conceptual frameworks. Rigor lies in the method of data analysis using cross verification of credibility between reported findings and scrutiny by stakeholders. We conclude that facilitated TBMA groups employing embodied methods and arts practices can act as a method for developing the self-management of MUS and improving wellbeing.
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Affiliation(s)
- Helen Payne
- School of Education, University of Hertfordshire, Hatfield, United Kingdom
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17
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Lewis S, Ainsworth J, Sanders C, Stockton-Powdrell C, Machin M, Whelan P, Hopkins R, He Z, Applegate E, Drake R, Bamford C, Roberts C, Wykes T. Smartphone-Enhanced Symptom Management In Psychosis: Open, Randomized Controlled Trial. J Med Internet Res 2020; 22:e17019. [PMID: 32788150 PMCID: PMC7453320 DOI: 10.2196/17019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/04/2020] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background Improving recovery from acute symptoms and preventing relapse are two significant challenges in severe mental illness. We developed a personalized smartphone-based app to monitor symptoms in real time and validated its acceptance, reliability, and validity. Objective To assess (i) acceptability of continuous monitoring to SMI patients and health professionals over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; and (iii) the feasibility of detecting early warning signs of relapse. Methods The active symptom monitoring smartphone app was built into an end-to-end system in two NHS Trusts to enable real-time symptom self-monitoring and detection by the clinical team of early signs of relapse in people with severe mental illness. We conducted an open randomized controlled trial of active symptom monitoring compared to usual management to assess: (i) acceptability and safety of continuous monitoring over 3 months; (ii) impact of active self-monitoring on positive psychotic symptoms assessed at 6 and 12 weeks; (iii) feasibility of detecting early warning signs of relapse communicated to the healthcare staff via an app streaming data to the electronic health record. Eligible participants with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of schizophrenia and related disorders, and a history of relapse within the previous two years were enrolled from an early intervention team and a community mental health team. Results Of 181 eligible patients, 81 (45%) consented and were randomized to either active symptom monitoring or management as usual. At 12 weeks, 90% (33/36) of those in the active monitoring group continued to use the system and exhibited an adherence rate (defined as responding to >33% of alerts) of 84% (30/36}. Active symptom monitoring was associated with no difference on the empowerment scale in comparison to the usual management group at 12 weeks. The pre-planned intent-to-treat analysis of the primary outcome, a positive score on the Positive and Negative Syndrome Scale (PANSS) scale, showed a significant reduction in the active symptom monitoring group over 12 weeks in the early intervention center. Alerts for personalized early warning signs of relapse were built into the workflows of both NHS Trusts, and 100% of health professional staff used the system in a new digital workflow. Qualitative analyses supported the acceptability of the system to participants and staff. Conclusions The active smartphone monitoring system is feasible and was accepted by users in a 3-month study of people with severe mental illness, with surprisingly high levels of adherence. App use was associated with psychotic symptom improvement in recent-onset participants, but not those with longstanding illness, supporting the notion of improved self-management. When built into clinical management workflows to enable personalized alerts of symptom deterioration, the app has demonstrated utility in promoting earlier intervention for relapse. Trial Registration ISRCTN Registry ISRCTN88145142; http://www.isrctn.com/ISRCTN88145142
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Affiliation(s)
- Shon Lewis
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Caroline Sanders
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Charlotte Stockton-Powdrell
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Matthew Machin
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Richard Hopkins
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Zhimin He
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom
| | - Eve Applegate
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Richard Drake
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Charlie Bamford
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Chris Roberts
- Manchester Academic Health Sciences Centre, Greater Manchester Mental Health Foundation Trust, The University of Manchester, Manchester, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Allen C, Vassilev I, Kennedy A, Rogers A. The work and relatedness of ties mediated online in supporting long-term condition self-management. Sociol Health Illn 2020; 42:579-595. [PMID: 31769045 PMCID: PMC7078997 DOI: 10.1111/1467-9566.13042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The 'care transition' is characterised by reduced state involvement in chronic illness management in response to socio-political movements aimed at meeting the challenges presented by an increased prevalence of chronic illness. Amongst these changes has been online communities' rising importance in everyday interactions and attention is being increasingly paid towards the ways online contacts might contribute to self-management. Whilst research has illuminated the relevance of personal networks in long-term condition management, it is relevant to extend this work to consider the place of ties mediated online in this bricolage of support, including better understanding the work drawn from them and the strategies involved in eliciting it. This study examined the work and relatedness of 30 participants, who used online communities. Participants were asked about the role of on and offline ties and ego network mapping was used to frame conversations about the nature of this support. The context of engagement followed three main themes. Participants drew from online communities in response to deficits in offline support, they used online ties to leverage support or action from offline ties and they used online ties to substitute offline support, with less intimate online ties.
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Affiliation(s)
- Chris Allen
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Ivaylo Vassilev
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Anne Rogers
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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Hai AA, Iftikhar S, Latif S, Herekar F, Patel MJ. Diabetes Self-care Activities and Their Relation with Glycemic Control in Patients Presenting to The Indus Hospital, Karachi. Cureus 2019; 11:e6297. [PMID: 31938590 PMCID: PMC6942497 DOI: 10.7759/cureus.6297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/05/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Nowadays, chronic conditions are increasing globally, stressing on self-management and patients' responsibility toward recognizing and resolving issues related to their illness. Diabetes is also a chronic illness, and diabetes-related self-care activities have been shown to be promising towards preventing its complications and achieving optimal glycemic control. Objective 1) To assess the association between glycemic control and diabetes-related self-care activities 2) To evaluate the association of patients' sociodemographic characteristics with diabetes-related self-care activities 3) To examine the impact of patients' sociodemographic characteristics on glycemic control Materials and methods This cross-sectional study was conducted at The Indus Hospital Karachi from February 2019 to July 2019. A total of 288 patients of both genders, age ≥18 years, having type 2 diabetes mellitus with glycated hemoglobin (HbA1c) done within the last three months from the interview date were enrolled in the study using a non-probability consecutive sampling technique. Whereas patients not giving consent for participation in the study, ICU admitted patients, critically ill patients, pregnant women, comatose, patients with type 1 diabetes mellitus, Alzheimer's disease, dementia, coexisting and chronic liver disease were excluded from the study. Results Majority of the patients were female (n=209; 72.6%) and had uncontrolled glycemic control (n=235; 81.6%). Furthermore, less than half of the patients had inadequate diabetes-related self-care activities (n=140; 48.6%). The Mean ± SD of age was 51.9±10.2 years. The significantly higher proportion of patients who have had a duration of illness and treatment ≥3 years had uncontrolled diabetes but adequate diabetes-related self-care activities. Moreover, there was no association between diabetes-related self-care activities and glycemic control. Conclusion There was no significant relationship between diabetes-related self-care activities and glycemic control. Moreover, a higher proportion of patients with a longer duration of diabetes (≥3 years) had poor glycemic control but adequate diabetes-related self-care activities.
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Affiliation(s)
- Ayesha A Hai
- Internal Medicine, The Indus Hospital, Karachi, PAK
| | - Sundus Iftikhar
- Statistics, Indus Hospital Research Center, The Indus Hospital, Karachi, PAK
| | - Saba Latif
- Internal Medicine, The Indus Hospital, Karachi, PAK
| | - Fivzia Herekar
- Internal Medicine and Infectious Diseases, The Indus Hospital, Karachi, PAK
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Eugene Nelson
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Andreas Hager
- Upstream Dream, Alviksvagen 43, SE-167 55, Stockholm, Bromma, Sweden
| | - Amy Price
- MedicineX, Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
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Hering T. [Support for self-helping - that's what patients like]. MMW Fortschr Med 2019; 161:48-51. [PMID: 30721489 DOI: 10.1007/s15006-019-0133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brady E, Segar J, Sanders C. Accessing support and empowerment online: The experiences of individuals with diabetes. Health Expect 2017; 20:1088-1095. [PMID: 28718928 PMCID: PMC5600220 DOI: 10.1111/hex.12552] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
Abstract
CONTEXT The use of the internet for health information by those with long-term conditions is growing. It has been argued that this represents a form of empowerment by patients, as it enables them to control the content and flow of the information available to them. To explore this, the use of online discussion groups by those with diabetes was examined. METHOD Semi-structured interviews were conducted with 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely discussion boards, newsletters, and research networks related to diabetes. RESULTS By drawing on the advice, information, and support shared online, participants were empowered to position themselves as active participants in their own health care and to further engage with health-care professionals. CONCLUSION The findings indicate that forums can play a valuable role in aiding and motivating individuals in the daily management diabetes and highlight how this support is used to complement formal health services. However, more work needs to be carried out to determine to explore when and under what circumstances online support may be particularly beneficial to those with long-term conditions.
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Affiliation(s)
- Ellen Brady
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Dunphy E, Hamilton FL, Button K. Taxonomy for the Rehabilitation of Knee Conditions (TRAK), a Digital Intervention to Support the Self-Care Components of Anterior Cruciate Ligament Rehabilitation: Protocol of a Feasibility Study. JMIR Res Protoc 2016; 5:e234. [PMID: 27919864 PMCID: PMC5168535 DOI: 10.2196/resprot.6402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 07/25/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is common, especially in the active population. In defining the problem of ACL rehabilitation, this study draws from the knowledge that improved self-care, strength, and fitness are associated with better outcomes. Traditional rehabilitation involves regular physiotherapy, but it is not clear what the optimal way for delivering rehabilitation is, and it varies widely across the world. Evidence for treatments are discussed in the literature, however standard length of rehabilitation and frequency of appointments are unknown. Additionally, current rehabilitation models in the National Health Service (NHS) struggle with catering to large volumes of patients and the lengthy time span over which rehabilitation is delivered. The use of eHealth (the Internet in health care) has been successful at delivering behavior change to a number of diverse patient groups. In physiotherapy, problems such as exercise compliance, exercise technique, and managing a broad program of rehabilitation and advice can be challenging. An eHealth intervention called Taxonomy for the Rehabilitation of Knee Conditions (TRAK) to support self-management and behavior change has been developed by patients and clinicians, and acceptability studies have yielded positive results. TRAK is not an exercise rehabilitation protocol; it is a tool to support ACL rehabilitation with personalized plans, prompts, and logs to help adherence and videos and instructions to improve quality and address queries. The patients have their own log-ins and can email their physiotherapist through the website. This novel platform is directly in line with current NHS England, National Institute for Health and Care Excellence, and NHS Improvement agendas that call for rehabilitation initiatives using both technology and supported self-management for patients. This study forms part of a research platform to identify a best practice model of ACL care from the literature and opinions of key stakeholders. Patients' exercise programs and duration of treatment are still based on individual needs, but use of the website may offer improved self-management and function and reduced health resource use. OBJECTIVE This is a feasibility study to establish recruitment, retention, sample size estimates, and practicality of collecting outcome measures to inform a future trial comparing the TRAK intervention, which has been rigorously designed to address the challenges of ACL rehabilitation, to usual care. METHODS This is a feasibility study comparing 2 groups: standard care and standard care plus eHealth. It will use convergent parallel mixed methods where both qualitative and quantitative data are sought for a more thorough understanding of the objectives. Primary outcomes relate to feasibility, including recruitment, retention, and usage. Secondary outcomes relate to health resource use and patient-rated outcome measures. RESULTS This research expects to establish the feasibility of a full-scale randomized controlled trial to explore whether patients who use an eHealth intervention to support ACL rehabilitation have better outcomes plus improved self-efficacy and reduced health resource use than a usual care group. CONCLUSIONS The study will provide essential information to support the development and powering of a future clinical trial of eHealth and physiotherapy for patients with ACL reconstruction in the NHS.
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Affiliation(s)
- Emma Dunphy
- EHealth Unit, Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona L Hamilton
- EHealth Unit, Primary Care and Population Health, University College London, London, United Kingdom
| | - Kate Button
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
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Abstract
While development of new treatments for cystic fibrosis (CF) has led to a significant improvement in survival age, routine daily treatment for CF is complex, burdensome, and time intensive. Adolescence is a period of decline in pulmonary function in CF, and is also a time when adherence to prescribed treatment plans for CF tends to decrease. Challenges to adherence in adolescents with CF include decreased parental involvement, time management and significant treatment burden, and adolescent perceptions of the necessity and value of the treatments prescribed. Studies of interventions to improve adherence are limited and focus on education, without significant evidence of success. Smaller studies on behavioral techniques do not focus on adolescents. Other challenges for improving adherence in adolescents with CF include infection control practices limiting in-person interactions. This review focuses on the existing evidence base on adherence intervention in adolescents with CF. Future directions for efforts to optimize treatment adherence in adolescents with CF include reducing treatment burden, developing patient-driven technology to improve tracking, communication, and online support, and rethinking the CF health services model to include assessment of individualized adherence barriers.
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Affiliation(s)
- Lara C Bishay
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
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van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmussen A, Jubiz Y, Bus SA. Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 Suppl 1:84-98. [PMID: 26340966 DOI: 10.1002/dmrr.2701] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Prevention of foot ulcers in patients with diabetes is extremely important to help reduce the enormous burden of foot ulceration on both patient and health resources. A comprehensive analysis of reported interventions is not currently available, but is needed to better inform caregivers about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to prevent first and recurrent foot ulcers in persons with diabetes who are at risk for ulceration. METHODS The available medical scientific literature in PubMed, EMBASE, CINAHL and the Cochrane database was searched for original research studies on preventative interventions. Both controlled and non-controlled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers. RESULTS From the identified records, a total of 30 controlled studies (of which 19 RCTs) and another 44 non-controlled studies were assessed and described. Few controlled studies, of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, multiple RCTs with low risk of bias show the benefit for the use of daily foot skin temperature measurements and consequent preventative actions, as well as for therapeutic footwear that demonstrates to relieve plantar pressure and that is worn by the patient. To prevent recurrence, some evidence exists for integrated foot care when it includes a combination of professional foot treatment, therapeutic footwear and patient education; for just a single session of patient education, no evidence exists. Surgical interventions can be effective in selected patients, but the evidence base is small. CONCLUSION The evidence base to support the use of specific self-management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong, but is small for the use of other, sometimes widely applied, interventions and is practically nonexistent for the prevention of a first foot ulcer and non-plantar foot ulcer.
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Affiliation(s)
- J J van Netten
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - P E Price
- Vice Chancellors' Office, Cardiff University, Cardiff, Wales, UK
| | - L A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Centre, Dallas, TX, USA
| | - M Monteiro-Soares
- CIDES/CINTESIS - Health Information and Decision Sciences Department (U753-FCT), Oporto Faculty of Medicine, Oporto, Portugal
| | - A Rasmussen
- Steno Diabetes Centre A/S, Gentofte, Denmark
| | - Y Jubiz
- Diabetic Foot Unit, Colombian Diabetes Association, Bogotá, Colombia
| | - S A Bus
- Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Keemink YS, Klok T, Brand PLP. Long-term adherence to daily controller medication in children with asthma: The role of outpatient clinic visits. Pediatr Pulmonol 2015; 50:1060-4. [PMID: 25469915 DOI: 10.1002/ppul.23138] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/25/2014] [Accepted: 11/02/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate changes in inhaled corticosteroids adherence, both before and after a scheduled follow-up visit, in young children in a comprehensive asthma management program. STUDY DESIGN One-year prospective follow-up study in 104 asthmatic children (mean age 4.8 years). Adherence to inhaled corticosteroids was assessed using electronic (Smartinhaler®) devices. We assessed changes in adherence before and after clinic visits. A > 10% increase in adherence in the 3 days preceding a clinic visit was considered to reflect clinically relevant white coat adherence (WCA) if it exceeded background variation in adherence (median change >0, and increase larger than adherence changes after a clinic visit). RESULTS Overall adherence was high (median 85%). A pre-visit increase in adherence of >10% was demonstrated in 17 patients (22%), but the median change in adherence around a clinic visit was 0. There were no significant differences in changes in adherence between the days before or after a visit (P > 0.2). The median coefficient of variation in adherence was 9%, and did not significantly differ between children with and without a pre-visit increase in adherence (P = 0.12). Twelve patients (15.4%) showed an increase of adherence in the month following a clinic visit; their overall mean (SE) adherence was slightly lower (73% (4.6%)) than those without such an increase (80% (2.2%), P = 0.054). CONCLUSIONS There was no WCA in children with asthma enrolled in a comprehensive asthma management program with high overall adherence. This suggests that WCA in pediatric chronic conditions primarily occurs against the background of low overall adherence.
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Affiliation(s)
- Yvette S Keemink
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands
| | - Ted Klok
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University Medical Center and University of Groningen, Groningen, The Netherlands
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Chaleshgar Kordasiabi M, Akhlaghi M, Baghianimoghadam MH, Morowatisharifabad MA, Askarishahi M, Enjezab B, Pajouhi Z. Self Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013. Glob J Health Sci 2015; 8:156-67. [PMID: 26493424 PMCID: PMC4803929 DOI: 10.5539/gjhs.v8n3p156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/01/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Rheumatoid Arthritis (RA) is a systemic, autoimmune and inflammatory disease with an unknown etiology that is associated with progressive joint degeneration, limitation of physical activity and disability. The aim of the study was to evaluate self-management behaviors and their associated factors in RA patients. MATERIAL & METHOD This cross-sectional study was performed in 2013 on185 patients in Iran. Data were selected through convenient sampling. The collected data included demographic variables, disease related variables, Arthritis Impact Measurement Scale 2 (AIMS-2SF), and Self-Management Behaviors (SMB). Data were analyzed by SPSS17 using Spearman correlation and logistic regression test. RESULT In this study drug management, regular follow-up, and food supplement were used as the most frequently applied SMB and aquatic exercise, diet, massage therapy, and relaxation were the least common SMBs. Age, education, health status, occupation, marital status, sex, DAS28 (Disease Activity Score 28 joints), and PGA (Physician Global Assessment) were significantly related with SMB. CONCLUSION The result of the study highlight the influence of demographic variables, health status, and disease related data on SMB. Thus, more studies are required to find factors influencing SMB in order to improve SMB.
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Kraal JJ, Peek N, Van den Akker-Van Marle ME, Kemps HM. Effects of home-based training with telemonitoring guidance in low to moderate risk patients entering cardiac rehabilitation: short-term results of the FIT@Home study. Eur J Prev Cardiol 2015; 21:26-31. [PMID: 25354951 DOI: 10.1177/2047487314552606] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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] [Indexed: 12/20/2022]
Abstract
BACKGROUND Home-based exercise training in cardiac rehabilitation (CR) has the potential to improve CR uptake, decrease costs and increase self-management skills. The FIT@Home study evaluates home-based CR with telemonitoring guidance using coaching interventions including strategies for behavioural changes with the aim to maintain adherence to a healthy lifestyle and to improve long-term effects. In this interim analysis we provide short-term results on exercise capacity, quality of life and training adherence of the first 50 patients included in the FIT@Home study. DESIGN The study design was a randomised controlled trial. METHODS Low to moderate risk CR patients were randomised to a 12-week home-based training (HT) programme or a 12-week centre-based training (CT) programme. In both groups, training was performed at 70-85% of maximal heart rate (HRmax) for 45-60 min, 2-3 times per week. The HT group received three supervised training sessions, before commencing training with a heart rate monitor in their home environment. These patients received individual coaching by telephone weekly, based on training data uploaded on the Internet. The CT programme was performed under the direct supervision of a physical therapist. Exercise capacity and health-related quality of life were assessed at baseline and at 12 weeks. RESULTS CT (n = 25) and HT (n = 25) both showed a significant improvement in peak oxygen uptake (peak VO2) (10% and 14% respectively) and quality of life after 12 weeks of training, without significant between-group differences. The average training intensity of the HT group was 73.3 ± 3.5% of HRmax. Training adherence was similar between groups. CONCLUSION This analysis shows that HT with telemonitoring guidance has similar short-term effects on exercise capacity and quality of life as CT in CR patients.
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Affiliation(s)
- Jos J Kraal
- Department of Medical Informatics, University of Amsterdam, the Netherlands
| | - Niels Peek
- Department of Medical Informatics, University of Amsterdam, the Netherlands Health eResearch Centre, University of Manchester, UK
| | | | - Hareld Mc Kemps
- Department of Medical Informatics, University of Amsterdam, the Netherlands Department of Cardiology, Máxima Medical Center Veldhoven, the Netherlands
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Abstract
The objective of this systematic review was to explore the role of mobile phone technologies in delivering health education programs in Asian and African countries. The search engine used was Pubmed during 2008-2011. Randomised controlled trials or controlled studies that improved health outcomes through delivery of health educational interventions using cell phone or text messaging were included in the review. Results showed studies from six Asian and African countries including Philippines, China, Kenya, South Korea, Taiwan and India. Mobile phone technology has shown to improve health outcomes for chronic disease conditions such as diabetes, heart disease and hypertension. Additional conditions include obesity and cardiopulmonary resuscitation guidance. Other studies have shown improvement in self management of breast cancer and post-hospitalisation HIV and pharmaceutical care. Overall results of the present review showed that mobile phone technologies can be a possible solution to improve healthcare outcome.
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Affiliation(s)
- Madhusmita Sahu
- Centre for Public Health Informatics, Asian Institute of Public Health, Bhubaneswar, Orissa 751002, India
| | - Ashoo Grover
- Indian Council of Medical Research, New Delhi 110029, India
| | - Ashish Joshi
- Centre for Global Health and Development and Department of Health Services Research Administration, College of Public Health, University of Nebraska Medical Centre, 984385 Nebraska Medical Center, Omaha, NE 68198-4385, USA
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Korus M, Cruchley E, Stinson JN, Gold A, Anthony SJ. Usability testing of the Internet program: "Teens Taking Charge: Managing My Transplant Online". Pediatr Transplant 2015; 19:107-17. [PMID: 25495484 DOI: 10.1111/petr.12396] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
Adolescents with SOT demonstrate high rates of medication non-adherence and higher rates of graft loss compared to all other age groups. Self-management interventions encompass information-based material designed to achieve disease-related learning and changes in the participant's knowledge and skill acquisition, while providing social support. These interventions have had some success in chronic disease populations by reducing symptoms and promoting self-efficacy and empowerment. Using findings from a needs assessment, an Internet-based self-management program, Teens Taking Charge: Managing My Transplant Online, for youth with SOT was developed. This program contains information on transplant, self-management and transition skills, and opportunities for peer support. The purpose of this study was to determine the usability and acceptability of the initial three modules (Medication and Vaccines; Diet after Transplant; and Living with a Transplant Organ) of the online program from the perspectives of youth with SOT. Participants were recruited from SOT clinics at a large pediatric tertiary care center in Canada. Three iterative cycles (seven patients per iteration) of usability testing took place to refine the Web site prototype. Study procedures involved participants finding items from a standardized list of features and talking aloud about issues they encountered, followed by a semi-structured interview to generate feedback about what they liked and disliked about the program. All 21 patients (mean age = 14.9 yr) found the Web site content to be trustworthy, they liked the picture content, and they found the videos of peer experiences to be particularly helpful. Participants had some difficulties finding information within submodules and suggested a more simplistic design with easier navigation. This web-based intervention is appealing to teenagers and may foster improved self-management with their SOT. Nine additional teen and two parent modules are being developed, and the completed Web site will undergo usability testing. In the future, a randomized control trial will determine the feasibility and effectiveness of this online self-management program on adherence, self-efficacy, and transition skills.
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Affiliation(s)
- M Korus
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
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Abstract
Technological innovations offer promise for improving intervention implementation in secondary, inclusive classrooms. A withdrawal design was employed with two high school students in order to assess the effectiveness of a technologically-delivered, self-monitoring intervention in improving on-task behavior in a science classroom. Two students ages 14 and 15 with diagnoses of specific learning disability (student 1) and attention deficit hyperactivity disorder (ADHD: student 2) were selected by case manager referral due to difficulties with on-task behavior despite long-term administration of psychostimulant medication. After baseline data were collected, both students were trained in the use of a self-monitoring application (I-Connect) delivered via a handheld tablet. On-task prompts were delivered at five min intervals in an ABAB withdrawal design. The intervention resulted in positive, stable improvements in the primary dependent variable of on-task behavior for both students and less clear improvement in the generalization variable of disruptive behavior.
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Affiliation(s)
- Howard P Wills
- Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave, Kansas City, KS 66101
| | - Benjamin A Mason
- Juniper Gardens Children's Project, University of Kansas, 444 Minnesota Ave, Kansas City, KS 66101
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Abstract
There is no conclusive evidence about the way to a promote behavior change in self-management programs for patients with chronic obstructive pulmonary disease (COPD). The latter is a significant knowledge gap as there is a need to promote a sustained effect in interventions like Pulmonary Rehabilitation or Supporting Programs. Embracing patient's values seems to be a key ingredient to ignite genuine motivation for behavior change. This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. The MI study consisted of a 3-month program of weekly coaching phone calls after one face-to-face visit. The following themes were outstanding: patients value the supportive communication with coach and believe the MI-based coaching created increased level of awareness and accountability. They perceived an increase in physical activity and reported "feeling better" or other benefits not directly related to exercise. The Mindfulness for Health Program was a mandatory 8-week program that consisted on 2-hour classes aimed to cultivate nonjudgmental attention in the moment (through different meditative practices and sharing) plus monthly face-to-face encounters aimed to sustain practice and sharing of life experiences for 1 year. The following themes (at 1 year) were outstanding: appreciating life by seeing hardships as opportunities, valuing the self through compassion and awareness, cultivating connectedness with others, acquiring joy, and adopting healthy behaviors. In the search for the "holy grail" for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously agree with.
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Affiliation(s)
- Roberto P Benzo
- Mindful Breathing Laboratory, Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
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Abebe NA, Capozza KL, Des Jardins TR, Kulick DA, Rein AL, Schachter AA, Turske SA. Considerations for community-based mHealth initiatives: insights from three Beacon Communities. J Med Internet Res 2013; 15:e221. [PMID: 24128406 PMCID: PMC3806518 DOI: 10.2196/jmir.2803] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [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: 06/28/2013] [Revised: 08/30/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022] Open
Abstract
Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs.
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Affiliation(s)
- Nebeyou A Abebe
- Louisiana Public Health Institute, Crescent City Beacon Community, New Orleans, LA, United States
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Blickem C, Kennedy A, Vassilev I, Morris R, Brooks H, Jariwala P, Blakeman T, Rogers A. Linking people with long-term health conditions to healthy community activities: development of Patient-Led Assessment for Network Support (PLANS). Health Expect 2013; 16:e48-59. [PMID: 23731452 PMCID: PMC3908360 DOI: 10.1111/hex.12088] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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] [Subscribe] [Scholar Register] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To combine insights from service users with long-term conditions (LTCs) to assist the development of a community referral intervention designed to promote engagement and improve access to health-relevant resources. BACKGROUND Social deprivation and reduced access to resources have been causally linked with social isolation and the ability to manage LTCs. Participation in meaningful activity has been associated with positive health benefits, and strategies to promote access to community activities have shown some potential to improve outcomes for people with LTCs. This suggests the need to develop an engagement and referral intervention in partnership with service users and community groups as part of mainstream self-care support. METHOD A series of focus groups and interviews with members of community groups in Greater Manchester designed as an iterative and collaborative approach to elicit the role of personal and community networks that support long-term condition management (LTCM) to develop a community referral tool. RESULTS Participants reported a broad range of resources relevant to LTCM that often went beyond the usual concerns associated with self-care. This helped to inform a tool (PLANS) to tailor access to types of community-based resources which can support LTCM. CONCLUSIONS Understanding the everyday challenges of living with a LTC highlighted the importance of connecting and engaging with localized support for people. In response to this, we developed an intervention (PLANS) which tailors access to local resources based on personal preferences, needs and acceptability to encourage service users to engage with sustainable health choices.
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Affiliation(s)
- Christian Blickem
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
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Padwal RS, Sharma AM, Fradette M, Jelinski S, Klarenbach S, Edwards A, Majumdar SR. The evaluating self-management and educational support in severely obese patients awaiting multidisciplinary bariatric care (EVOLUTION) trial: rationale and design. BMC Health Serv Res 2013; 13:321. [PMID: 24059346 PMCID: PMC3751526 DOI: 10.1186/1472-6963-13-321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/14/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In Canada, demand for multidisciplinary bariatric (obesity) care far outstrips capacity. Consequently, prolonged wait times exist and contribute to substantial health impairments.A supportive, educational intervention (with in-person and web-based versions) designed to enhance the self-management skills of patients wait-listed for multidisciplinary bariatric medical and surgical care has been variably implemented across Alberta, Canada. However, its effectiveness has not been evaluated. Our objectives were: 1. To determine if this program improves clinical and humanistic outcomes and is cost-effective compared to a control intervention; and 2. To compare the effectiveness and cost-effectiveness of in-person group-based versus web-based care. We hypothesize that both the web-based and in-person programs will reduce body weight and improve outcomes compared to the control group. Furthermore, we hypothesize that the in-person version will be more effective but more costly than the web-based version. METHODS/DESIGN This pragmatic, prospective controlled trial will enrol 660 wait-listed subjects (220 per study arm) from regional bariatric programs in Alberta and randomly assign them to: 1. an in-person, group-based intervention (9 modules delivered over 10 sessions); 2. a web-based intervention (13 modules); and 3. controls who will receive mailed literature. Subjects will have three months to review the content assigned to them (the intervention period) after which they will immediately enter the weight management clinic. Data will be collected at baseline and every 3 months for 9 months (study end), including: 1. Clinical [5% weight loss responders (primary outcome), absolute and % weight losses, changes in obesity-related comorbidities]; 2. Humanistic (health related quality of life, patient satisfaction, depression, and self-efficacy); and 3. Economic (incremental costs and utilities and cost per change in BMI assessed from the third party health care payor perspective) outcomes. Covariate-adjusted baseline-to-nine-month change-scores will be compared between groups for each outcome using linear regression for continuous outcomes and logistic regression for dichotomous ones. DISCUSSION Our findings will determine whether this intervention is effective and cost-effective compared to controls and if online or in-person care delivery is preferred. This information will be useful for clinicians, health-service providers and policy makers and should be generalizable to similar publically-funded bariatric care programs. TRIAL REGISTRATION Trial Identifier: NCT01860131.
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Affiliation(s)
- Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- 2F1.26 Walter C. Mackenzie Health Sciences Centre, 8440-112th Street, Edmonton T6G 2B7, Alberta, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
| | - Miriam Fradette
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Jelinski
- Applied Sciences and Research, Alberta Health Services, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
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Carnes D, Taylor SJC, Homer K, Eldridge S, Bremner S, Pincus T, Rahman A, Underwood M. Effectiveness and cost-effectiveness of a novel, group self-management course for adults with chronic musculoskeletal pain: study protocol for a multicentre, randomised controlled trial (COPERS). BMJ Open 2013; 3:e002492. [PMID: 23358564 PMCID: PMC3563130 DOI: 10.1136/bmjopen-2012-002492] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 12/17/2012] [Accepted: 12/20/2012] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Chronic musculoskeletal pain is a common condition that often responds poorly to treatment. Self-management courses have been advocated as a non-drug pain management technique, although evidence for their effectiveness is equivocal. We designed and piloted a self-management course based on evidence for effectiveness for specific course components and characteristics. METHODS/ANALYSIS COPERS (coping with persistent pain, effectiveness research into self-management) is a pragmatic randomised controlled trial testing the effectiveness and cost-effectiveness of an intensive, group, cognitive behavioural-based, theoretically informed and manualised self-management course for chronic pain patients against a control of best usual care: a pain education booklet and a relaxation CD. The course lasts for 15 h, spread over 3 days, with a -2 h follow-up session 2 weeks later. We aim to recruit 685 participants with chronic musculoskeletal pain from primary, intermediate and secondary care services in two UK regions. The study is powered to show a standardised mean difference of 0.3 in the primary outcome, pain-related disability. Secondary outcomes include generic health-related quality of life, healthcare utilisation, pain self-efficacy, coping, depression, anxiety and social engagement. Outcomes are measured at 6 and 12 months postrandomisation. Pain self-efficacy is measured at 3 months to assess whether change mediates clinical effect. ETHICS/DISSEMINATION Ethics approval was given by Cambridgeshire Ethics 11/EE/046. This trial will provide robust data on the effectiveness and cost-effectiveness of an evidence-based, group self-management programme for chronic musculoskeletal pain. The published outcomes will help to inform future policy and practice around such self-management courses, both nationally and internationally. TRIAL REGISTRATION ISRCTN24426731.
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Affiliation(s)
- Dawn Carnes
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie JC Taylor
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Homer
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Stephen Bremner
- Centre for Primary Care and Public Health, Blizard Institute Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Anisur Rahman
- Department of Rheumatology, University College Hospital, London, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, Warwick University, Coventry, UK
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Gee T. Personal Health Management (PHM): Singapore’s national strategy to activate and empower patients and care givers through innovative personal health technologies. Int J Integr Care 2012; 12:e61. [PMCID: PMC3571167] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Introduction Aims and objectives Results Conclusion
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Boerema I, de Leeuw R. Effects on personal control of people with psychotic vulnerability by the use of an internet-based program (PCR): a pilot study. Int J Integr Care 2012. [PMCID: PMC3571168] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Starting in 2008 an internet-based platform: Personal Control and Rehabilitation (PCR) has been developed for people with psychotic vulnerability and their formal and informal caregivers and was tested in two mental health institutions in The Netherlands. The Trimbos-institute and the Julius-Centrum evaluated the development, the implementation and the preliminary effects of PCR on patients, informal caregivers and professionals. Aims of the study It was expected that personal control and communication between patients and their (informal) caregivers will be facilitated by the use of PCR. Patients have insight in their treatment goals and medication. Communication no longer depends on the hours that the caregivers are available. Methods The development and implementation of PCR was followed by an effect and process evaluation. The process of implementation of PCR was evaluated with interviews, validated questionnaires and focusgroup discussions. The questionnaires measure Quality of life, Empowerment, Satisfaction with care, and social functioning (patients), sense of burden (informal caregivers), job satisfaction and workload (professionals) before the implementation of PCR, three and six months later. Results Results show that patients are satisfied with the use of PCR. They reported more insight in their treatment goals and easier communication with each other and (in)formal caregivers. Professionals are enthusiastic of the idea of an internet tool for this target group, as long as it is not a replacement for face-to-face contact. These and additional results will be presented and discussed. Conclusions The use of PCR is appreciated by patients, although professionals and informal caregivers have to get more involved.
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Affiliation(s)
- Ina Boerema
- Trimbos, Netherlands Institute of Mental Health and Addiction, The Netherlands
| | - Rob de Leeuw
- University Medical Center Utrecht, The Netherlands
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van der Weegen S, Verwey R, Spreeuwenberg M, Tange H, van der Weijden T, de Witte L. User-centred development of a monitoring and feedback tool to stimulate physical activity. Int J Integr Care 2012. [PMCID: PMC3571178] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introduction Aim Methods Results Conclusions
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Affiliation(s)
- Sanne van der Weegen
- CAPHRI, Department of Health Services Research Maastricht University, The Netherlands
| | - Renée Verwey
- CAPHRI, Department of Health Services Research Maastricht University, The Netherlands
| | - Marieke Spreeuwenberg
- CAPHRI, Department of Health Services Research Maastricht University, The Netherlands
| | - Huibert Tange
- CAPHRI, Department of General Practice, Maastricht University, The Netherlands
| | | | - Luc de Witte
- CAPHRI, Department of Health Services Research Maastricht University, The Netherlands
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Vermeulen J, Neyens JCL, Spreeuwenberg MD, Van Rossum E, Hewson D, De Witte LP. The added value of user involvement during the development of a feedback system regarding physical functioning for community-dwelling elderly people. Int J Integr Care 2012. [PMCID: PMC3571197] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The number of frail elderly people is increasing. Unfortunately, the number of caregivers is not increasing at the same pace, which affects older people, caregivers and healthcare systems. Because of these developments, self-management is becoming more important in healthcare. To support community-dwelling elderly people in their self-management, a system was developed that monitors their physical functioning. This system provides feedback to elderly people and their caregivers regarding physical indicators of frailty. The feedback is provided to elderly people via the screen of a mobile phone. It is important that elderly people understand the content of the feedback and are able to use the mobile phone properly. If not, it is unlikely that the system can support self-management. Many interactive health technologies that have been developed do not fulfil their promises. An important reason for this is that human and other non-technology issues are not sufficiently taken into consideration during the development process. Objective To collaborate with elderly people during the development and evaluation of a feedback system for community-dwelling elderly people regarding physical functioning. Methods An iterative user-centered design that consists of five phases was used to develop and evaluate the feedback system. These five phases were: 1) Selection of users, 2) Analysis of users and their context, 3) Identification of user needs, 4) Development of a prototype, and 5) Evaluation of the prototype. Three representatives of a target group panel for elderly people were selected in phase 1. They shared their needs and preferences during three expert group meetings that took place during the development process. This resulted in the development of a prototype which was first evaluated in a heuristic evaluation. Once adjustments were made, 11 elderly people evaluated the adjusted prototype using a think aloud procedure. They rated the usability and acceptability of the developed interface on a scale from 1 till 7 using an adapted version of the Post-Study System Usability Questionnaire (PSSUQ). Results A feedback system was developed that provides feedback regarding physical indicators of frailty via a touch screen mobile phone. The interface uses colours, smiley’s, and spoken/written messages to provide feedback that is easy to understand. The heuristic evaluation revealed that there were some problems with consistency and the use of user language. The think aloud evaluation showed that the 11 elderly people were able to navigate through the interface without much difficulty despite some small problems related to the lay-out of the interface. The mean score on an adapted version of the PSSUQ was 5.90 (SD 1.09) which indicates high user satisfaction and good usability. Conclusions The involvement of end-users significantly influenced the lay-out of the interface that was developed. This resulted in an interface that was accepted by the target group. Evaluation of the prototype revealed that the usability of the interface was good. The feedback system will only succeed in supporting self-management when elderly people are able to use the interface and understand the feedback. The input of elderly people during the development process contributed to this.
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Affiliation(s)
| | | | - Marieke D Spreeuwenberg
- Maastricht University, Maastricht; Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Erik Van Rossum
- Maastricht University, Maastricht; Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - David Hewson
- Université de Technologie de Troyes, Troyes, France
| | - Luc P De Witte
- Maastricht University, Maastricht, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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van Noort E, Mennema-Vastenhout T. Online self-management in patients with COPD: with or without the doctor/nurse. Int J Integr Care 2012. [PMCID: PMC3571174] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introduction COPD Case study Results Discussion
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Abstract
BACKGROUND Chronic hip pain is prevalent and disabling and has considerable consequences for the individual, and health and social care. Evidence-based guidelines recommend that patients with chronic hip pain benefit from exercise, but these guidelines are predominantly based on the efficacy of knee rehabilitation programmes. Studies investigating hip rehabilitation programmes suggest that these may not be feasible, citing issues with case identification. This study evaluated the feasibility of an exercise-based rehabilitation programme in a primary care hospital. METHODS Forty-eight participants with chronic hip pain were randomly allocated to receive a five-week exercise and self-management programme or to continue under the management of their general practitioner (GP). Participants were assessed at baseline, six weeks and six months. Outcome measures included Western Ontario and McMaster Universities osteoarthritis index physical function subscale, pain, objective functional performance, self-efficacy, anxiety and depression. RESULTS This programme was feasible, well tolerated and easily implemented into a primary healthcare facility. Adherence to the programme was high (81% attendance). Immediately following rehabilitation, all outcomes measures improved (effect sizes 0.2-0.4), although these improvements diminished at six months. There were no differences between the groups (all p > 0.05). CONCLUSIONS An exercise-based rehabilitation programme was found to be feasible and well tolerated by people with chronic hip pain. The moderate effects in all outcomes immediately following rehabilitation suggested that it warrants further investigation. Issues with diagnosis and adaptations to the programme were identified and will be addressed in a randomized controlled trial.
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Abstract
AIM To examine knowledge and management of diabetes by older people. METHODS A representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed. RESULTS The majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes. CONCLUSIONS Most older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment.
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Affiliation(s)
- J Hewitt
- London School of Hygiene and Tropical Medicine and Portsmouth Hospitals Trust, Queen Alexandra Hospital, Portsmouth, UK.
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Abstract
The Perceived Medical Condition Self-Management Scale (PMCSMS), a generic instrument developed to assess self-management self-efficacy in specific medical conditions, was tailored for use with HIV+ individuals and administered to 125 HIV+ adults, predominantly men. Cronbach's alpha was 0.78, indicating internal consistency reliability. Correlations between the Perceived HIV Self-Management Scale (PHIVSMS) and other validated psychometric instruments measuring generalized self efficacy, dispositional optimism, depressive symptoms, positive and negative affect and HIV quality of life demonstrate the validity of using this scale with an HIV population. The PMCSMS has broad utility as a generic template that can easily be adapted to different medical conditions.
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Affiliation(s)
- Kenneth A Wallston
- School of Nursing, Vanderbilt University, 421 Godchaux Hall, Nashville, TN 37240, USA.
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Kosmala-Anderson J, Wallace LM, Turner A. Does the professional and working context of United Kingdom clinicians predict if they use practices to support patients with long term conditions to self manage? Arch Med Sci 2010; 6:815-21. [PMID: 22419944 PMCID: PMC3298354 DOI: 10.5114/aoms.2010.17100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 09/27/2009] [Accepted: 10/16/2009] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Our study examines how the professional and employment context may influence clinicians' practice self management support for patients with long term conditions (LTC). MATERIAL AND METHODS We surveyed clinicians working with patients with depression, chronic obstructive pulmonary disorder (COPD), chronic musculo skeletal pain and diabetes. RESULTS Clinicians most frequently endorsed items on a scale concerned with patient centeredness, and less frequently endorsed items concerned with clinical and organizational self management support. The most important factors predicting these latter activities were the intensity of working experience with patients with LTC and attending professional training addressing the principles and practice of self management support. Practicing patient centeredness was endorsed by nearly all respondents, and so was not sensitive to variation on work variables. CONCLUSIONS The interaction of training and intensity of work with patients with LTC seems to have the most powerful effect on undertaking clinical and organizational self management support practices. To facilitate clinicians' practice of self management support for patients with LTC it is very important to provide relevant professional training and to build specialized patient care teams with professionals having complimentary skills.
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Affiliation(s)
- Joanna Kosmala-Anderson
- Applied Research Centre in Health and Lifestyle Interventions, Coventry University, Coventry, United Kingdom
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Druss BG, Zhao L, von Esenwein SA, Bona JR, Fricks L, Jenkins-Tucker S, Sterling E, DiClemente R, Lorig K. The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res 2010; 118:264-70. [PMID: 20185272 PMCID: PMC2856811 DOI: 10.1016/j.schres.2010.01.026] [Citation(s) in RCA: 253] [Impact Index Per Article: 18.1] [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: 11/17/2009] [Revised: 01/26/2010] [Accepted: 01/28/2010] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions. METHODS The study team developed and pilot-tested the Health and Recovery Program (HARP), an adaptation of the Chronic Disease Self-Management Program (CDSMP) for mental health consumers. A manualized, six-session intervention, delivered by mental health peer leaders, helps participants become more effective managers of their chronic illnesses. A pilot trial randomized 80 consumers with one or more chronic medical illness to either the HARP program or usual care. RESULTS At six month follow-up, participants in the HARP program had a significantly greater improvement in patient activation than those in usual care (7.7% relative improvement vs. 5.7% decline, p=0.03 for group *time interaction), and in rates of having one or more primary care visit (68.4% vs. 51.9% with one or more visit, p=0.046 for group *time interaction). Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence, and, and though not statistically significant, had similar effect sizes as those seen for the CDSMP in general medical populations. Improvements in HRQOL were largest among medically and socially vulnerable subpopulations. CONCLUSIONS This peer-led, medical self-management program was feasible and showed promise for improving a range of health outcomes among mental health consumers with chronic medical comorbidities. The HARP intervention may provide a vehicle for the mental health peer workforce to actively engage in efforts to reduce morbidity and mortality among mental health consumers.
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Affiliation(s)
- Benjamin G. Druss
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316 Dr Druss: , Mrs. Zhao: , Dr. von Esenwein: , Dr. DiClemente:
| | - Liping Zhao
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316 Dr Druss: , Mrs. Zhao: , Dr. von Esenwein: , Dr. DiClemente:
| | - Silke A. von Esenwein
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316 Dr Druss: , Mrs. Zhao: , Dr. von Esenwein: , Dr. DiClemente:
| | - Joseph R. Bona
- Dekalb Community Service Board P.O. Box 1648 Decatur, GA
| | - Larry Fricks
- Appalachian Consulting Group, 3173 Highway 129 North; Cleveland, GA 30528,
| | - Sherry Jenkins-Tucker
- GA Mental Health Consumer Network Inc., 246 Sycamore St # 260, Decatur, GA 30030-3434,
| | - Evelina Sterling
- Independent Consultant, 1590 Asheforde Drive, Marietta, GA 30068,
| | - Ralph DiClemente
- Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30316 Dr Druss: , Mrs. Zhao: , Dr. von Esenwein: , Dr. DiClemente:
| | - Kate Lorig
- Stanford Pt. Education Research Center, 1000 Welch Rd, Suite 204, Palo Alto CA 94304,
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van Splunteren P, Boerema BI, de Leeuw R. Self management for people with schizophrenia: a pilot in two mental health institutions. Int J Integr Care 2009. [PMCID: PMC2807110] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose Context Data source Case description (Preliminary) conclusions Discussion
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Affiliation(s)
- P. van Splunteren
- Trimbos Instituut, Netherlands Institute of Mental Heath and Addiction, Utrecht, The Netherlands
| | - Ba I. Boerema
- Trimbos Instituut, Netherlands Institute of Mental Heath and Addiction, Utrecht, The Netherlands
| | - R. de Leeuw
- Julius Center, University Medical Center Utrecht, The Netherlands
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de Vries MP, van den Bemt L, Aretz K, Thoonen BPA, Muris JWM, Kester ADM, Cloosterman S, van Schayck CPO. House dust mite allergen avoidance and self-management in allergic patients with asthma: randomised controlled trial. Br J Gen Pract 2007; 57:184-90. [PMID: 17359604 PMCID: PMC2042544] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND The efficacy of bed covers that are impermeable to house dust mites has been disputed. AIM The aim of the present study was to investigate whether the combination of 'house dust mite impermeable' covers and a self-management plan, based on peak flow values and symptoms, leads to reduced use of inhaled corticosteroids (ICS) than self-management alone. DESIGN OF STUDY Prospective, randomised, double blind, placebo-controlled trial. SETTING Primary care in a south-eastern region of the Netherlands. METHOD Asthma patients aged between 16 and 60 years with a house dust mite allergy requiring ICS were randomised to intervention and placebo groups. They were trained to use a self-management plan based on peak flow and symptoms. After a 3-month training period, the intervention commenced using house dust mite impermeable and placebo bed covers. The follow-up period was 2 years. Primary outcome was the use of ICS; secondary outcomes were peak expiratory flow parameters, asthma control, and symptoms. RESULTS One hundred and twenty-six patients started the intervention with house dust mite impermeable or placebo bed covers. After 1 and 2 years, significant differences in allergen exposure were found between the intervention and control groups (P<0.001). No significant difference between the intervention and control groups was found in the dose of ICS (P = 0.08), morning peak flow (P = 0.52), peak flow variability (P = 0.36), dyspnoea (P = 0.46), wheezing (P = 0.77), or coughing (P = 0.41). There was no difference in asthma control between the intervention and control groups. CONCLUSION House dust mite impermeable bed covers combined with self-management do not lead to reduced use of ICS compared with self-management alone.
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Affiliation(s)
- Marjolein P de Vries
- Department of General Practice, Research Institute Caphri, Maastricht University, The Netherlands
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Kennedy AP, Nelson E, Reeves D, Richardson G, Roberts C, Robinson A, Rogers AE, Sculpher M, Thompson DG. A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease. Gut 2004; 53:1639-45. [PMID: 15479685 PMCID: PMC1774266 DOI: 10.1136/gut.2003.034256] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [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] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We developed a patient centred approach to chronic disease self management by providing information designed to promote patient choice. We then conducted a randomised controlled trial of the approach in inflammatory bowel disease (IBD) to assess whether it could alter clinical outcome and affect health service use. DESIGN A multicentre cluster randomised controlled trial. SETTING The trial was conducted in the outpatient departments of 19 hospitals with randomisation by treatment centre, 10 control sites, and nine intervention sites. For patients at intervention sites, an individual self management plan was negotiated and written information provided. PARTICIPANTS A total of 700 patients with established inflammatory bowel disease were recruited. MAIN OUTCOME MEASURES Main outcome measures recorded at one year were: quality of life, health service resource use, and patient satisfaction. Secondary outcomes included measures of enablement-confidence to cope with the condition. RESULTS One year following the intervention, self managing patients had made fewer hospital visits (difference -1.04 (95% confidence interval (CI) -1.43 to -0.65); p<0.001) without increase in the number of primary care visits, and quality of life was maintained without evidence of anxiety about the programme. The two groups were similar with respect to satisfaction with consultations. Immediately after the initial consultation, those who had undergone self management training reported greater confidence in being able to cope with their condition (difference 0.90 (95% CI 0.12-1.68); p<0.03). CONCLUSIONS Adoption of this approach for the management of chronic disease such as IBD in the NHS and other managed health care organisations would considerably reduce health provision costs and benefit disease control.
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Affiliation(s)
- A P Kennedy
- National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
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Affiliation(s)
- P Moayyedi
- Gastroenterology Unit, City Hospital NHS Trust, Dudley Rd, Birmingham B18 7QH, UK.
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