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Sample records for self-management support programs

  1. Establishing an independent mobile health program for chronic disease self-management support in bolivia.

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    Piette, John D; Valverde, Helen; Marinec, Nicolle; Jantz, Rachel; Kamis, Kevin; de la Vega, Carlos Lazo; Woolley, Timothy; Pinto, Bismarck

    2014-01-01

    Mobile health (m-health) work in low- and middle-income countries (LMICs) mainly consists of small pilot programs with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia. Three hundred sixty-four primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry. Thirty-seven percent of survey respondents spoke indigenous languages at home and 38% had six or fewer years of education. Eighty-two percent had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients' ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients' likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with 19/20 (95%) reporting that they would recommend it to a friend. By collaborating with LMICs, m-health programs can be transferred from higher-resource centers to LMICs and implemented in ways that improve access to self-management support among

  2. Development of a training program to support health care professionals to deliver the SPACE for COPD self-management program

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    Blackmore C

    2017-06-01

    Full Text Available Claire Blackmore,1 Vicki L Johnson-Warrington,2 Johanna EA Williams,2 Lindsay D Apps,2 Hannah ML Young,2 Claire LA Bourne,2 Sally J Singh2 1Kettering General Hospital National Health Service (NHS Trust, Kettering, Northamptonshire, 2Centre for Exercise and Rehabilitation Science, Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, UK Background: With the growing burden of COPD and associated morbidity and mortality, a need for self-management has been identified. The Self-management Programme of ­Activity, Coping and Education for Chronic Obstructive Pulmonary Disease (SPACE for COPD manual was developed to support self-management in COPD patients. Currently, there is no literature available regarding health care professionals’ training needs when supporting patients with COPD on self-management.Aim: This study sought to identify these needs to inform, design and develop a training program for health care professionals being trained to deliver a self-management program in COPD.Methods: Fourteen health care professionals from both primary and secondary care COPD services participated in face-to-face semistructured interviews. Thematic analysis was used to produce a framework and identify training needs and views on delivery of the SPACE for COPD self-management program. Components of training were web-based knowledge training, with pre- and posttraining knowledge questionnaires, and a 1-day program to introduce the self-management manual. Feedback was given after training to guide the development of the training program.Results: Health care professionals were able to identify areas where they required increased knowledge to support patients. This was overwhelming in aspects of COPD seen to be outside of their current clinical role. Skills in goal setting and behavioral change were not elicited as a training need, suggesting a lack of understanding of components of supporting self-management

  3. Establishing an Independent Mobile Health Program for Chronic Disease Self-Management Support in Bolivia

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    Piette, John D.; Valverde, Helen; Marinec, Nicolle; Jantz, Rachel; Kamis, Kevin; de la Vega, Carlos Lazo; Woolley, Timothy; Pinto, Bismarck

    2014-01-01

    Background: Mobile health (m-health) work in low- and middle-income countries (LMICs) mainly consists of small pilot programs with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia. Methods: Three hundred sixty-four primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry. Results: Thirty-seven percent of survey respondents spoke indigenous languages at home and 38% had six or fewer years of education. Eighty-two percent had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with 19/20 (95%) reporting that they would recommend it to a friend. Conclusion: By collaborating with LMICs, m-health programs can be transferred from higher-resource centers to LMICs and implemented in ways that

  4. Physiotherapists supporting self-management through health coaching: a mixed methods program evaluation.

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    Dufour, Sinéad Patricia; Graham, Shane; Friesen, Josh; Rosenblat, Michael; Rous, Colin; Richardson, Julie

    2015-01-01

    To evaluate a program in support of chronic disease self-management (CDSM) that is founded on a health coaching (HC) approach, includes supervised exercise and mindfulness-based stress reduction components and is delivered within a private practice physiotherapy setting. An explanatory mixed method design, framed by theory-based program evaluation, was employed to evaluate an eight-week group-based program. Standardized self-rated and performance measures were evaluated pre- and post intervention. Additionally, participant focus groups were conducted following the intervention period. An inductive thematic approach was undertaken to analyze the qualitative data. Seventeen participants (N = 17) completed the study. Improvements were seen in both self-report and performance outcomes. Participants explained how and why they felt the program was beneficial. Six themes were generated: (1) group dynamic; (2) learning versus doing; (3) holism and comprehensive care; (4) self-efficacy and empowerment; (5) previous solutions versus new management strategies; and (6) healthcare provider support. This study established that a group program in support of CDSM founded on a HC approach demonstrated potential value from participants as well as favorable outcomes. A pragmatic randomized control trial is required to determine efficacy of this intervention.

  5. The patient’s voice: an exploratory study of the impact of a group self-management support program

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    Johnston Sharon

    2012-06-01

    Full Text Available Abstract Background Given the potential value of self-management support programs for people with chronic diseases, it is vital to understand how they influence participants’ health attitudes and behaviours. The Stanford Chronic Disease Self-Management Program (CDSMP, the most well-known and widely studied such program, is funded in many provinces and jurisdictions throughout Canada. However, there is little published evidence on its impact in the Canadian health-care system. We studied participants’ reactions and perceived impacts of attending the Stanford program in one Ontario health region so we could assess its value to the health region. The study asked: What are participants’ reactions and perceived impacts of attending the Stanford CDSMP? Methods This mixed methods exploratory study held four focus groups approximately one year after participants attended a Stanford program workshop. At the beginning of each session, participants filled out a survey on the type and frequency of community and health resources used for their self-management. During the sessions, a moderator guided the discussion, asking about such things as long-term impact of the program on their lives and barriers to self-management of their chronic conditions. Results Participants perceived diverse effects of the workshop: from having a profound impact on one area to affecting all aspects of their lives. A change in physical activity patterns was the most prominent behaviour change, noted by over half the participants. Other recurrent effects included an improved sense of social connection and better coping skills. Barriers to self-management were experienced by almost all participants with several dominant themes emerging including problems with the health system and patient-physician interaction. Participants reported a wide variety of resources used in their self-management, and in some cases, an increase in use was noted for some resources. Conclusions Self-management

  6. A systematic review of the effectiveness of stroke self-management programs for improving function and participation outcomes: self-management programs for stroke survivors

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    Warner, G.; Packer, T.L.; Villeneuve, M.; Audulv, A.; Versnel, J.

    2015-01-01

    PURPOSE: A systematic review of stroke self-management programs was conducted to: (i) identify how many and what self-management support strategies were included in stroke self-management interventions and (ii) describe whether self-management programs effectively improved outcomes, focusing

  7. Development of Family-Based Dietary Self-Management Support Program on Dietary Behaviors in Patients with Type 2 Diabetes Mellitus in Indonesia: A Literature Review

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    Aklima Aklima

    2012-08-01

    Full Text Available Background: WHO statistics show that Indonesia has the fourth highest number of diabetes sufferers. The International Diabetes Federation‟s 5th estimated that in 2011 there were 71.4 million people in South East Asia region were suffering with DM Purpose: To develop a family-based dietary self-management support program to improve dietary behaviors in patients with T2DM. Method: A literature review was conducted by reviewing articles related evidence-based practices. Only articles in the English and Indonesian languages were reviewed. The search found eleven published experimental studies related to the topic. Result: Even though dietary self-management has benefits for patients with diabetes, many studies have found that these patients often have difficulty in establishing or maintaining an effective program to self-manage their dietary behaviors. Lack of family support is one factor that often seems to be related to such failures. Family participation in a diabetes education program also had positive psychosocial impacts. Otherwise, another study found that family might not always have a positive impact on self-management. Therefore, this review recommends that development of a family-based support program could be a positive factor in helping to improve dietary self-management behaviors in patients with T2DM. Self-management theory by Funnell and Anderson‟s work (2004 can guide the development of a program with the goal of empowering individuals and families in improving the patient‟s dietary behaviors. The program consists of: (1 reflecting on current and/or past self-management experiences by listening to the patient about their dietary behaviors, (2 discussing the emotions and feelings of the patients, (3 engaging the patient in improving their situation by active listening and helping the patient reflect on their problems and identifying effective strategies, (4 providing information about dietary management and problem

  8. Self-management education and support in chronic disease management.

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    McGowan, Patrick T

    2012-06-01

    With the changing health care environment, prevalence of chronic health conditions, and burgeoning challenges of health literacy, obesity, and homelessness, self-management support provides an opportunity for clinicians to enhance effectiveness and, at the same time, to engage patients to participate in managing their own personal care. This article reviews the differences between patient education and self-management and describes easy-to-use strategies that foster patient self-management and can be used by health care providers in the medical setting. It also highlights the importance of linking patients to nonmedical programs and services in the community. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Supporting self-management of chronic health conditions: common approaches.

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    Lawn, Sharon; Schoo, Adrian

    2010-08-01

    The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches. We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field. Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored. There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary. The nature and context for patients' contact with services, and patients' specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  10. Factors associated with integrating self-management support into primary care.

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    Crespo, Richard; Shrewsberry, Molly

    2007-06-01

    The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care. Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. A standardized set of questions was used in the interviews. The data from the interviews were analyzed using content analysis techniques. One of the principle findings is that self-management support requires putting a system in place, not just adding a new component to primary care. The health centers that fully implemented the self-management program made an organizational commitment to keep self-management on the agenda in management meetings, clinical staff set the example by adopting self-management behaviors, and patient self-management support was implemented in multiple patient care venues. Primary care centers with limited financial resources are able to integrate self-management support into their system of chronic illness care.

  11. SELF MANAGEMENT PROGRAM MENINGKATKAN KOPING, NIAT DAN KEPATUHAN BEROBAT PASIEN PJK SETELAH PEMBERIAN SELF MANAGEMENT PROGRAM

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    Hanim mufarokhah mufarokhah

    2016-04-01

    Full Text Available Introduction: Management coronary artery disease required lifelong treatment. The successful management of CHD requires efective coping, intention and medication adherence of CHD’s patients. This study aimed to explain the changes of coping, intention, and medication adherence in patients with CHD after giving self management programme in RSUD Jombang based on Theory Planned Behavior.Method: This study used a quasy experimental pretest-posttest control group design and 28 respondens selected by consecutive sampling. Independent variable was self management programme while dependent variables were coping, intention, medication adherence. Data were collected by using questonnaires measuring coping level, intention and medication adherence. The statistical test used was Mann Whitney, Wilcoxone Signed Rank and t-Test. Result: The result showed that 1 self management programme improve the level of coping in patients with CHD (p < 0,001, 2 self management programme improve the level of intention in patients with CHD (p < 0,001, 3 self management programme improve the level of medication adherence in patients with CHD (p < 0,001. Discussion: To change a behavior requires improvement of coping and intentions. This is in according to the Theory of Planned Behavior that behavior change is influenced by the attitude toward the behavior, subjective norm, perceived behavioral control and intention. Keywords: self management program, coping, intention, medication adherence, coronary heart disease

  12. Development of a chronic care ostomy self-management program.

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    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C; Wendel, Christopher S; Krouse, Robert

    2013-03-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long-term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self-Management Program, which was informed by (1) evidence on published quality-of-life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self-Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies.

  13. Development of a Chronic Care Ostomy Self Management Program

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    Grant, Marcia; McCorkle, Ruth; Hornbrook, Mark C.; Wendel, Christopher S.; Krouse, Robert

    2012-01-01

    Each year a percentage of the 1.2 million men and women in the United States with a new diagnosis of colorectal cancer join the 700,000 people who have an ostomy. Education targeting the long term, chronic care of this population is lacking. This report describes the development of a Chronic Care Ostomy Self Management Program, which was informed by (1) evidence on published quality of life changes for cancer patients with ostomies, (2) educational suggestions from patients with ostomies, and (3) examination of the usual care of new ostomates to illustrate areas for continued educational emphases and areas for needed education and support. Using these materials, the Chronic Care Ostomy Self Management Program was developed by a team of multi-disciplinary researchers accompanied by experienced ostomy nurses. Testing of the program is in process. Pilot study participants reported high satisfaction with the program syllabus, ostomy nurse leaders, and ostomate peer buddies. PMID:23104143

  14. The Roles of Social Support and Health Literacy in Self-Management Among Patients With Chronic Kidney Disease.

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    Chen, Yu-Chi; Chang, Li-Chun; Liu, Chieh-Yu; Ho, Ya-Fang; Weng, Shuo-Chun; Tsai, Tzu-I

    2018-05-01

    To investigate the relationships among social support, health literacy, and self-management, and the factors influencing self-management of chronic kidney disease (CKD). Cross-sectional study. A random sample of 410 patients was recruited from nephrology clinics. Data were collected using structured questionnaires and chart reviews from January 2013 to February 2014. Hierarchical regression analysis was used to determine the predictive factors of self-management behaviors and ∆R 2 to determine each variable's explanatory power. Health literacy and social support were positively correlated with self-management behaviors. Furthermore, social support, health literacy, and marital status were significant predictors of self-management behaviors. Social support had a relatively greater explanatory power for self-management behaviors than did health literacy. Particularly, healthcare provider support had the greatest influence on patients' self-management behaviors. Health literacy and social support play independent positive roles in self-management behaviors of patients with CKD, with social support having a particularly dominant role. Further research using a systems approach to improving self-management behaviors is necessary to clarify the role of social support. Health literacy and social support are independently and positively related to self-management. Social support, which is a system-level factor, is a relatively stronger and crucial predictor than is health literacy. Nurses have to refine self-management programs to focus on families and adopt a systems approach to help CKD patients improve their self-management behaviors. © 2018 Sigma Theta Tau International.

  15. Toward consensus on self-management support: the international chronic condition self-management support framework.

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    Mills, Susan L; Brady, Teresa J; Jayanthan, Janaki; Ziabakhsh, Shabnam; Sargious, Peter M

    2017-12-01

    Self-management support (SMS) initiatives have been hampered by insufficient attention to underserved and disadvantaged populations, a lack of integration between health, personal and social domains, over emphasis on individual responsibility and insufficient attention to ethical issues. This paper describes a SMS framework that provides guidance in developing comprehensive and coordinated approaches to SMS that may address these gaps and provides direction for decision makers in developing and implementing SMS initiatives in key areas at local levels. The framework was developed by researchers, policy-makers, practitioners and consumers from 5 English-speaking countries and reviewed by 203 individuals in 16 countries using an e-survey process. While developments in SMS will inevitably reflect local and regional contexts and needs, the strategic framework provides an emerging consensus on how we need to move SMS conceptualization, planning and development forward. The framework provides definitions of self-management (SM) and SMS, a collective vision, eight guiding principles and seven strategic directions. The framework combines important and relevant SM issues into a strategic document that provides potential value to the SMS field by helping decision-makers plan SMS initiatives that reflect local and regional needs and by catalyzing and expanding our thinking about the SMS field in relation to system thinking; shared responsibility; health equity and ethical issues. The framework was developed with the understanding that our knowledge and experience of SMS is continually evolving and that it should be modified and adapted as more evidence is available, and approaches in SMS advance. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. An environmental scan of policies in support of chronic disease self-management in Canada.

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    Liddy, C; Mill, K

    2014-02-01

    The evidence supporting chronic disease self-management warrants further attention. Our aim was to identify existing policies, strategies and frameworks that support self-management initiatives. This descriptive study was conducted as an environmental scan, consisting of an Internet search of government and other publicly available websites, and interviews with jurisdictional representatives identified through the Health Council of Canada and academic networking. We interviewed 16 representatives from all provinces and territories in Canada and found 30 publicly available and relevant provincial and national documents. Most provinces and territories have policies that incorporate aspects of chronic disease self-management. Alberta and British Columbia have the most detailed policies. Both feature primary care prominently and are not disease specific. Both also have provincial level implementation of chronic disease self-management programming. Canada's northern territories all lacked specific policies supporting chronic disease self-management despite a significant burden of disease. Engaging patients in self-management of their chronic diseases is important and effective. Although most provinces and territories have policies that incorporate aspects of chronic disease self-management, they were often embedded within other initiatives and/or policy documents framed around specific diseases or populations. This approach could limit the potential reach and effect of self-management.

  17. Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support.

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    Brady, Teresa J; Sacks, Jeffrey J; Terrillion, Albert J; Colligan, Erin M

    2018-04-05

    Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS-related research.

  18. COPD self-management supportive care: chaos and complexity theory.

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    Cornforth, Amber

    This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

  19. Design Considerations for Internet-Delivered Self-Management Programs for Adults With Hearing Impairment.

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    Preminger, Jill E; Rothpletz, Ann M

    2016-10-01

    Hearing impairment (HI) is a chronic condition; thus, even with treatment, residual participation restrictions and activity limitations typically remain. Individuals must learn to self-manage their HI. The purpose of this research note is to review components of successful Internet-based self-management programs and to evaluate group auditory rehabilitation (AR) programs with varying content, in order to make recommendations for the design of future Internet-based self-management programs. Effect sizes for changes in HI-specific quality of life following group AR activities from 4 published studies were calculated to determine if effect size varied systematically as a function of group activities. These findings are described using a self-management framework. Successful group AR activities include (a) psychosocial activities to promote role management, emotional management, and social support; (b) informational lectures and group discussion to promote education; (c) communication strategy exercises to promote self-efficacy and self-management skills; and (d) the inclusion of a frequent communication partner to promote social support and self-tailoring. It is recommended that future Internet-based self-management programs focus on the mechanisms of social support and education to promote learning and self-management skills. Future research will determine if these AR activities may be implemented effectively via the Internet.

  20. Diabetes self management training and psychological support weekends

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    Smeesters, Hannah; Skinner, Chas; Martin, Jo

    2007-01-01

    A lack of knowledge in diabetes self management skills, such as insulin administration, glucose testing and diet, have been identified in a high percentage of adults with the condition ever since insulin treatment was first introduced (Watkins et al, 1967; Murata et al, 2003). Adult support weeke...

  1. Twelve evidence-based principles for implementing self-management support in primary care.

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    Battersby, Malcolm; Von Korff, Michael; Schaefer, Judith; Davis, Connie; Ludman, Evette; Greene, Sarah M; Parkerton, Melissa; Wagner, Edward H

    2010-12-01

    Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed. The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options. There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.

  2. [Chronic Disease Self-management Support for People with a Migrant Background: towards a Peer-led Group Program to Improve Equity in Health].

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    Zanoni, S; Gabriel, E; Salis Gross, C; Deppeler, M; Haslbeck, J

    2018-03-01

    Limited health literacy and language skills are barriers for people with a migrant background (PMB) to access health information and healthcare services, in particular for those living with chronic conditions. During the introduction of a peer-led Stanford chronic disease self-management course in Switzerland, special interest in the program as well as motivation of PMB was observed. In response, we examined if the program can be implemented in German for people with limited language skills. This explorative study is part of the evaluation study on introducing the adapted Stanford program in Switzerland and German-speaking Europe. Following the principles of Grounded Theory, semi-structured focus group and individual interviews were conducted with course participants, leaders and coordinators (n=30) and analyzed thematically. The focus was on the feasibility, satisfaction and course content. In principle, the program seems to have positive value for PMB, may work for them in German, have high relevance for everyday life and give an impetus for social integration. The need for and extent of modification of the program for PMB has to be further explored in order to make it more accessible for vulnerable groups. © Georg Thieme Verlag KG Stuttgart · New York.

  3. A diabetes self-management program designed for urban American Indians.

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    Castro, Sarah; O'Toole, Mary; Brownson, Carol; Plessel, Kimberly; Schauben, Laura

    2009-10-01

    Although the American Indian population has a disproportionately high rate of type 2 diabetes, little has been written about culturally sensitive self-management programs in this population. Community and clinic partners worked together to identify barriers to diabetes self-management and to provide activities and services as part of a holistic approach to diabetes self-management, called the Full Circle Diabetes Program. The program activities and services addressed 4 components of holistic health: body, spirit, mind, and emotion. Seven types of activities or services were available to help participants improve diabetes self-management; these included exercise classes, educational classes, and talking circles. Ninety-eight percent of program enrollees participated in at least 1 activity, and two-thirds participated in 2 or more activities. Program participation resulted in a significant improvement in knowledge of resources for managing diabetes. The Full Circle Diabetes Program developed and implemented culturally relevant resources and supports for diabetes self-management in an American Indian population. Lessons learned included that a holistic approach to diabetes self-management, community participation, and stakeholder partnerships are needed for a successful program.

  4. [Educative programs based on self-management: an integrative review].

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    Nascimento, Luciana da Silva; de Gutierrez, Maria Gaby Rivero; De Domenico, Edvane Birelo Lopes

    2010-06-01

    The objective was to identify definitions and/or explanations of the term self-management in educative programs that aim its development. The authors also aimed to describe the educative plans and results of the educative programs analyzed. As a methodology we used integrative review, with 15 published articles (2002 the 2007). The inclusion criteria was: the occurrence of the term self-management; the existence of an educative program for the development of self-management; to be related to the area of the health of the adult. Self-management means the improvement or acquisition of abilities to solve problems in biological, social and affective scopes. The review pointed to different educational methodologies. However, it also showed the predominance of traditional methods, with conceptual contents and of physiopathological nature. The learning was evaluated as favorable, with warns in relation to the application in different populations and contexts and to the increase of costs of the educative intervention. It was concluded that research has evidenced the importance of the education for self-management, but lacked in strength for not relating the biopsychosocial demands of the chronic patient and for not describing in detail the teaching and evaluation methodologies employed.

  5. Development of a capacity building program for village health volunteers to support self-management in a high risk population for diabetes in a rural community in northeast Thailand

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    Pakinee Srisarakham

    2016-07-01

    Full Text Available Similar to other parts of the world, the prevalence of type 2 diabetes mellitus (T2DM in the Asia-Pacific Region has rapidly increased during the last few decades. The purposes of this pilot study were to determine the feasibility and the effects of a capacity building program for Village Health Volunteers (VHVs to support self-management in a T2DM high risk population from a rural subdistrict in Northeast Thailand. Both quantitative and qualitative data were collected using surveys, focus group discussions, and in-depth interviews. Data were analyzed and used to develop a 12-week capacity building program for VHVs. This program was then implemented on 60 subjects at high risk of T2DM in the selected community. According to the paired t-test and Wilcoxon-signed rank test, VHVs had higher scores on knowledge and self-efficacy of T2DM prevention after a 12 week intervention (p = .03 and p = .02, respectively. Study participants at risk for T2DM also had a significant increase in T2DM knowledge and self-management (p < .001. Implementation of the capacity building program for VHVs in Northeast Thailand was feasible. The key successes were strong community bonding, community empowerment, and support from family and public health nurses. Effects of the program should be examined with those in other Asia-Pacific countries.

  6. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views.

    Directory of Open Access Journals (Sweden)

    Emma Boger

    Full Text Available Self-management has received growing attention as an effective approach for long-term condition management. Little is known about which outcomes of supported self-management are valued by patients, their families, health professionals and those who commission self-management services. This study systematically reviewed published empirical evidence in accordance with PRISMA guidelines to determine the outcomes of self-management valued by these key stakeholder groups, using three prominent exemplar conditions: colorectal cancer, diabetes and stroke.To systematically review the literature to identify which generic outcomes of self-management have been targeted and are considered important using three exemplar conditions (colorectal cancer, diabetes and stroke, which collectively have a range of features that are likely to be representative of generic self-management issues.Systematic searching of nine electronic databases was conducted in addition to hand searches of review articles. Abstracts were identified against inclusion criteria and appraised independently by two reviewers, using a critical appraisal tool. Synthesis of findings was conducted using mixed research synthesis.Over 20,536 abstracts were screened. 41 studies which met the review criteria were fully retrieved and appraised. The majority of evidence related to diabetes. Few studies directly focussed on stakeholders' views concerning desired self-management outcomes; the majority of evidence was derived from studies focusing upon the experience of self-management. The views of health care commissioners were absent from the literature. We identified that self-management outcomes embrace a range of indicators, from knowledge, skills, and bio-psychosocial markers of health through to positive social networks.Patients', families', health professionals' and commissioners' views regarding which outcomes of self-management are important have not been clearly elicited. The extent to which

  7. A couples’ based self-management program for heart failure: Results of a feasibility study

    Directory of Open Access Journals (Sweden)

    Ranak Trivedi

    2016-08-01

    Full Text Available Background: Heart failure (HF is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers. Objective: To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others. Methods: We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases. The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life. Results: Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and

  8. Chronic condition self-management support for Aboriginal people: Adapting tools and training.

    Science.gov (United States)

    Battersby, Malcolm; Lawn, Sharon; Kowanko, Inge; Bertossa, Sue; Trowbridge, Coral; Liddicoat, Raylene

    2018-04-22

    Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts. The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program. Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed. A total of 825 health professionals  across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability. The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally. © 2018 National Rural Health Alliance Ltd.

  9. Patient factors that influence clinicians' decision making in self-management support : A clinical vignette study

    NARCIS (Netherlands)

    Bos-Touwen, Irene D.; Trappenburg, Jaap C A; Van Der Wulp, Ineke; Schuurmans, Marieke J.; De Wit, Niek J.

    2017-01-01

    BACKGROUND AND AIM: Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current

  10. An integrative literature review to examine the provision of self-management support following transient ischaemic attack.

    Science.gov (United States)

    Kessler, Dorothy; Liddy, Clare

    2017-11-01

    which approaches are most effective. Given the limited evidence to support any one program for persons with TIA, clinicians and programs that provide self-management support should evaluate and monitor outcomes to ensure client needs are being met. © 2016 John Wiley & Sons Ltd.

  11. Self-Management Strategies to Support Students with ASD

    Science.gov (United States)

    Schulze, Margaret A.

    2016-01-01

    Self-management is a set of procedures that students can be taught to apply to their own behaviors to change them. In self-management, students are taught to observe, assess, and modify their own behavior. These procedures include such things as self-identifying and observing a target behavior and setting a goal to change it. Self-management…

  12. Chronic disease self-management support for persons with dementia, in a clinical setting

    Directory of Open Access Journals (Sweden)

    Ibrahim JE

    2017-01-01

    age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level. Keywords: chronic disease, dementia, self-management, cognitive domains

  13. [Effects of gout web based self-management program on knowledge related to disease, medication adherence, and self-management].

    Science.gov (United States)

    Oh, Hyun Soo; Park, Won; Kwon, Seong Ryul; Lim, Mie Jin; Suh, Yeon Ok; Seo, Wha Sook; Park, Jong Suk

    2013-08-01

    This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.

  14. Direct to Public Peer Support and e-Therapy Program Versus Information to Aid Self-Management of Depression and Anxiety: Protocol for a Randomized Controlled Trial.

    Science.gov (United States)

    Kaylor-Hughes, Catherine J; Rawsthorne, Mat; Coulson, Neil S; Simpson, Sandra; Simons, Lucy; Guo, Boliang; James, Marilyn; Moran, Paul; Simpson, Jayne; Hollis, Chris; Avery, Anthony J; Tata, Laila J; Williams, Laura; Morriss, Richard K

    2017-12-18

    Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe, anonymized public health-driven Web-based services such as Big White Wall (BWW), which offer immediate peer support at low cost. Using Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) methodology, the aim of this study was to determine the population reach, effectiveness, cost-effectiveness, and barriers and drivers to implementation of BWW compared with Web-based information compiled by UK's National Health Service (NHS, NHS Choices Moodzone) in people with probable mild to moderate depression and anxiety disorder. A pragmatic, parallel-group, single-blind randomized controlled trial (RCT) is being conducted using a fully automated trial website in which eligible participants are randomized to receive either 6 months access to BWW or signposted to the NHS Moodzone site. The recruitment of 2200 people to the study will be facilitated by a public health engagement campaign involving general marketing and social media, primary care clinical champions, health care staff, large employers, and third sector groups. People will refer themselves to the study and will be eligible if they are older than 16 years, have probable mild to moderate depression or anxiety disorders, and have access to the Internet. The primary outcome will be the Warwick-Edinburgh Mental Well-Being Scale at 6 weeks. We will also explore the reach, maintenance, cost-effectiveness, and barriers and drivers to implementation and possible mechanisms of actions using a range of qualitative and quantitative methods. This will be the first fully digital trial of a direct to public online peer support program for common mental disorders. The potential advantages of adding this to current NHS mental health services and the challenges of designing a public health campaign and RCT of

  15. Self-management-support in dementia care: A mixed methods study among nursing staff.

    Science.gov (United States)

    Verkaik, Renate; van Antwerpen-Hoogenraad, Paulien; de Veer, Anke; Francke, Anneke; Huis In Het Veld, Judith

    2017-11-01

    Background Self-management in patients and family caregivers confronted with dementia is not self-evident. Self-management skills may be limited because of the progressive cognitive decline of the patient and because family caregivers are often also very aged. Self-management support by nursing staff is therefore of paramount importance. Objectives To gain insight into how nursing staff perceive their self-management support tasks, and how they put them into practice. Research questions are: 'What are the opinions and experiences of Dutch nursing staff working in home care or residential elderly care regarding self-management support for people with dementia and their family caregivers?' and 'Do nursing staff feel sufficiently trained and skilled for self-management support?'. Methods A mixed methods approach was used, combining cross-sectional quantitative survey data from 206 Dutch nursing professionals with qualitative interviews among 12 nursing staff working in home care or residential elderly care in The Netherlands. Results Nursing staff working in home care experienced self-management support of people with dementia as a part of their job and as an attractive task. They consider 'helping people with dementia to maintain control over their lives by involving them in decisions in daily care' the essence of self-management support. Nursing staff saw family caregivers as their main partners in providing self-management support to the patient. They were less aware that family caregivers themselves might also need self-management support. Nursing staff often felt insufficiently trained to give adequate self-management support. RN's and CNA's did not differ in their opinions, experiences and training needs. Conclusions Nursing staff in home care do consider self-management support an important and attractive task in dementia care. Their skills for providing self-management support to patients with dementia and family caregivers need improvement. Recommendations

  16. Diabetes self-management support for patients with low health literacy: Perceptions of patients and providers

    NARCIS (Netherlands)

    Fransen, Mirjam P.; Beune, Erik J. A. J.; Baim-Lance, Abigail M.; Bruessing, Raynold C.; Essink-Bot, Marie-Louise

    2015-01-01

    The aim of the present study was to explore perceptions and strategies of health care providers regarding diabetes self-management support for patients with low health literacy (LHL), and to compare their self-management support with the needs of patients with LHL and type 2 diabetes. This study

  17. Self-management support for peritoneal dialysis patients.

    Science.gov (United States)

    Sarian, Mari; Brault, Diane; Perreault, Nathalie

    2012-01-01

    The increasing prevalence of chronic illnesses and kidney disease, in particular, makes it necessary to adopt new approaches towards their management (Wagner, 1998). Evidence suggests that promoting self-management improves the health status of peritoneal dialysis (PD) patients, as they manage upwards of 90% of their own care. Patients who are unable to self-manage suffer from various complications. This project proposes an intervention aimed at improving self-management skills among PD patients. To promote self-management in peritoneal dialysis patients. This is achieved through the following objectives: (a) develop an algorithm that can improve patients' ability to solve the specific problem of fluid balance maintenance, (b) develop an educational session for patients on how to use the algorithm, and (c) develop an implementation strategy in collaboration with the PD nurse. Three measures evaluate the effectiveness of the intervention. First, a telephone call log shows that participating patients call the clinic less to inquire about fluid balance maintenance. Next, a pre- and post-intervention knowledge test measures definite knowledge increase. Finally, a Patient Satisfaction Questionnaire reveals overall satisfaction with the intervention. This project, which proved beneficial to our patient population, could be duplicated in other clinics. The algorithm "How do I choose a dialysis bag" and the slides of the educational sessions can be shared with PD nurses across the country for the benefit of PD patients.

  18. Diabetes self-management support for patients with low health literacy: Perceptions of patients and providers.

    Science.gov (United States)

    Fransen, Mirjam P; Beune, Erik J A J; Baim-Lance, Abigail M; Bruessing, Raynold C; Essink-Bot, Marie-Louise

    2015-05-01

    The aim of the present study was to explore perceptions and strategies of health care providers regarding diabetes self-management support for patients with low health literacy (LHL), and to compare their self-management support with the needs of patients with LHL and type 2 diabetes. This study serves as a problem analysis for systematic intervention development to improve diabetes self-management among patients with LHL. This qualitative study used in-depth interviews with general practitioners (n = 4), nurse practitioners (n = 5), and patients with LHL (n = 31). The results of the interviews with health care providers guided the patient interviews. In addition, we observed 10 general practice consultations. Providers described patients with LHL as uninvolved and less motivated patients who do not understand self-management. Their main strategy to improve self-management was to provide standard information on a repeated basis. Patients with LHL seemed to have a different view of diabetes self-management than their providers. Most demonstrated a low awareness of what self-management involves, but did not express needing more information. They reported several practical barriers to self-management, although they seemed reluctant to use the information provided to overcome them. Providing and repeating information does not fit the needs of patients with LHL regarding diabetes self-management support. Health care providers do not seem to have the insight or the tools to systematically support diabetes self-management in this group. Systematic intervention development with a focus on skills-based approaches rather than cognition development may improve diabetes self-management support of patients with LHL. © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  19. The emotional context of self-management in chronic illness: A qualitative study of the role of health professional support in the self-management of type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Dunbar James

    2008-10-01

    Full Text Available Abstract Background Support for patient self-management is an accepted role for health professionals. Little evidence exists on the appropriate basis for the role of health professionals in achieving optimum self-management outcomes. This study explores the perceptions of people with type 2 diabetes about their self-management strategies and how relationships with health professionals may support this. Methods Four focus groups were conducted with people with type 2 diabetes: two with English-speaking and one each with Turkish and Arabic-speaking. Transcripts from the groups were analysed drawing on grounded hermeneutics and interpretive description. Results We describe three conceptually linked categories of text from the focus groups based on emotional context of self management, dominant approaches to self management and support from health professionals for self management. All groups described important emotional contexts to living with and self-managing diabetes and these linked closely with how they approached their diabetes management and what they looked for from health professionals. Culture seemed an important influence in shaping these linkages. Conclusion Our findings suggest people construct their own individual self-management and self-care program, springing from an important emotional base. This is shaped in part by culture and in turn determines the aims each person has in pursuing self-management strategies and the role they make available to health professionals to support them. While health professionals' support for self-care strategies will be more congruent with patients' expectations if they explore each person's social, emotional and cultural circumstances, pursuit of improved health outcomes may involve a careful balance between supporting as well as helping shift the emotional constructs surrounding a patient life with diabetes.

  20. Using an electronic self-management tool to support patients with chronic kidney disease (CKD): a CKD clinic self-care model.

    Science.gov (United States)

    Ong, Stephanie W; Jassal, Sarbjit V; Porter, Eveline; Logan, Alexander G; Miller, Judith A

    2013-01-01

    New healthcare delivery models are needed to enhance the patient experience and improve quality of care for individuals with chronic conditions such as kidney disease. One potential avenue is to implement self-management strategies. There is growing evidence that self-management interventions help optimize various aspects of chronic disease management. With the increasing use of information technology (IT) in health care, chronic disease management programs are incorporating IT solutions to support patient self-management practices. IT solutions have the ability to promote key principles of self-management, namely education, empowerment, and collaboration. Positive clinical outcomes have been demonstrated for a number of chronic conditions when IT solutions were incorporated into self-management programs. There is a paucity of evidence for self-management in chronic kidney disease (CKD) patients. Furthermore, IT strategies have not been tested in this patient population to the same extent as other chronic conditions (e.g., diabetes, hypertension). Therefore, it is currently unknown if IT strategies will promote self-management behaviors and lead to improvements in overall patient care. We designed and developed an IT solution called My KidneyCare Centre to support self-management strategies for patients with CKD. In this review, we discuss the rationale and vision of incorporating an electronic self-management tool to support the care of patients with CKD. © 2013 Wiley Periodicals, Inc.

  1. Multiple domains of social support are associated with diabetes self-management among Veterans.

    Science.gov (United States)

    Gray, Kristen E; Hoerster, Katherine D; Reiber, Gayle E; Bastian, Lori A; Nelson, Karin M

    2018-01-01

    Objectives To examine, among Veterans, relationships of general social support and diabetes-specific social support for physical activity and healthy eating with diabetes self-management behaviors. Methods Patients from VA Puget Sound, Seattle completed a cross-sectional survey in 2012-2013 ( N = 717). We measured (a) general social support and (b) diabetes-specific social support for healthy eating and physical activity with domains reflecting support person participation, encouragement, and sharing ideas. Among 189 self-reporting diabetes patients, we fit linear and modified Poisson regression models estimating associations of social support with diabetes self-management behaviors: adherence to general and diabetes-specific diets and blood glucose monitoring (days/week); physical activity (social support was not associated with diabetes self-management. For diabetes-specific social support, higher healthy eating support scores across all domains were associated with better adherence to general and diabetes-specific diets. Higher physical activity support scores were positively associated with ≥150 min/week of physical activity only for the participation domain. Discussion Diabetes-specific social support was a stronger and more consistent correlate of improved self-management than general social support, particularly for lifestyle behaviors. Incorporating family/friends into Veterans' diabetes self-management routines may lead to better self-management and improvements in disease control and outcomes.

  2. Support for self-management of cardiovascular disease by people with learning disabilities.

    Science.gov (United States)

    Young, Anita F; Naji, Simon; Kroll, Thilo

    2012-08-01

    Cardiovascular disease (CVD) is the second most common cause of death among people with learning disabilities (LD), and lifestyle has been linked to risk factors. With a shift towards illness prevention and self-management support, it is important to know how people with LD can be involved in this process. To elicit the perceptions of people with LD, carers and health professionals regarding supported self-management of CVD. A qualitative approach used in-depth semi-structured interviews based on vignettes with accompanying pictures. Fourteen people with LD, 11 carers/care staff and 11 health professionals were recruited and interviewed. Thematic framework analysis was used to analyse interview data. In total, 11 men and 25 women were interviewed. All respondents contributed views of self-management with a wide range of opinions expressed within each participant group. Four key themes encompassed: strategies for self-management; understanding the prerequisites for self-management support; preferred supporters and challenges for self-management implementation. Facilitated service user involvement in self-management decision making was highly valued in all groups. Service users wished for co-ordinated incremental support from across agencies and individuals. People with LD can be effectively consulted regarding health management and their views can inform service development. Promoting joined-up support across health and social care and families will require investment in resources, education and dismantling of professional barriers.

  3. Can models of self-management support be adapted across cancer types? A comparison of unmet self-management needs for patients with breast or colorectal cancer.

    Science.gov (United States)

    Mansfield, Elise; Mackenzie, Lisa; Carey, Mariko; Peek, Kerry; Shepherd, Jan; Evans, Tiffany-Jane

    2018-03-01

    There is an increased focus on supporting patients with cancer to actively participate in their healthcare, an approach commonly termed 'self-management'. Comparing unmet self-management needs across cancer types may reveal opportunities to adapt effective self-management support strategies from one cancer type to another. Given that breast and colorectal cancers are prevalent, and have high survival rates, we compared these patients' recent need for help with self-management. Data on multiple aspects of self-management were collected from 717 patients with breast cancer and 336 patients with colorectal cancer attending one of 13 Australian medical oncology treatment centres. There was no significant difference between the proportion of patients with breast or colorectal cancer who reported a need for help with at least one aspect of self-management. Patients with breast cancer were significantly more likely to report needing help with exercising more, while patients with colorectal cancer were more likely to report needing help with reducing alcohol consumption. When controlling for treatment centre, patients who were younger, experiencing distress or had not received chemotherapy were more likely to report needing help with at least one aspect of self-management. A substantial minority of patients reported an unmet need for self-management support. This indicates that high-quality intervention research is needed to identify effective self-management support strategies, as well as implementation trials to identify approaches to translating these strategies into practice. Future research should continue to explore whether self-management support strategies could be adapted across cancer types.

  4. Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.

    Science.gov (United States)

    Jordan, Joanne E; Briggs, Andrew M; Brand, Caroline A; Osborne, Richard H

    2008-11-17

    Although emphasis on the prevention of chronic disease is important, governments in Australia need to balance this with continued assistance to the 77% of Australians reported to have at least one long-term medical condition. Self-management support is provided by health care and community services to enhance patients' ability to care for their chronic conditions in a cooperative framework. In Australia, there is a range of self-management support initiatives that have targeted patients (most notably, chronic disease self-management education programs) and health professionals (financial incentives, education and training). To date, there has been little coordination or integration of these self-management initiatives to enhance the patient-health professional clinical encounter. If self-management support is to work, there is a need to better understand the infrastructure, systems and training that are required to engage the key stakeholders - patients, carers, health professionals, and health care organisations. A coordinated approach is required in implementing these elements within existing and new health service models to enhance uptake and sustainability.

  5. eHealth technologies to support nutrition and physical activity behaviors in diabetes self-management

    Directory of Open Access Journals (Sweden)

    Rollo ME

    2016-11-01

    Full Text Available Megan E Rollo,1 Elroy J Aguiar,2 Rebecca L Williams,1 Katie Wynne,3 Michelle Kriss,3 Robin Callister,4 Clare E Collins1 1School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia; 2Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA; 3Department of Diabetes and Endocrinology, John Hunter Hospital, Hunter New England Health, New Lambton, NSW, Australia;\t4School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, Australia Abstract: Diabetes is a chronic, complex condition requiring sound knowledge and self-management skills to optimize glycemic control and health outcomes. Dietary intake and physical activity are key diabetes self-management (DSM behaviors that require tailored education and support. Electronic health (eHealth technologies have a demonstrated potential for assisting individuals with DSM behaviors. This review provides examples of technologies used to support nutrition and physical activity behaviors in the context of DSM. Technologies covered include those widely used for DSM, such as web-based programs and mobile phone and smartphone applications. In addition, examples of novel tools such as virtual and augmented reality, video games, computer vision for dietary carbohydrate monitoring, and wearable devices are provided. The challenges to, and facilitators for, the use of eHealth technologies in DSM are discussed. Strategies to support the implementation of eHealth technologies within practice and suggestions for future research to enhance nutrition and physical activity behaviors as a part of broader DSM are provided. Keywords: diabetes self-management, eHealth, nutrition, physical activity, smartphones, wearables

  6. Experiences of peer support in self-management interventions among people with ischemic heart disease

    DEFF Research Database (Denmark)

    Enggaard, Helle; Uhrenfeldt, Lisbeth

    2016-01-01

    Review question/objective: The objective of this review is to identify, appraise and synthesize the best available evidence regarding people with ischemic heart disease and their experiences with peer support in self-management interventions. More specifically, the review question is: How do people...... with ischemic heart disease experience peer support in structured self-management interventions led or co-led by peers?...

  7. eHealth technologies to support nutrition and physical activity behaviors in diabetes self-management.

    Science.gov (United States)

    Rollo, Megan E; Aguiar, Elroy J; Williams, Rebecca L; Wynne, Katie; Kriss, Michelle; Callister, Robin; Collins, Clare E

    2016-01-01

    Diabetes is a chronic, complex condition requiring sound knowledge and self-management skills to optimize glycemic control and health outcomes. Dietary intake and physical activity are key diabetes self-management (DSM) behaviors that require tailored education and support. Electronic health (eHealth) technologies have a demonstrated potential for assisting individuals with DSM behaviors. This review provides examples of technologies used to support nutrition and physical activity behaviors in the context of DSM. Technologies covered include those widely used for DSM, such as web-based programs and mobile phone and smartphone applications. In addition, examples of novel tools such as virtual and augmented reality, video games, computer vision for dietary carbohydrate monitoring, and wearable devices are provided. The challenges to, and facilitators for, the use of eHealth technologies in DSM are discussed. Strategies to support the implementation of eHealth technologies within practice and suggestions for future research to enhance nutrition and physical activity behaviors as a part of broader DSM are provided.

  8. Starting early: integration of self-management support into an acute stroke service.

    Science.gov (United States)

    Mäkelä, Petra; Gawned, Sara; Jones, Fiona

    2014-01-01

    Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of self-management support in acute stroke settings has not been evaluated. The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit. The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating self-management support into ways of working in the acute stroke setting. Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed. Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care. Staff initiated an audit of washing and dressing practices pre- and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training. This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further

  9. Self-Management Support Interventions for Stroke Survivors: A Systematic Meta-Review.

    Directory of Open Access Journals (Sweden)

    Hannah L Parke

    Full Text Available There is considerable policy interest in promoting self-management in patients with long-term conditions, but it remains uncertain whether these interventions are effective in stroke patients.Systematic meta-review of the evidence for self-management support interventions with stroke survivors to inform provision of healthcare services.We searched MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, BNI, Database of Abstracts of Reviews for Effectiveness, and Cochrane Database of Systematic Reviews for systematic reviews of self-management support interventions for stroke survivors. Quality was assessed using the R-AMSTAR tool, and data extracted using a customised data extraction form. We undertook a narrative synthesis of the reviews' findings.From 12,400 titles we selected 13 systematic reviews (published 2003-2012 representing 101 individual trials. Although the term 'self-management' was rarely used, key elements of self-management support such as goal setting, action planning, and problem solving were core components of therapy rehabilitation interventions. We found high quality evidence that supported self-management in the context of therapy rehabilitation delivered soon after the stroke event resulted in short-term (< 1 year improvements in basic and extended activities of daily living, and a reduction in poor outcomes (dependence/death. There is some evidence that rehabilitation and problem solving interventions facilitated reintegration into the community.Self-management terminology is rarely used in the context of stroke. However, therapy rehabilitation currently successfully delivers elements of self-management support to stroke survivors and their caregivers with improved outcomes. Future research should focus on managing the emotional, medical and social tasks of long-term survivorship.

  10. Supporting chronic disease self-management: translating policies and principles into clinical practice.

    Science.gov (United States)

    Higgins, Rosemary; Murphy, Barbara; Worcester, Marian; Daffey, Angela

    2012-01-01

    To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d.=4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.

  11. Self-management program in treatment of asthma

    Directory of Open Access Journals (Sweden)

    Milenković Branislava

    2007-01-01

    Full Text Available Introduction. Recently published national and international guidelines stress the importance of self-management in asthma. They have recommended that self-management plans should be an essential part of the long-term management of asthmatic patients. These plans essentially focus on the early recognition of unstable or deteoriorating asthma, by monitoring peak flow or symptoms. Objective. The aim of our one-year study was to compare the efficacy of peak-flow based self-management of asthma with traditional treatment. Method. Sixty clinically stable adult patients with mild and moderate persistent asthma were randomly allocated to peakflow based self-management (Group A, n=30 or to conventional treatment (Group B, n=30, with no significant difference between groups in terms of age, sex distribution and initial lung function. The recorded measurements were: lung function, asthma exacerbations, unscheduled ambulatory care facilities (hospital-based emergency department, consultations with general practitioner or pulmonologist, courses of oral prednisolone, courses of antibiotics, days off work. Results. There was a significant difference between groups in number of asthma exacerbations (p<0.05, unscheduled visits to ambulatory care facilities (p<0.005, days off work (p<0.0001, courses of oral prednisolone (p<0.001 and antibiotics (p<0.05. At the final visit, there was a significant improvement in some measurements of asthma severity in group A (reduced unscheduled visits for ambulatory care, reduced treatment requirements for oral corticosteroids and antibiotics, reduced days off work, but a lack of statistical difference in lung function and the maintenance-inhaled corticosteroid dose. There was no significant change in group B. Conclusion. These results suggest that peak-flow based self management is more effective than traditonal treatment in mild and moderate persistent asthma. .

  12. Digital Support Interventions for the Self-Management of Low Back Pain

    DEFF Research Database (Denmark)

    Nicholl, Barbara I; Sandal, Louise Fleng; Stochkendahl, Mette Jensen

    2017-01-01

    BACKGROUND: Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost......-effective strategies for LBP management and there is increasing interest in the potential role of digital health. OBJECTIVE: The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific...... questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have...

  13. [Effects of Self-management Program applying Dongsasub Training on Self-efficacy, Self-esteem, Self-management Behavior and Blood Pressure in Older Adults with Hypertension].

    Science.gov (United States)

    Kim, Myoungsuk; Song, Misoon

    2015-08-01

    The purpose of this study was to develop a self-management program applying Dongsasub training based on self-efficacy theory, and to verify the program effectiveness on self-esteem as well as self-efficacy, self-management behaviors, and blood pressure. The study design was a non-equivalent, pre-post controlled quasi-experiment study. Thirty-eight patients aged 65 and older from a senior welfare center in Seoul participated in this study (20 patients in the experimental group and 18 patients in the control group). The self-management program applying Dongsasub training consisted of eight sessions. After development was complete the program was used with the experimental group. Outcome variables included self-efficacy, self-esteem, self-management behaviors measured by questionnaires, and blood pressure measured by electronic manometer. Self-efficacy (t=2.42, p=.021), self-esteem (t=2.57, p=.014) and self-management behaviors (t=2.21, p=.034) were significantly higher and systolic blood pressure (t=-2.14, p=.040) was significantly lower in the experimental group compared to the control group. However, diastolic blood pressure (t=-.85, p=.400) was not significantly different between the two groups. The results indicate that the self-management program applying Dongsasub training can be used as a nursing intervention in community settings for improving self-management behaviors for older adults with hypertension.

  14. Patient-perceived self-management tasks and support needs of people with chronic illness: generic or disease specific?

    NARCIS (Netherlands)

    Houtum, L. van; Rijken, M.; Heijmans, M.; Groenewegen, P.

    2015-01-01

    Background: Self-management is widely accepted as an essential component of chronic care. Nevertheless, little is known about patients’ perceptions of self-management. Purpose: This study aims to explore which self-management tasks and support needs people with chronic illness perceive for

  15. [The use of systematic review to develop a self-management program for CKD].

    Science.gov (United States)

    Lee, Yu-Chin; Wu, Shu-Fang Vivienne; Lee, Mei-Chen; Chen, Fu-An; Yao, Yen-Hong; Wang, Chin-Ling

    2014-12-01

    Chronic kidney disease (CKD) has become a public health issue of international concern due to its high prevalence. The concept of self-management has been comprehensively applied in education programs that address chronic diseases. In recent years, many studies have used self-management programs in CKD interventions and have investigated the pre- and post-intervention physiological and psychological effectiveness of this approach. However, a complete clinical application program in the self-management model has yet to be developed for use in clinical renal care settings. A systematic review is used to develop a self-management program for CKD. Three implementation steps were used in this study. These steps include: (1) A systematic literature search and review using databases including CEPS (Chinese Electronic Periodical Services) of Airiti, National Digital Library of Theses and Dissertations in Taiwan, CINAHL, Pubmed, Medline, Cochrane Library, and Joanna Briggs Institute. A total of 22 studies were identified as valid and submitted to rigorous analysis. Of these, 4 were systematic literature reviews, 10 were randomized experimental studies, and 8 were non-randomized experimental studies. (2) Empirical evidence then was used to draft relevant guidelines on clinical application. (3) Finally, expert panels tested the validity of the draft to ensure the final version was valid for application in practice. This study designed a self-management program for CKD based on the findings of empirical studies. The content of this program included: design principles, categories, elements, and the intervention measures used in the self-management program. This program and then was assessed using the content validity index (CVI) and a four-point Liker's scale. The content validity score was .98. The guideline of self-management program to CKD was thus developed. This study developed a self-management program applicable to local care of CKD. It is hoped that the guidelines

  16. Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China.

    Science.gov (United States)

    Xu, Wenhong; Sun, Changxian; Lin, Zheng; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

    2016-01-01

    Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible.

  17. Focus groups for developing a peer mentoring program to improve self-management in pediatric inflammatory bowel disease.

    Science.gov (United States)

    Mackner, Laura M; Ruff, Jessica M; Vannatta, Kathryn

    2014-10-01

    Inflammatory bowel disease (IBD) presents challenges for self-management in many areas. A peer mentoring program may offer advantages over other forms of self-management interventions because youth may be more receptive to learning self-management skills from a peer than from a parent or professional. The purpose of the present study was to identify themes from focus groups to inform development of a peer mentoring program for improving self-management in pediatric IBD. Focus groups were conducted for youth ages 12 to 17, stratified by age (3 groups; n = 14), young adults ages 18 to 20 (1 group; n = 5), and parents of the youth (3 groups; n = 17). Broad questions covered program goals, general program characteristics, mentor/mentee characteristics, and family involvement, and transcriptions were analyzed via directed content analysis, with the a priori codes specified as the broad questions above. Participants identified the primary goals of a program as support, role model, information/education, and fun. They described a program that would include a year-long, 1-on-1 mentor relationship with a peer who has had IBD for at least a year, educational group activities, fun activities that are not focused on IBD, expectations for in-person contact 1 to 2 times per month, and mentor-to-mentor and parent support. Many of the suggestions from the focus groups correspond with research findings associated with successful mentoring programs. Using participants' suggestions and empirically based best practices for mentoring may result in an effective peer mentoring program for improving self-management in youth with IBD.

  18. Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes.

    Science.gov (United States)

    Harvey, Peter W; Petkov, John N; Misan, Gary; Fuller, Jeffrey; Battersby, Malcolm W; Cayetano, Teofilo N; Warren, Kate; Holmes, Paul

    2008-05-01

    The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

  19. The Effectiveness of self management program on quality of life in patients with sickle cell disease

    Science.gov (United States)

    Ahmadi, M; Jahani, S; Poormansouri, S; Shariati, A; Tabesh, H

    2015-01-01

    Background Sickle cell patients suffer from many physical, psychological, and social problems that can affect their quality of life. To deal with this chronic condition and manage their disease and prevent complications associated with the disease, they must learn skills and behaviours. The aim of this study was to determine the effectiveness of self-management programs on quality of life in these patients. Material and Methods Samples of this quasi-experimental study, which included 69 patients with sickle cell disease referring to the Thalassemia Clinic of Shafa Hospital, were entered into the study by census method. Patients received a self-management program using the 5A model for 12 weeks, while their quality of life before the intervention were assessed at the twelfth week and thirty-sixth week using SF-36 questionnaire. Data were analyzed by descriptive statistics, paired t-test, Wilcoxon test, Hotelling's T2, and repeated measures test. Results The eight dimensions and the total QoL score after intervention were significantly increased compared to those before the intervention (P<0.001). Repeated measures test showed that the mean score of eight QoL dimensions and the total QoL score decreased in the thirty-sixth week, compared to twelfth week. However, it was significantly enhanced in comparison with the intervention baseline (P<0.05). Conclusions Current study revealed the efficacy of self-management interventions on the quality of life in patients with sickle cell disease. Therefore, application of this supportive method could be useful to empower the patients and help them to manage the disease. PMID:25914799

  20. [Effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus].

    Science.gov (United States)

    Kim, HeeSook; Kim, Sue

    2013-02-01

    The purpose of the study was to investigate the effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus (GDM). A non-equivalent control group non-synchronized quasi-experimental design was used. A total of 55 women with GDM were recruited from Cheil General Hospital, Seoul, Korea and were assigned to an experimental (n=28) or control group (n=27). The participants were 24-30 weeks pregnant women who had been diagnosed with GDM as of July 30, 2010. The program was conducted as a 1 hour small group meeting 3 out of 5 times and by telephone-counseling 2 out of 5 times. The integrated self-management program was verified by an expert panel. Although there was no significant reduction in HbA1c (U= -1.17, p=.238), there were statistically significant increases in self-management (U= -3.80, pidentity (U= -4.48, pmanagement program for women with GDM improves self-management, maternal identity, and glycemic control. Further studies are needed to identify the effects of an integrated self-management program on pregnancy and neonatal outcomes.

  1. A Systematic Review of Reviews Evaluating Technology-Enabled Diabetes Self-Management Education and Support.

    Science.gov (United States)

    Greenwood, Deborah A; Gee, Perry M; Fatkin, Kathy J; Peeples, Malinda

    2017-09-01

    Since the introduction of mobile phones, technology has been increasingly used to enable diabetes self-management education and support. This timely systematic review summarizes how currently available technology impacts outcomes for people living with diabetes. A systematic review of high quality review articles and meta analyses focused on utilizing technology in diabetes self-management education and support services was conducted. Articles were included if published between January 2013 and January 2017. Twenty-five studies were included for analysis. The majority evaluated the use of mobile phones and secure messaging. Most studies described healthy eating, being active and metabolic monitoring as the predominant self-care behaviors evaluated. Eighteen of 25 reviews reported significant reduction in A1c as an outcome measure. Four key elements emerged as essential for improved A1c: (1) communication, (2) patient-generated health data, (3) education, and (4) feedback. Technology-enabled diabetes self-management solutions significantly improve A1c. The most effective interventions incorporated all the components of a technology-enabled self-management feedback loop that connected people with diabetes and their health care team using 2-way communication, analyzed patient-generated health data, tailored education, and individualized feedback. The evidence from this systematic review indicates that organizations, policy makers and payers should consider integrating these solutions in the design of diabetes self-management education and support services for population health and value-based care models. With the widespread adoption of mobile phones, digital health solutions that incorporate evidence-based, behaviorally designed interventions can improve the reach and access to diabetes self-management education and ongoing support.

  2. Social Support for Diabetes Self-Management via eHealth Interventions.

    Science.gov (United States)

    Vorderstrasse, Allison; Lewinski, Allison; Melkus, Gail D'Eramo; Johnson, Constance

    2016-07-01

    eHealth interventions have been increasingly used to provide social support for self-management of type 2 diabetes. In this review, we discuss social support interventions, types of support provided, sources or providers of support, outcomes of the support interventions (clinical, behavioral, psychosocial), and logistical and clinical considerations for support interventions using eHealth technologies. Many types of eHealth interventions demonstrated improvements in self-management behaviors, psychosocial outcomes, and clinical measures, particularly HbA1c. Important factors to consider in clinical application of eHealth support interventions include participant preferences, usability of eHealth technology, and availability of personnel to orient or assist participants. Overall, eHealth is a promising adjunct to clinical care as it addresses the need for ongoing support in chronic disease management.

  3. Development of a peer-supported, self-management intervention for people following mental health crisis.

    Science.gov (United States)

    Milton, Alyssa; Lloyd-Evans, Brynmor; Fullarton, Kate; Morant, Nicola; Paterson, Bethan; Hindle, David; Kelly, Kathleen; Mason, Oliver; Lambert, Marissa; Johnson, Sonia

    2017-11-09

    A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of

  4. Differences in Osteoarthritis Self-Management Support Intervention Outcomes According to Race and Health Literacy

    Science.gov (United States)

    Sperber, Nina R.; Bosworth, Hayden B.; Coffman, Cynthia J.; Lindquist, Jennifer H.; Oddone, Eugene Z.; Weinberger, Morris; Allen, Kelli D.

    2013-01-01

    We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain…

  5. mHealth intervention to support asthma self-management in adolescents : The ADAPT study

    NARCIS (Netherlands)

    Kosse, R.C.; Bouvy, M.L.; de Vries, T.W.; Kaptein, A.A.; Geers, H.C.J.; van Dijk, Liset; Koster, E.S.

    2017-01-01

    Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving

  6. mHealth intervention to support asthma self-management in adolescents: the ADAPT study.

    NARCIS (Netherlands)

    Kosse, R.C.; Bouvy, M.L.; Vries, T.W. de; Kaptein, A.A.; Geers, H.C.J.; Dijk, L. van; Koster, E.S.

    2017-01-01

    Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving

  7. Use of behavioral change techniques in web-based self-management programs for type 2 diabetes patients: systematic review.

    Science.gov (United States)

    van Vugt, Michael; de Wit, Maartje; Cleijne, Wilmy H J J; Snoek, Frank J

    2013-12-13

    Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic metabolic disease characterized by hyperglycemia and cardiovascular risks. Without proper treatment, T2DM can lead to long-term complications. Diabetes self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs for T2DM patients can help to successfully improve patient health behaviors and health-related outcomes. Theories can help to specify key determinants of the target behaviors and behavior change strategies required to arrive at the desired health outcomes, which can then be translated into specific behavioral techniques or strategies that patients can learn to apply in their daily life. From previous reviews of a wide range of online diabetes self-management tools and programs, it appears that it is still unclear which behavioral change techniques (BCTs) are primarily used and are most effective when it comes to improving diabetes self-management behaviors and related health outcomes. We set out to identify which BCTs are being applied in online self-management programs for T2DM and whether there is indication of their effectiveness in relation to predefined health outcomes. Articles were systematically searched and screened on the mentioned use of 40 BCTs, which were then linked to reported statistically significant improvements in study outcomes. We found 13 randomized controlled trials reporting on 8 online self-management interventions for T2DM. The BCTs used were feedback on performance, providing information on consequences of behavior, barrier identification/problem solving, and self-monitoring of behavior. These BCTs were also linked to positive outcomes for health behavior change, psychological well-being, or clinical parameters. A relatively small number of theory-based online self-management support programs for T2DM have been reported using only a select number of BCTs. The development of future online self-management

  8. Group affiliation in self-management: support or threat to identity?

    Science.gov (United States)

    Bossy, Dagmara; Knutsen, Ingrid Ruud; Rogers, Anne; Foss, Christina

    2017-02-01

    Self-management is considered important in chronic illness, and contemporary health policy recommends participation in support groups for individuals with chronic conditions. Although withdrawal from or non-participation in support groups is an important problem, there is limited knowledge about individuals' own motivation for participation in or withdrawal from self-management support groups. To investigate how individuals with type 2 diabetes perceive participation in group-based self-management support. This is a qualitative focus group study using a semi-structured interview guide. Sixteen participants diagnosed with type 2 diabetes were included in the study. Individuals with and without group affiliations were mixed in three focus groups to trigger discussions. In the analysis, reoccurring themes of engagement and discussions between participants were focused within a theoretical frame of institutional logic. The focus groups are seen as social spaces where participants construct identity. Both participation and non-participation in group-based self-management support are associated with dealing with the stigma of having type 2 diabetes. Negotiations contribute to constructing an illness dignity as a response to the logic of moral responsibility for the disease. Contemporary policy contributes to societal understandings of individuals with type 2 diabetes as morally inadequate. Our study shows that group-based self-management support may counteract blame and contribute in negotiations of identity for individuals with type 2 diabetes. This mechanism makes participation in groups beneficial for some but stigma inducing for others. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

  9. Attrition in Chronic Disease Self-Management Programs and Self-Efficacy at Enrollment

    Science.gov (United States)

    Verevkina, Nina; Shi, Yunfeng; Fuentes-Caceres, Veronica Alejandra; Scanlon, Dennis Patrick

    2014-01-01

    Among other goals, the Chronic Disease Self-Management Program (CDSMP) is designed to improve self-efficacy of the chronically ill. However, a substantial proportion of the enrollees often leave CDSMPs before completing the program curriculum. This study examines factors associated with program attrition in a CDSMP implemented in a community…

  10. Attrition in Chronic Disease Self-Management Programs and self-efficacy at enrollment.

    Science.gov (United States)

    Verevkina, Nina; Shi, Yunfeng; Fuentes-Caceres, Veronica Alejandra; Scanlon, Dennis Patrick

    2014-12-01

    Among other goals, the Chronic Disease Self-Management Program (CDSMP) is designed to improve self-efficacy of the chronically ill. However, a substantial proportion of the enrollees often leave CDSMPs before completing the program curriculum. This study examines factors associated with program attrition in a CDSMP implemented in a community setting. We used data from the Our Pathways to Health program, implemented in Humboldt County, California, from 2008 to 2011. Our conceptual framework is based on Bandura's self-efficacy theory, and we used logistic regression to investigate whether baseline self-efficacy and other members' efficacy are associated with participants dropping out of the CDSMP. Twenty-three percent of the participants did not complete the program similar to previous studies. Lower baseline self-efficacy increased the odds of dropout, but other members' efficacy was not associated with differential odds of dropout. Age, educational difference between the individual and the group, weekday sessions, and social/role activity limitations are also found to be associated with program attrition. Our results suggest that participants with low starting self-efficacy may need extra help to complete the program. Further research is needed to understand how to effectively provide additional support to this group. © 2014 Society for Public Health Education.

  11. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients

    OpenAIRE

    Pamungkas, Rian Adi; Chamroonsawasdi, Kanittha; Vatanasomboon, Paranee

    2017-01-01

    The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose moni...

  12. Effects of a Self-Management Educational Program for the Control of Childhood Asthma.

    Science.gov (United States)

    Perez, Maria Gabriela; Feldman, Lya; Caballero, Fernan

    1999-01-01

    Evaluates the effects of a self-management educational program on 29 children and their parents. Program consists of six sessions of information giving and cognitive-behavioral strategies for the children, and two talks and a brochure for the parents. Results indicate a significant effect on children's asthma knowledge and practice of…

  13. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

    Science.gov (United States)

    Perrin, Karen M; Burke, Somer Goad; O'Connor, Danielle; Walby, Gary; Shippey, Claire; Pitt, Seraphine; McDermott, Robert J; Forthofer, Melinda S

    2006-10-26

    Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

  14. Factors contributing to intervention fidelity in a multi-site chronic disease self-management program

    Directory of Open Access Journals (Sweden)

    Pitt Seraphine

    2006-10-01

    Full Text Available Abstract Background and objectives Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. Methods The Florida Health Literacy Study (FHLS was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. Results This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. Conclusion Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

  15. Strategies for self-management support by patients with stroke: integrative review

    Directory of Open Access Journals (Sweden)

    Huana Carolina Cândido Morais

    2015-02-01

    Full Text Available OBJECTIVE To analyze strategies for self-management support by patients with stroke in the light of the methodology of the five A's (ask, advice, assess, assist and arrange. METHODS Integrative review conducted at the following databases CINAHL, SCOPUS, PubMed, Cochrane and LILACS. RESULTS A total of 43 studies published between 2000 and 2013 comprised the study sample. All proposed actions in the five A's methodology and others were included. We highlight the Assist and Arrange, in which we added actions, especially with regard to the use of technological resources and joint monitoring between patients, families and professionals. No study included all five A's, which suggests that the actions of supported self-management are developed in a fragmented way. CONCLUSION The use of five A's strategy provides guidelines for better management of patients with stroke with lower cost and higher effectiveness.

  16. Establishing an independent mobile health programme for chronic disease self-management support in Bolivia

    Directory of Open Access Journals (Sweden)

    John D Piette

    2014-08-01

    Full Text Available Background: Mobile health (m-health work in low and middle-income countries (LMICs mainly consists of pilot programmes with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD self-management support in Bolivia. Methods: 364 primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. 165 of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly Interactive Voice Response (IVR calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry. Results: 37% of survey respondents spoke indigenous languages at home, and 38% had six or fewer years of education. 82% had a mobile phone; half (45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR programme participants completed 1007 self-management support calls, with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status or healthcare access. IVR health and self-care reports were consistent with information reported during baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health via IVR increased during programme participation, and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the programme, with 19/20 (95% reporting that they would recommend it to a friend. Conclusions: By collaborating with LMICs, m-health programmes can be transferred from higher-resource centres to LMICs and implemented in ways that improve access to self-management support among people

  17. Effect Evaluation of a Self-Management Program for Dutch Workers with a Chronic Somatic Disease: A Randomized Controlled Trial

    NARCIS (Netherlands)

    Frank van Dijk; Josephine Engels; Sarah Detaille; Yvonne Heerkens; Joost van der Gulden

    2013-01-01

    Purpose: The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease. Methods: In a

  18. Supporting self-management by Community Matrons through a group intervention; an action research study.

    Science.gov (United States)

    Barkham, Abigail M; Ersser, Steven J

    2017-07-01

    The aim of this study was to examine the feasibility and impact of a group intervention by Community Matrons to support those living with multiple long-terms conditions. Little evidence exists as to how the role of the Community Matron (CM) should be delivered to effectively enhance disease self-management and levels of self-efficacy for the service users. This qualitative participatory action research study explored the use of group work as a method of intervention by CMs. A purposive sample of 29 participants was recruited. Each patient group had 8-10 participants, led by a CM working in both the researcher and practitioner role, operating over 12-month period. Data were collected by participant observation, researcher reflexive account and interviews. Grounded theory method was used to systematically analyse the data. Three main data categories emerged: (i) comparison by patients that leads to re-motivation of the self; (ii) learning, leading to enhanced self-management techniques, through storytelling and understanding of each other's experiences; and (iii) ownership that resulted in the self-awareness, cognisance and insight into the role of the support group they were based in and how it benefited them. The core category of 'Taking back the self - understanding the whole,' conveyed the impact that this care delivery method had upon readjusting the balance of power between health professional and service users and its consequence in refreshing and improving their self-management and the patients' self-efficacy. It was concluded that CM intervention using a model of group learning can lead to more effective and efficient support, through improving self-efficacy and patients' related self-management ability. © 2017 John Wiley & Sons Ltd.

  19. Learning to Swim Using Video Modelling and Video Feedback within a Self-Management Program

    Science.gov (United States)

    Lao, So-An; Furlonger, Brett E.; Moore, Dennis W.; Busacca, Margherita

    2016-01-01

    Although many adults who cannot swim are primarily interested in learning by direct coaching there are options that have a focus on self-directed learning. As an alternative a self-management program combined with video modelling, video feedback and high quality and affordable video technology was used to assess its effectiveness to assisting an…

  20. Use of Self-Management with the CW-FIT Group Contingency Program

    Science.gov (United States)

    Kamps, Debra; Conklin, Carl; Wills, Howard

    2015-01-01

    The purpose of the study was to determine the effects of self-management as a tier two enhancement to the group contingency intervention, Class-Wide Function-related Intervention Teams Program (CW-FIT). Two classrooms, first and fourth grade, and two students in each of the classrooms participated in the intervention. The group contingency…

  1. Standardising the Lay: Logics of Change in Programs of Disease Self-management

    Directory of Open Access Journals (Sweden)

    Annegrete Juul Nielsen

    2012-11-01

    Full Text Available The health political discourse on self-care is dominated by the view that the selfmanaging patient represents a more democratic and patient-centric perspective, as he or she is believed to renegotiate the terms on which patient participation in health care has hitherto taken place. The self-managing patient is intended as a challenge to traditional medical authority by introducing lay methods of knowing disease. Rather than a meeting between authoritative professionals and vulnerable patients, the self-managing patient seeks to open up new spaces for a meeting between experts. The present paper questions these assumptions through an ethnographic exploration of a patient-led self-management program called the Chronic Disease Self-Management Program. The program is concerned with what its developers call the social and mental aspects of living with a chronic disease and uses trained patients as role models and program leaders. Drawing inspiration from Annemarie Mol’s term ‘logic’, we explore the rationale of ‘situations of selfmanagement’ and identify what we call a ‘logic of change’, which involves very specific ideas on how life with a chronic condition should be dealt with and directs attention towards particular manageable aspects of life with a chronic condition. This logic of change entails, we argue, a clash not between ‘medical’ and ‘lay’ forms of knowledge but between different logics or perceptions of how transformation can be achieved: through open-ended and ongoing reflection and experimentation in social settings or through standardised trajectories of change. Returning to the literature on lay forms of knowledge and illness perspectives, we question whether programs such as the Chronic Disease Self-Management Program – despite its apparent patient-centric perspective – reproduces classical hierarchical relations between lay and expert knowledge, albeit in new forms.

  2. Commercially Available Smartphone Apps to Support Postoperative Pain Self-Management: Scoping Review.

    Science.gov (United States)

    Lalloo, Chitra; Shah, Ushma; Birnie, Kathryn A; Davies-Chalmers, Cleo; Rivera, Jordan; Stinson, Jennifer; Campbell, Fiona

    2017-10-23

    Recently, the use of smartphones to deliver health-related content has experienced rapid growth, with more than 165,000 mobile health (mHealth) apps currently available in the digital marketplace. With 3 out of 4 Canadians currently owning a smartphone, mHealth apps offer opportunities to deliver accessible health-related knowledge and support. Many individuals experience pain after surgery, which can negatively impact their health-related quality of life, including sleep, emotional, and social functioning. Smartphone apps that provide remote real-time monitoring and symptom management have the potential to improve self-management skills in patients experiencing postoperative pain. Increased confidence and practice of self-management skills could contribute to decreased postoperative pain and reduce risk of developing persistent pain. Published reviews of general pain self-management apps demonstrate a lack of evidence-based content, theoretical grounding, and health care professional involvement. However, no review to date has focused on the app marketplace specific for individuals with postoperative pain. The aim of this study was to characterize and critically appraise the content and functionality of commercially available postoperative pain self-management apps. An electronic search and extraction was conducted between December 2016 and March 2017 of the official Canadian app stores for the three major smartphone operating systems (iPhone operating system [iOS], Android, and Windows). Stores were searched separately using predetermined search terms. Two authors screened apps based on information provided in the public app description. Metadata from all included apps were abstracted into a standard spreadsheet. Two authors verified the data with reference to the apps and downloaded apps themselves. The content and functionality of each app as it pertained to postoperative pain self-management was rated. A total of 10 apps met the inclusion criteria. All

  3. Diabetes Medication Assistance Service: the pharmacist's role in supporting patient self-management of type 2 diabetes (T2DM) in Australia.

    Science.gov (United States)

    Mitchell, Bernadette; Armour, Carol; Lee, Mary; Song, Yun Ju; Stewart, Kay; Peterson, Greg; Hughes, Jeff; Smith, Lorraine; Krass, Ines

    2011-06-01

    To evaluate the capacity and effectiveness of trained community pharmacists in delivering the Diabetes Medication Assistance Service (DMAS) via (1) number and types of self-management support interventions (SMSIs); (2) number of goals set and attained by patients and (3) patient outcomes (glycaemic control, medication adherence and satisfaction). Pharmacists (n=109) from 90 community pharmacies in Australia were trained and credentialed to deliver the DMAS. The training focused on developing pharmacists' knowledge and skills in supporting patients' diabetes self-management. A total of 387 patients completed the trial. The mean number of SMSIs per patient was 35 (SD ±31) and the majority (87%) had at least one documented goal that was fully or partially attained. There were significant health benefits for patients including improved glycaemic control and a reduced risk of non-adherence to medications. Over 90% of DMAS patients reported improvements in their knowledge about diabetes self-management. The DMAS provides self management support in the community pharmacy for people with T2DM which may result in improved clinical outcomes. Given appropriate training in diabetes care and behavior change strategies, community pharmacists can offer programs which provide self-management support to their patients with T2DM and improve their health outcomes. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Applying the Chronic Care Model to Support Ostomy Self-Management: Implications for Oncology Nursing Practice.

    Science.gov (United States)

    Ercolano, Elizabeth; Grant, Marcia; McCorkle, Ruth; Tallman, Nancy J; Cobb, Martha D; Wendel, Christopher; Krouse, Robert

    2016-06-01

    Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.

  5. Impact of a community-based diabetes self-management program on key metabolic parameters

    Directory of Open Access Journals (Sweden)

    Johnson C

    2014-12-01

    Full Text Available Objective: Characterize the impact of a pharmacist-led diabetes self-management program on three key metabolic parameters: glycosylated hemoglobin (HbA1c, low-density lipoprotein cholesterol (LDL-C, and mean arterial blood pressure (MAP among employee health program participants. Methods: A self-insured company in the Kansas City metropolitan area began offering a pharmacist-led diabetes self-management program to eligible company employees and their dependents in 2008. A retrospective pre-post analysis was conducted to determine if the program affected key metabolic parameters in participants by determining mean change after one year of participation. Results: Among 183 program participants, 65 participants met inclusion criteria. All three key metabolic parameters were significantly reduced from baseline to one year of program participation: HbA1c decreased from 8.1% to 7.3% (p=0.007; LDL-C decreased from 108.3 mg/dL to 96.4 mg/dL (p=0.009; and MAP decreased from 96.1 to 92.3 mm Hg (p=0.005. Conclusions: The pharmacist-led diabetes self-management program demonstrated significant reductions in HbA1c, LDL-C, and MAP from baseline to one year of program participation. Improvements were statistically significant and clinically relevant for each parameter. Previous studies indicate these reductions may cause reduced overall healthcare costs.

  6. Mindfulness-based lifestyle programs for the self-management of Parkinson's disease in Australia.

    Science.gov (United States)

    Vandenberg, Brooke E; Advocat, Jenny; Hassed, Craig; Hester, Jennifer; Enticott, Joanne; Russell, Grant

    2018-04-11

    Despite emerging evidence suggesting positive outcomes of mindfulness training for the self-management of other neurodegenerative diseases, limited research has explored its effect on the self-management of Parkinson's disease (PD). We aimed to characterize the experiences of individuals participating in a facilitated, group mindfulness-based lifestyle program for community living adults with Stage 2 PD and explore how the program influenced beliefs about self-management of their disease. Our longitudinal qualitative study was embedded within a randomized controlled trial exploring the impact of a 6-week mindfulness-based lifestyle program on patient-reported function. The study was set in Melbourne, Australia in 2012-2013. We conducted semi-structured interviews with participants before, immediately after, and 6 months following participation in the program. Sixteen participants were interviewed prior to commencing the program. Of these, 12 were interviewed shortly after its conclusion, and 9 interviewed at 6 months. Prior to the program, participants felt a lack of control over their illness. A desire for control and a need for alternative tools for managing the progression of PD motivated many to engage with the program. Following the program, where participants experienced an increase in mindfulness, many became more accepting of disease progression and reported improved social relationships and self-confidence in managing their disease. Mindfulness-based lifestyle programs have the potential for increasing both participants' sense of control over their reactions to disease symptoms as well as social connectedness. Community-based mindfulness training may provide participants with tools for self-managing a number of the consequences of Stage 2 PD.

  7. Denmark's comparative position regarding health status, healthcare provision, self-management and social support

    DEFF Research Database (Denmark)

    Hansen, Ulla Møller; Jones, Allan; Zander, Mette

    2015-01-01

    AIMS: The aim of this study was to benchmark the Danish sample of the second Diabetes, Attitudes, Wishes and Needs (DAWN2) study with the global average in order to determine Denmark's comparative position for health status, healthcare provision, self-management and social support from...... to be an untapped potential when it comes to converting education participation of FM into social support for PWD. CONCLUSIONS: Our findings suggest that PWD in Denmark rank above the global average on measures of psychological wellbeing, despite psychological wellbeing being under-prioritised by HCP. However...

  8. Comparative analysis of diabetes self-management education programs in the European Union Member States.

    Science.gov (United States)

    Saha, Sarama; Riemenschneider, Henna; Müller, Gabriele; Levin-Zamir, Diane; Van den Broucke, Stephan; Schwarz, Peter E H

    2017-12-01

    Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  9. Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

    Science.gov (United States)

    Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E

    2017-06-01

    Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Kathryn A. Boschen

    2016-01-01

    Full Text Available Background. Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT and physical exercise (PE are empirically supported treatments that can reduce pain and improve quality of life. Objectives. To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario. Methods. The pain management group (PMG consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning. Results. From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Paired t-tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men. Discussion. The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.

  11. Digital Support Interventions for the Self-Management of Low Back Pain: A Systematic Review.

    Science.gov (United States)

    Nicholl, Barbara I; Sandal, Louise F; Stochkendahl, Mette J; McCallum, Marianne; Suresh, Nithya; Vasseljen, Ottar; Hartvigsen, Jan; Mork, Paul J; Kjaer, Per; Søgaard, Karen; Mair, Frances S

    2017-05-21

    Low back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health. The study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes? Bibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively. Of the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114

  12. Shifting mindsets: a realist synthesis of evidence from self-management support training.

    Science.gov (United States)

    Davies, Freya; Wood, Fiona; Bullock, Alison; Wallace, Carolyn; Edwards, Adrian

    2018-03-01

    Accompanying the growing expectation of patient self-management is the need to ensure health care professionals (HCPs) have the required attitudes and skills to provide effective self-management support (SMS). Results from existing training interventions for HCPs in SMS have been mixed and the evidence base is weaker for certain settings, including supporting people with progressive neurological conditions (PNCs). We set out to understand how training operates, and to identify barriers and facilitators to training designed to support shifts in attitudes amongst HCPs. We undertook a realist literature synthesis focused on: (i) the influence of how HCPs, teams and organisations view and adopt self-management; and (ii) how SMS needs to be tailored for people with PNCs. A traditional database search strategy was used alongside citation tracking, grey literature searching and stakeholder recommendations. We supplemented PNC-specific literature with data from other long-term conditions. Key informant interviews and stakeholder advisory group meetings informed the synthesis process. Realist context-mechanism-outcome configurations were generated and mapped onto the stages described in Mezirow's Transformative Learning Theory. Forty-four original articles were included (19 relating to PNCs), from which seven refined theories were developed. The theories identified important training elements (evidence provision, building skills and confidence, facilitating reflection and generating empathy). The significant influence of workplace factors as possible barriers or facilitators was highlighted. Embracing SMS often required challenging traditional professional role boundaries. The integration of SMS into routine care is not an automatic outcome from training. A transformative learning process is often required to trigger the necessary mindset shift. Training should focus on how individual HCPs define and value SMS and how their work context (patient group and organisational

  13. Brief Report: Reduction of Inappropriate Vocalizations for a Child with Autism Using a Self-Management Treatment Program.

    Science.gov (United States)

    Mancina, Catherine; Tankersley, Melody; Kamps, Debra; Kravits, Tammy; Parrett, Jean

    2000-01-01

    A study examined the effects of a self-management program used to reduce high rates of inappropriate vocalizations (e.g., humming, tongue clucking, perseveration, and echolalic words/phases) in a 12-year-old girl with autism. When self-management was applied to inappropriate vocalizations during leisure, prevocational, and reading tasks, the…

  14. The Impact of Self-management Knowledge and Support on the Relationships Among Self-efficacy, Patient Activation, and Self-management in Rural Patients With Heart Failure.

    Science.gov (United States)

    Young, Lufei; Kupzyk, Kevin; Barnason, Susan

    Self-management (SM) is an essential component of heart failure (HF) management. The mechanisms to improve SM behaviors are unclear. The objective of this study is to examine whether patient activation mediates the effect of self-efficacy on SM behaviors in rural HF patients. A secondary analysis was conducted using data collected from a randomized controlled trial aimed to improve SM behaviors. The main variables included were SM knowledge, self-efficacy, patient activation, and SM behaviors. Mediation analysis showed patient activation mediated the effect of self-efficacy on SM. Both self-efficacy and patient activation were significantly related to SM behaviors, respectively (r = 0.46, P self-efficacy was no longer directly related to SM behaviors when patient activation was entered into the final model (β = .17, P = .248). Self-management knowledge and support were significant moderators. In patients with high levels of SM knowledge, patient activation did not mediate the effect of self-efficacy on SM behaviors (β = .15, P = .47). When SM support was entered in the path model, patient activation was not a significant mediator between self-efficacy and SM behavior at high (β = .27, P = .27) or low (β = .27, P = .25) levels of SM support. Study findings suggest that targeted SM support for high-risk HF patients with low SM knowledge and support may be useful. In addition, strategies to increase patient activation may improve HF patients' SM confidence.

  15. Time to question diabetes self-management support for Arabic-speaking migrants: exploring a new model of care.

    Science.gov (United States)

    Alzubaidi, H; Mc Namara, K; Browning, C

    2017-03-01

    The objective of this study was to explore a new model for diabetes self-management support in Arabic-speaking migrants. Two qualitative methods were used: face-to-face semi-structured individual interviews and focus groups. Interviews were audio-taped, transcribed verbatim and coded thematically. Arabic-speaking migrants with Type 2 diabetes were recruited from several primary, secondary and tertiary healthcare settings in metropolitan Melbourne, Australia. These settings were purposefully selected to obtain a diverse group of participants. Data collection continued until saturation was reached. This is the first study that involved members of Arabic-speaking communities in Australia in a formal process of consumer and public involvement to inform research design and recruitment in order to provide evidence for a new model of diabetes self-management for Arabic-speaking migrants. No self-management support was offered to Arabic-speaking migrants beyond the initial diagnosis period. Significant knowledge gaps and skills deficits in all self-management domains were evident. The provision of tailored self-management support was considered crucial. When asked about preferred structure and delivery modalities, a strong preference was reported for face-to-face storytelling interactions over telephone- or internet-based interventions. Gender-specific group education and self-management support sessions delivered by Arabic-speaking diabetes health professionals, lay peers or social workers trained in diabetes self-management were highly regarded. A patient and public involvement approach allows genuine engagement with Arabic-speaking migrants with diabetes. There is urgent need for a new model for self-management support among Arabic-speaking migrants. Findings yielded new recommendations for diabetes health professionals working with these migrant communities to support behaviour change. © 2016 Diabetes UK.

  16. Social support and self-management behaviour among patients with Type 2 diabetes

    DEFF Research Database (Denmark)

    Schiøtz, M. L.; Bøgelund, M.; Almdal, T.

    2012-01-01

    Aims To investigate the relationship between structural and functional social support and patient activation, diabetes-related emotional distress, perceived diabetes care, self-management behaviour and HbA 1c levels among patients with Type2 diabetes. Methods Self-administered questionnaires were...... emotional distress, negative assessment of care, less health-promoting eating habits and less frequent foot examinations. Conclusions Good social support is significantly associated with health-promoting behaviours and well-being among patients with Type2 diabetes. However, HbA 1c levels are higher...... for cohabitant persons, indicating barriers for social support. Intervention research is needed to investigate the causal relationship between social networks and health-promoting behaviours. This knowledge should be used in clinical practice when targeting and designing education, support and care for patients...

  17. Cost-Effectiveness Analysis of the Self-Management Program for Thai Patients with Metabolic Syndrome.

    Science.gov (United States)

    Sakulsupsiri, Anut; Sakthong, Phantipa; Winit-Watjana, Win

    2016-05-01

    Lifestyle modification programs are partly evaluated for their usefulness. This study aimed to assess the cost-effectiveness and healthy lifestyle persistence of a self-management program (SMP) for patients with metabolic syndrome (MetS) in Thai health care settings. A cost-effectiveness analysis was performed on the basis of an intervention study of 90 patients with MetS randomly allocated to the SMP and control groups. A Markov model with the Difference-in-Difference method was used to predict the lifetime costs from a societal perspective and quality-adjusted life-years (QALYs), of which 95% confidence intervals (CIs) were estimated by bootstrapping. The cost-effectiveness analysis, along with healthy lifestyle persistence, was performed using the discount rate of 3% per annum. Parameter uncertainties were identified using one-way and probabilistic sensitivity analyses. The lifetime costs tended to decrease in both groups. The SMP could save lifetime costs (-2310 baht; 95% CI -5960 to 1400) and gain QALYs (0.0098; 95% CI -0.0003 to 0.0190), compared with ordinary care. The probability of cost-effectiveness was 99.4% from the Monte-Carlo simulation, and the program was deemed cost-effective at dropout rates below 69% per year as determined by the threshold of 160,000 baht per QALY gained. The cost of macrovascular complications was the most influencing variable for the overall incremental cost-effectiveness ratio. The SMP provided by the health care settings is marginally cost-effective, and the persistence results support the implementation of the program to minimize the complications and economic burden of patients with MetS. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  18. Self-management-support in dementia care: a mixed methods study among nursing staff.

    NARCIS (Netherlands)

    Verkaik, R.; Antwerpen-Hogenraad, P. van; Veer, A. de; Francke, A.; Huis in het Veld, J.

    2017-01-01

    Background: Self-management in patients and family caregivers confronted with dementia is not self-evident. Self-management skills may be limited because of the progressive cognitive decline of the patient and because family caregivers are often also very aged. Self-management

  19. Self-management support and eHealth for patients and informal caregivers confronted with advanced cancer : An online focus group study among nurses

    NARCIS (Netherlands)

    Slev, Vina N.; Pasman, H. Roeline W.; Eeltink, Corien M.; Van Uden-Kraan, Cornelia F.; Verdonck-De Leeuw, Irma M.; Francke, Anneke L.

    2017-01-01

    Background: Self-management by patients and informal caregivers confronted with advanced cancer is not self-evident. Therefore they might need self-management support from nurses. This article reports on nurses' perspectives on self-management support for people confronted with advanced cancer, and

  20. Why do GPs hesitate to refer diabetes patients to a self-management education program: a qualitative study

    Directory of Open Access Journals (Sweden)

    De Maeseneer Jan

    2011-09-01

    Full Text Available Abstract Background Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially reluctant to refer patients to a self-management education program in Belgium. Methods Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework. Results Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer. Conclusions The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before

  1. Why do GPs hesitate to refer diabetes patients to a self-management education program: a qualitative study.

    Science.gov (United States)

    Sunaert, Patricia; Vandekerckhove, Marie; Bastiaens, Hilde; Feyen, Luc; Bussche, Piet Vanden; De Maeseneer, Jan; De Sutter, An; Willems, Sara

    2011-09-08

    Self-management support is seen as a cornerstone of good diabetes care and many countries are currently engaged in initiatives to integrate self-management support in primary care. Concerning the organisation of these programs, evidence is growing that engagement of health care professionals, in particular of GPs, is critical for successful application. This paper reports on a study exploring why a substantial number of GPs was (initially) reluctant to refer patients to a self-management education program in Belgium. Qualitative analysis of semi-structured face-to-face interviews with a purposive sample of 20 GPs who were not regular users of the service. The Greenhalgh diffusion of innovation framework was used as background and organising framework. Several barriers, linked to different components of the Greenhalgh model, emerged from the interview data. One of the most striking ones was the limited readiness for innovation among GPs. Feelings of fear of further fragmentation of diabetes care and frustration and insecurity regarding their own role in diabetes care prevented them from engaging in the innovation process. GPs needed time to be reassured that the program respects their role and has an added value to usual care. Once GPs considered referring patients, it was not clear enough which of their patients would benefit from the program. Some GPs expressed the need for training in motivational skills, so that they could better motivate their patients to participate. A practical but often mentioned barrier was the distance to the centre where the program was delivered. Further, uncertainty about continuity interfered with the uptake of the offer. The study results contribute to a better understanding of the reasons why GPs hesitate to refer patients to a self-management education program. First of all, the role of GPs and other health care providers in diabetes care needs to be clarified before introducing new functions. Feelings of security and a basic trust

  2. Social organization of self-management support of persons with diabetes: a health systems comparison.

    Science.gov (United States)

    Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

    2012-09-01

    Identify important organizational elements for providing self-management support (SMS). Semi-structured qualitative interviews conducted in two healthcare systems. Kaiser Permanente Northern California and the Danish Health Care System. 36 managers and healthcare professionals in the two healthcare systems. Elements important to providing self-management support to persons with diabetes. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.

  3. mHealth intervention to support asthma self-management in adolescents: the ADAPT study.

    Science.gov (United States)

    Kosse, Richelle C; Bouvy, Marcel L; de Vries, Tjalling W; Kaptein, Ad A; Geers, Harm Cj; van Dijk, Liset; Koster, Ellen S

    2017-01-01

    Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. The ADAPT intervention consists of an interactive smartphone application (app) connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1) a questionnaire function to rate asthma symptoms and monitor these over time; 2) short movie clips with medication and disease information; 3) a medication reminder; 4) a chat function with peers; and 5) a chat function with the pharmacist. The pharmacist receives data from the patient's app through the desktop application, which enables the pharmacist to send information and feedback to the patient. The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient's self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. This study will provide in-depth knowledge on the effectiveness of an mHealth intervention to support asthma self-management in adolescents. These insights will also be useful for adolescents with other chronic diseases.

  4. Self-management support by final year nursing students: A correlational study of performance and person-related associated factors.

    Science.gov (United States)

    Duprez, Veerle; Beeckman, Dimitri; Verhaeghe, Sofie; Van Hecke, Ann

    2017-09-01

    Chronic conditions put a heavy burden on healthcare in every country. Supporting persons with a chronic illness to take an active role in the management of their condition is a core component in the Chronic Care Model. It implies confidence and good skills from professionals. To date, there is no evidence on final year nursing students' performance in supporting patients' self-management, nor on factors associated with this performance. To explore self-reported performance of supporting patients' self-management by final year nursing students, and person-related factors associated with this performance. A correlational multi-centre study of final year nursing students (N=256) from eight nursing schools. Students were recruited from a convenience sample of eight nursing schools. All final year students were invited to participate. Data were collected between January 2015 and May 2016 using self-administered validated questionnaires. Theoretical behavioural frameworks were used to select hypothesized associated factors for self-management support: self-efficacy to perform self-management support and socio-structural factors (Social Cognitive Theory); needs for autonomy, competence and relatedness, and patient-invested contingent self-esteem (Self-Determination Theory); and attitudes towards supporting patients' self-management (Theory of Planned Behaviour). Final year nursing students (N=256) reported an overall low level of performance in delivering self-management support during internship. Students lacked mainly competencies in collaborative goal setting and shared decision making. Students reported a significant gap between their confidence and their actual performance in self-management support (pLearning opportunities can be introduced in classroom activities and on internship. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. The Alert Program for Self-Management of Behaviour in Second Level Schools: Results of Phase 1 of a Pilot Study

    Science.gov (United States)

    Mac Cobb, Siobhan; Fitzgerald, Brian; Lanigan-O'Keeffe, Carolyn

    2014-01-01

    This article reports on Phase 1 of a pilot programme on self-management of behaviour with challenging class groups of students as part of the evidence-informed practice of the National Behaviour Support Service. The Alert Program is a structured active learning programme using an engine analogy. The person's engine runs on high, low or just right…

  6. Intervention mapping protocol for developing a theory-based diabetes self-management education program.

    Science.gov (United States)

    Song, Misoon; Choi, Suyoung; Kim, Se-An; Seo, Kyoungsan; Lee, Soo Jin

    2015-01-01

    Development of behavior theory-based health promotion programs is encouraged with the paradigm shift from contents to behavior outcomes. This article describes the development process of the diabetes self-management program for older Koreans (DSME-OK) using intervention mapping (IM) protocol. The IM protocol includes needs assessment, defining goals and objectives, identifying theory and determinants, developing a matrix to form change objectives, selecting strategies and methods, structuring the program, and planning for evaluation and pilot testing. The DSME-OK adopted seven behavior objectives developed by the American Association of Diabetes Educators as behavioral outcomes. The program applied an information-motivation-behavioral skills model, and interventions were targeted to 3 determinants to change health behaviors. Specific methods were selected to achieve each objective guided by IM protocol. As the final step, program evaluation was planned including a pilot test. The DSME-OK was structured as the 3 determinants of the IMB model were intervened to achieve behavior objectives in each session. The program has 12 weekly 90-min sessions tailored for older adults. Using the IM protocol in developing a theory-based self-management program was beneficial in terms of providing a systematic guide to developing theory-based and behavior outcome-focused health education programs.

  7. Psychological skills training to support diabetes self-management: Qualitative assessment of nurses' experiences.

    Science.gov (United States)

    Graves, Helen; Garrett, Christopher; Amiel, Stephanie A; Ismail, Khalida; Winkley, Kirsty

    2016-10-01

    Evidence for the efficacy of psychological skills training as a method of supporting patients' self-management is growing, but there is a shortage of mental health providers with specialist diabetes knowledge to deliver them. Primary care nurses are now increasingly expected to learn and use these techniques. This study explores nurse experience of training in six psychological skills to support patients' self-management of type 2 diabetes. Semi-structured interviews elicited themes relating to nurses' experiences of participating in a trial of a psychological intervention, the Diabetes-6 study (D-6). Nurses were employed in GP surgeries in 5 South London boroughs. Thematic framework analysis was used to compare and contrast themes across participants. Nine nurses delivering the intervention (n=11), and 7 from the control intervention (n=12, no psychological element) were interviewed. Three key themes were identified: (i) positive and negative impact of D6 on nurses' practice: positives included patient empowerment; negatives included patients' capacity to engage; (ii) professional boundaries including concerns about over-stepping role as a nurse and (iii) concerns about degree of support from physicians at participating practices in integrating psychological and diabetes care. Primary care nurses report that psychological skills training can have a positive impact on patient care. Significant role adjustment is required, which may be aided by additional support from the practice team. Qualitative evaluation of effectiveness of psychological interventions may reveal processes that hinder or contribute to efficacy and translation. Appropriate support is necessary for primary care nurses to deliver psychological therapies with confidence. Copyright © 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  8. The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders.

    Science.gov (United States)

    Hudon, Catherine; Chouinard, Maud-Christine; Diadiou, Fatoumata; Bouliane, Danielle; Lambert, Mireille; Hudon, Émilie

    2016-04-01

    Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program. This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program. A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis. Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program. The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates. © The Author 2016. Published by Oxford University Press.

  9. Long-Term Condition Self-Management Support in Online Communities: A Meta-Synthesis of Qualitative Papers

    Science.gov (United States)

    Vassilev, Ivaylo; Kennedy, Anne; Rogers, Anne

    2016-01-01

    Background Recent years have seen an exponential increase in people with long-term conditions using the Internet for information and support. Prior research has examined support for long-term condition self-management through the provision of illness, everyday, and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilization of an online illness “workforce.” Objective The aim was to understand the negotiation of long-term condition illness work in patient online communities and how such work may assist the self-management of long-term conditions in daily life. Methods A systematic search of qualitative papers was undertaken using various online databases for articles published since 2004. A total of 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities for those with a long-term condition. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis. Results The main themes identified in relation to the negotiation of self-management support were (1) redressing offline experiential information and knowledge deficits, (2) the influence of modeling and learning behaviors from others on self-management, (3) engagement that validates illness and negates offline frustrations, (4) tie formation and community building, (5) narrative expression and cathartic release, and (6) dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for self-management support in patient online communities were identified. These were (1) collective knowledge and identification through lived experience; (2) support, information, and engagement through readily accessible gifting relationships; (3) sociability that extends beyond illness; and (4) online disinhibition as a facilitator

  10. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness.

    Science.gov (United States)

    Stenberg, Una; Haaland-Øverby, Mette; Fredriksen, Kari; Westermann, Karl Fredrik; Kvisvik, Toril

    2016-11-01

    To give a comprehensive overview of benefits and challenges from participating in group based patient education programs that are carried out by health care professionals and lay participants, aimed at promoting self-management for people living with chronic illness. We searched 8 literature databases. Full text articles meeting the inclusion criteria were retrieved and reviewed. Arksey and O'Malley's framework for scoping studies guided the review process and thematic analysis was undertaken to synthesize extracted data. Of the 5935 titles identified, 47 articles were included in this review. The participants experienced the programs as beneficial according to less symptom distress and greater awareness of their own health, improved self-management strategies, peer support, learning and hope. A substantial evidence base supports the conclusion that group based self-management patient education programs in different ways have been experienced as beneficial, but more research is needed. The insights gained from this review can enable researchers, health care professionals, and participants to understand the complexity in evaluating self-management patient education programs, and constitute a basis for a more standardized and systematic evaluation. The results may also encourage health care professionals in planning and carrying out programs in cooperation with lay participants. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Can a Self-Management Education Program for Patients with Chronic Obstructive Pulmonary Disease Improve Quality of Life ?

    Directory of Open Access Journals (Sweden)

    Manon Labrecque

    2011-01-01

    Full Text Available OBJECTIVE: To assess the effects of a self-management program on health-related quality of life (HRQoL and morbidity commonly associated with chronic obstructive pulmonary disease (COPD.

  12. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients

    Directory of Open Access Journals (Sweden)

    Rian Adi Pamungkas

    2017-09-01

    Full Text Available The rate of type-2 diabetes mellitus (T2D is dramatically increasing worldwide. Continuing diabetes mellitus (DM care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were “type 2 diabetes,” “self-management,” “diabetes self-management education (DSME,” “family support,” “social support,” and “uncontrolled glycaemia.” Joanna Briggs Institute (JBI guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.

  13. Text message-based diabetes self-management support (SMS4BG): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Dobson, Rosie; Whittaker, Robyn; Jiang, Yannan; Shepherd, Matthew; Maddison, Ralph; Carter, Karen; Cutfield, Richard; McNamara, Catherine; Khanolkar, Manish; Murphy, Rinki

    2016-04-02

    Addressing the increasing prevalence, and associated disease burden, of diabetes is a priority of health services internationally. Interventions to support patients to effectively self-manage their condition have the potential to reduce the risk of costly and debilitating complications. The utilisation of mobile phones to deliver self-management support allows for patient-centred care at the frequency and intensity that patients desire from outside the clinic environment. Self-Management Support for Blood Glucose (SMS4BG) is a novel text message-based intervention for supporting people with diabetes to improve self-management behaviours and achieve better glycaemic control and is tailored to individual patient preferences, demographics, clinical characteristics, and culture. This study aims to assess whether SMS4BG can improve glycaemic control in adults with poorly controlled diabetes. This paper outlines the rationale and methods of the trial. A two-arm, parallel, randomised controlled trial will be conducted across New Zealand health districts. One thousand participants will be randomised at a 1:1 ratio to receive SMS4BG, a theoretically based and individually tailored automated text message-based diabetes self-management support programme (intervention) in addition to usual care, or usual care alone (control). The primary outcome is change in glycaemic control (HbA1c) at 9 months. Secondary outcomes include glycaemic control at 3 and 6 months, self-efficacy, self-care behaviours, diabetes distress, health-related quality of life, perceived social support, and illness perceptions. Cost information and healthcare utilisation will also be collected as well as intervention satisfaction and interaction. This study will provide information on the effectiveness of a text message-based self-management support tool for people with diabetes. If found to be effective it has the potential to provide individualised support to people with diabetes across New Zealand (and

  14. A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients.

    Science.gov (United States)

    Pamungkas, Rian Adi; Chamroonsawasdi, Kanittha; Vatanasomboon, Paranee

    2017-09-15

    The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were "type 2 diabetes," "self-management," "diabetes self-management education (DSME)," "family support," "social support," and "uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.

  15. A randomized clinical trial of diabetes self-management for Mexican Americans: Are there serendipitous health benefits for supporters of study participants?

    Directory of Open Access Journals (Sweden)

    Sharon A Brown

    2017-01-01

    Full Text Available Objectives: Studies of social support in diabetes have focused on the effects of support on the person with type 2 diabetes. We explored diabetes prevention effects of a culturally tailored diabetes self-management intervention in individuals without diabetes who were supporters of intervention participants. Methods: This is a secondary analysis of data from a randomized clinical trial that involved 256 Mexican Americans with diabetes. Each study participant designated a supporter—spouse, relative, friend—who attended intervention sessions and assisted participants in attaining effective diabetes self-management. Supporter’s glycosylated hemoglobin (A1C data were tracked for 1 year to determine diabetes conversion rates in supporters without diabetes at baseline. Results: Fewer individuals in the intervention group (n = 9 converted to an A1C above the 7% threshold, compared to the 1-year wait-listed control group (n = 16. We found a statistically significant difference (p = .021 at 12 months in the number of individuals whose A1C was ⩽8%, with fewer supporters above threshold in the intervention group (reduction of 48%. Supporters in the intervention group with prediabetes, based on baseline A1C, experienced a slight reduction in A1C, while control group supporters with prediabetes experienced an increase. Discussion: The results suggest that there are potential benefits for family members and other supporters of persons with diabetes who participated in diabetes self-management programs.

  16. BUS TRIPS—A Self-Management Program for People with Cognitive Impairments after Stroke

    Directory of Open Access Journals (Sweden)

    Emma Carlstedt

    2017-11-01

    Full Text Available Stroke is a major cause of disability worldwide and different types of impairments can affect the individual’s ability to manage everyday activities such as travel that is essential for participation in society. The purpose of this study was to investigate the feasibility of a new self-management intervention (BUS TRIPS focusing on travelling by bus, and potential contributions to an improved ability to travel by bus for people with cognitive impairments after stroke. This is a pilot study of five individuals, utilizing a multiple case study design with a mixed methods approach. Assessments (Stroke Impact Scale, General Self-Efficacy Scale and Life Satisfaction Scale-11, Item 1 were performed before, two weeks after, and three months after the program. The data collection also comprised reflection notes from the group leaders (an occupational therapist and a physiotherapist, a semi-structured group interview and an individual phone survey. The feasibility of the intervention was presented in four sub-categories: (1 appreciated group format despite too short sessions; (2 the importance of skilled leaders and motivated participants; (3 session material adequate but needs minor revision to fit the target group; and (4 homework is valuable but reflective group discussions must be supported. The narratives of each case showed that all participants made some progress related to travelling by bus, but the overall positive results could not be verified by all of the quantitative assessments. We conclude that the BUS TRIPS intervention is feasible and can potentially contribute to an improved ability to travel by bus for the target group. Future studies is called for, and should focus on recruitment challenges, to clarify assessments that would be suitable to use in larger scale clinical trials and during subsequent implementation in clinical practice.

  17. Randomized controlled trial of a psychoeducation program for the self-management of chronic cardiac pain.

    Science.gov (United States)

    McGillion, Michael H; Watt-Watson, Judy; Stevens, Bonnie; Lefort, Sandra M; Coyte, Peter; Graham, Anthony

    2008-08-01

    Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [F=11.75(1,114), Phealth [F=10.94(1,114), P=0.001] aspects of generic HRQL. Angina frequency [F=5.57(1,115), P=0.02], angina stability [F=7.37(1,115), P=0.001], and self-efficacy to manage disease [F=8.45(1,115), P=0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.

  18. Persian Diabetes Self-Management Education (PDSME) program: evaluation of effectiveness in Iran.

    Science.gov (United States)

    Shakibazadeh, Elham; Bartholomew, Leona Kay; Rashidian, Arash; Larijani, Bagher

    2016-09-01

    Despite increasing rate of diabetes, no standard self-management education protocol has been developed in Iran. We designed Persian Diabetes Self-Management Education (PDSME) program using intervention mapping. Effectiveness of program was assessed in newly diagnosed people with type 2 diabetes and those who had received little self-management education. Individuals aged 18 and older (n = 350) were recruited in this prospective controlled trial during 2009-2011 in Tehran, Iran. Patients were excluded if they were pregnant, were housebound or had reduced cognitive ability. Participants were randomly allocated in intervention and control groups. PDSME patients attended eight workshops over 4-week period following two follow-up sessions. Validated questionnaires assessed cognitive outcomes at baseline, 2 and 8 weeks. HbA1c was assessed before and 18-21 months after intervention in both groups. The CONSORT statement was adhered to where possible. A total of 280 individuals (80%) attended the program. By 18-21 months, the PDSME group showed significant improvements in mean HbA1c (-1.1 versus +0.2%, p =0.008, repeated measure ANOVA (RMA)). Diabetes knowledge improved more in PDSME patients treated with oral antidiabetic agents than in those receiving usual care over time (RMA, F = 67.08, p intervention mapping for planning effective interventions. Given the large number of people with diabetes and lack of affordable diabetes education, PDSME deserves consideration for implementation. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. A chronic care ostomy self-management program for cancer survivors.

    Science.gov (United States)

    Krouse, Robert S; Grant, Marcia; McCorkle, Ruth; Wendel, Christopher S; Cobb, Martha D; Tallman, Nancy J; Ercolano, Elizabeth; Sun, Virginia; Hibbard, Judith H; Hornbrook, Mark C

    2016-05-01

    Individuals with ostomies experience extensive changes in health-related quality of life (HRQOL) and daily routine. Patients and families are typically forced to use trial and error to improve self-management. This is a longitudinal one-group design pilot study of a five-session ostomy self-care curriculum based on the Chronic Care Model to improve HRQOL and self-management for cancer survivors with ostomies. Participants were surveyed to evaluate each session. Multiple instruments were administered to examine outcomes at baseline, post-intervention, and at 6-month follow-up (Patient Activation Measure, self-efficacy, Hospital Anxiety and Depression Scale, Ways of Coping, Group Health Association of America Satisfaction with ostomy care survey, and the City of Hope Quality of Life Ostomy). Changes from pre-intervention to post-intervention and pre-intervention to follow-up were evaluated with paired t-tests. Text responses were coded and evaluated for important themes and recommendations. Thirty-eight subjects participated in the study. Most had a history of rectal cancer (60.5%) or bladder cancer (28.9%). Participants rated the overall program high (4.4-4.8 on 5-point scale). Text feedback indicated that participants enjoyed the group forums, wanted more participants, and more hands-on training. Scores on multiple surveys were shown to be improved and sustained, including patient activation (p = 0.0004), self-efficacy (p = 0.006), total HRQOL (p = 0.01), physical well-being (p = 0.005), and social well-being (p = 0.002). Survivor anxiety was significantly reduced by follow-up (p = 0.047). This self-management ostomy program can help cancer survivors with ostomies adapt to their stoma. Initiating this program in the community setting would be beneficial to many cancer survivors. Copyright © 2016 John Wiley & Sons, Ltd.

  20. The effectiveness of interventions to enhance self-management support competencies in the nursing profession: a systematic review.

    Science.gov (United States)

    Duprez, Veerle; Vandecasteele, Tina; Verhaeghe, Sofie; Beeckman, Dimitri; Van Hecke, Ann

    2017-08-01

    The aim of this study was to explore the effectiveness and effective components of training interventions to enhance nurses' competencies in self-management support in chronic care. The growing burden of chronic diseases puts an increasing focus on nurses' self-management support of people living with a chronic illness. The most effective method to train nurses' competencies in self-management support remains unclear. Systematic literature review. PubMed, CINAHL, Cochrane CENTRAL, EMBASE, Web of Science, ERIC and PsycARTICLES databases were searched up to August 2015. Eligible studies reported on training interventions to enhance chronic care self-management support competencies in nurses. Outcomes were defined as trainees' reactions to the training (level 1), changes in trainees' competencies (level 2) or changes in trainees' performance in practice (level 3) concerning self-management support. Risk of bias was assessed. Level 1 outcomes were synthesized narratively. Standardized mean differences were calculated per study for level 2 and 3 outcomes. In total, 25 studies were included. Twelve of these studies included level 1 outcomes, eight studies included level 2 outcomes and 10 studies included level 3 outcomes. Effect sizes in favour of training ranged from -0·36 - 1·56 (level 2) and from 0·06 - 5·56 (level 3). Theory-driven training interventions with time to practice, (video) feedback and follow-up generated the most training effects. Caution is needed due to the inconsistent study quality. To date, there is a knowledge gap concerning the most effective method to train nurses' competencies in self-management support. More well-designed, longitudinal studies are needed. © 2016 John Wiley & Sons Ltd.

  1. Self-management support: A qualitative study of ethical dilemmas experienced by nurses

    NARCIS (Netherlands)

    H. van de Bovenkamp; Dr. J. Dwarswaard

    2015-01-01

    Objective: Policymakers increasingly focus their attention on stimulating patients’ self-management. Critical reflection on this trend is often limited. A focus on self-management does not only change nurses’ activities, but also the values underlying the nurse–patient relationship. The latter can

  2. Stanford Chronic Disease Self-Management Program in myotonic dystrophy: New opportunities for occupational therapists: Stanford Chronic Disease Self-Management Program dans la dystrophie myotonique : De nouvelles opportunités pour les ergothérapeutes.

    Science.gov (United States)

    Raymond, Kateri; Levasseur, Mélanie; Chouinard, Maud-Christine; Mathieu, Jean; Gagnon, Cynthia

    2016-06-01

    Chronic disease self-management is a priority in health care. Personal and environmental barriers for populations with neuromuscular disorders might diminish the efficacy of self-management programs, although they have been shown to be an effective intervention in many populations. Owing to their occupational expertise, occupational therapists might optimize self-management program interventions. This study aimed to adapt the Stanford Chronic Disease Self-Management Program (CDSMP) for people with myotonic dystrophy type 1 (DM1) and assess its acceptability and feasibility in this population. Using an adapted version of the Stanford CDSMP, a descriptive pilot study was conducted with 10 participants (five adults with DM1 and their caregivers). A semi-structured interview and questionnaires were used. The Stanford CDSMP is acceptable and feasible for individuals with DM1. However, improvements are required, such as the involvement of occupational therapists to help foster concrete utilization of self-management strategies into day-to-day tasks using their expertise in enabling occupation. Although adaptations are needed, the Stanford CDSMP remains a relevant intervention with populations requiring the application of self-management strategies. © CAOT 2016.

  3. Considerations for the Development of Mobile Phone Apps to Support Diabetes Self-Management: Systematic Review.

    Science.gov (United States)

    Adu, Mary D; Malabu, Usman H; Callander, Emily J; Malau-Aduli, Aduli Eo; Malau-Aduli, Bunmi S

    2018-06-21

    There is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients. This systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management. A comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review. A total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6%), education (6/11, 54.5%) and reminder (6/11, 54.5%). There were 5/11(45.5%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1%) study considered health behavioral theory and user involvement

  4. Self-management support at the end of life: Patients', carers' and professionals' perspectives on managing medicines.

    Science.gov (United States)

    Campling, N; Richardson, A; Mulvey, M; Bennett, M; Johnston, B; Latter, S

    2017-11-01

    Pain is a frequently reported symptom by patients approaching the end of life and well-established that patients and carers hold fears relating to opioids, and experience side effects related to their use. The management of medicines is intrinsic to achieving effective pain relief. The concept of self-management support whilst well characterised in the context of chronic illness has not been elaborated with respect to end of life care. To identify patient, carer and professional views on the concept of self-management support at end of life, specifically in relation to analgesia and related medicines (for side-effect management) in order to describe, characterise and explain self-management support in this context. Qualitative design, data collection methods involved focus groups and interviews. Topics included the meaning of self-management support in this context, roles and behaviours adopted to manage pain-related medicines, and factors that influence these. A largely deductive approach was used, involving verification and validation of key frameworks from the literature, but with capacity for new findings to emerge. Participants were drawn from two different localities in England, one North, the other South. Interviews with patients and carers took place in their own homes and focus groups with healthcare professionals were held at local hospices. 38 individuals participated. 15 patients, in the last year of life, and 4 carers under the care of community-based specialist palliative care services and 19 specialist palliative care health professionals (predominantly community palliative care nurses). The concept of self-management support had salience for patients, carers and specialist nurses alongside some unique features, specific to the end of life context. Specifically self-management was identified as an ever-changing process enacted along a continuum of behaviours fluctuating from full to no engagement. Disease progression, frequent changes in symptoms and

  5. The PLE(2)NO self-management and exercise program for knee osteoarthritis: Study Protocol for a Randomized Controlled Trial.

    Science.gov (United States)

    Marconcin, Priscila; Espanha, Margarida; Yázigi, Flávia; Campos, Pedro

    2016-06-07

    International recommendations suggest exercise and self-management programs, including non-pharmacological treatments, for knee osteoarthritis (KOA) because they can benefit pain relief and improve function and exercise adherence. The implementation of a combined self-management and exercise program termed PLE(2)NO may be a good method for controlling KOA symptoms because it encourages the development of self-efficacy to manage the pathology. This study will assess the effects of a self-management and exercise program in comparison to an educational intervention (control program) on symptoms, physical fitness, health-related quality of life, self-management behaviors, self-efficacy, physical activity level and coping strategies. This PLE(2)NO study is a single-blinded, randomized controlled trial of elderly (aged above 60 yrs old) patients with clinical and radiographic KOA. The patients will be allocated into either an educational group (control) or a self-management and exercise group (experimental). All participants will receive a supplement of chondroitin and glucosamine sulfates. This paper describes the protocol that will be used in the PLE(2)NO program. This program has several strengths. First, it involves a combination of self-management and exercise approaches, is available in close proximity to the patients and occurs over a short period of time. The latter two characteristics are crucial for maintaining participant adherence. Exercise components will be implemented using low-cost resources that permit their widespread application. Moreover, the program will provide guidance regarding the effectiveness of using a self-management and exercise program to control KOA symptoms and improve self-efficacy and health-related quality of life. NCT02562833 (09/23/2015).

  6. A case series of an off-the-shelf online health resource with integrated nurse coaching to support self-management in COPD

    Directory of Open Access Journals (Sweden)

    Early F

    2017-10-01

    Full Text Available Frances Early,1 Jane S Young,2 Elizabeth Robinshaw,3 Emma Z Mi,4 Ella Z Mi,4 Jonathan P Fuld1 1Centre for Self Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2Faculty of Health, Social Care and Education, School of Nursing and Midwifery, Anglia Ruskin University, Cambridge, UK; 3Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK; 4School of Clinical Medicine, University of Cambridge, Cambridge, UK Background: COPD has significant psychosocial impact. Self-management support improves quality of life, but programs are not universally available. IT-based self-management interventions can provide home-based support, but have mixed results. We conducted a case series of an off-the-shelf Internet-based health-promotion program, The Preventive Plan (TPP, coupled with nurse-coach support, which aimed to increase patient activation and provide self-management benefits. Materials and methods: A total of 19 COPD patients were recruited, and 14 completed 3-month follow-up in two groups: groups 1 and 2 with more and less advanced COPD, respectively. Change in patient activation was determined with paired t-tests and Wilcoxon signed-rank tests. Benefits and user experience were explored in semistructured interviews, analyzed thematically. Results: Only group 1 improved significantly in activation, from a lower baseline than group 2; group 1 also improved significantly in mastery and anxiety. Both groups felt significantly more informed about COPD and reported physical functioning improvements. Group 1 reported improvements in mood and confidence. Overall, group 2 reported fewer benefits than group 1. Both groups valued nurse-coach support; for group 1, it was more important than TPP in building confidence to self-manage. The design of TPP and lack of motivation to use IT were barriers to use, but disease severity and poor IT skills were not. Discussion: Our findings demonstrate the feasibility of combining

  7. A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI).

    Science.gov (United States)

    Jones, Taryn M; Dean, Catherine M; Hush, Julia M; Dear, Blake F; Titov, Nickolai

    2015-04-19

    Individuals living with acquired brain injury, typically caused by stroke or trauma, are far less likely to achieve recommended levels of physical activity for optimal health and well-being. With a growing number of people living with chronic disease and disability globally, self-management programs are seen as integral to the management of these conditions and the prevention of secondary health conditions. However, to date, there has been no systematic review of the literature examining the efficacy of self-management programs specifically on physical activity in individuals with acquired brain injury, whether delivered face-to-face or remotely. Therefore, the purpose of this review is to evaluate the efficacy of self-management programs in increasing physical activity levels in adults living in the community following acquired brain injury. The efficacy of remote versus face-to-face delivery was also examined. A systematic review of the literature was conducted. Electronic databases were searched. Two independent reviewers screened all studies for eligibility, assessed risk of bias, and extracted relevant data. Five studies met the inclusion criteria for this review. Studies were widely heterogeneous with respect to program content and delivery characteristics and outcomes, although all programs utilized behavioral change principles. Four of the five studies examined interventions in which physical activity was a component of a multifaceted intervention, where the depth to which physical activity specific content was covered, and the extent to which skills were taught and practiced, could not be clearly established. Three studies showed favorable physical activity outcomes following self-management interventions for stroke; however, risk of bias was high, and overall efficacy remains unclear. Although not used in isolation from face-to-face delivery, remote delivery via telephone was the predominant form of delivery in two studies with support for its inclusion

  8. Costs of an ostomy self-management training program for cancer survivors.

    Science.gov (United States)

    Hornbrook, Mark C; Cobb, Martha D; Tallman, Nancy J; Colwell, Janice; McCorkle, Ruth; Ercolano, Elizabeth; Grant, Marcia; Sun, Virginia; Wendel, Christopher S; Hibbard, Judith H; Krouse, Robert S

    2018-03-01

    To measure incremental expenses to an oncologic surgical practice for delivering a community-based, ostomy nurse-led, small-group, behavior skills-training intervention to help bladder and colorectal cancer survivors understand and adjust to their ostomies and improve their health-related quality of life, as well as assist family caregivers to understand survivors' needs and provide appropriate supportive care. The intervention was a 5-session group behavior skills training in ostomy self-management following the principles of the Chronic Care Model. Faculty included Wound, Ostomy, and Continence Nurses (WOCNs) using an ostomy care curriculum. A gender-matched peer-in-time buddy was assigned to each ostomy survivor. The 4-session survivor curriculum included the following: self-management practice and solving immediate ostomy concerns; social well-being; healthy lifestyle; and a booster session. The single family caregiver session was coled by a WOCN and an ostomy peer staff member and covered relevant caregiver and ostomate support issues. Each cohort required 8 weeks to complete the intervention. Nonlabor inputs included ostomy supplies, teaching materials, automobile mileage for WOCNs, mailing, and meeting space rental. Intervention personnel were employed by the University of Arizona. Labor expenses included salaries and fringe benefits. The total incremental expense per intervention cohort of 4 survivors was $7246 or $1812 per patient. A WOCN-led group self-help ostomy survivorship intervention provided affordable, effective, care to cancer survivors with ostomies. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Health Professionals' Expanding eHealth Competences for Supporting Patients' Self-Management.

    Science.gov (United States)

    Kujala, Sari; Rajalahti, Elina; Heponiemi, Tarja; Hilama, Pirjo

    2018-01-01

    An increasing number of new eHealth services that support patients' self-management has changed health professionals' work and has created a need for a new eHealth competence. In this study, we evaluated the health professionals' eHealth competences and training needs in a public health organization in Finland. The target organization's goal was to increase the number of eHealth services provided to patients, and health professionals and their competences were seen as critical for the adoption of services. Data was collected through an online survey of 701 health professionals working in the target organization. Professionals perceived their basic computer skills as good and they were mostly willing to use eHealth services in patient work. However, health professionals need guidance, especially in their patient work in the new eHealth-enabled environment. They were less confident about their competence to motivate and advise patients to use eHealth services and how to communicate with patients using eHealth solutions. The results also imply that eHealth competence is not merely about an individual's skills but that organizations need to develop new working processes, work practices and distribution of work. We suggest that the training and support needs identified be considered in curricula and lifelong learning.

  10. A Hardware-Supported Algorithm for Self-Managed and Choreographed Task Execution in Sensor Networks

    Directory of Open Access Journals (Sweden)

    Borja Bordel

    2018-03-01

    Full Text Available Nowadays, sensor networks are composed of a great number of tiny resource-constraint nodes, whose management is increasingly more complex. In fact, although collaborative or choreographic task execution schemes are which fit in the most perfect way with the nature of sensor networks, they are rarely implemented because of the high resource consumption of these algorithms (especially if networks include many resource-constrained devices. On the contrary, hierarchical networks are usually designed, in whose cusp it is included a heavy orchestrator with a remarkable processing power, being able to implement any necessary management solution. However, although this orchestration approach solves most practical management problems of sensor networks, a great amount of the operation time is wasted while nodes request the orchestrator to address a conflict and they obtain the required instructions to operate. Therefore, in this paper it is proposed a new mechanism for self-managed and choreographed task execution in sensor networks. The proposed solution considers only a lightweight gateway instead of traditional heavy orchestrators and a hardware-supported algorithm, which consume a negligible amount of resources in sensor nodes. The gateway avoids the congestion of the entire sensor network and the hardware-supported algorithm enables a choreographed task execution scheme, so no particular node is overloaded. The performance of the proposed solution is evaluated through numerical and electronic ModelSim-based simulations.

  11. mHealth intervention to support asthma self-management in adolescents: the ADAPT study

    Directory of Open Access Journals (Sweden)

    Kosse RC

    2017-03-01

    Full Text Available Richelle C Kosse,1 Marcel L Bouvy,1 Tjalling W de Vries,2 Ad A Kaptein,3 Harm CJ Geers,1 Liset van Dijk,4 Ellen S Koster1 1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, 2Department of Paediatrics, Medical Center Leeuwarden, Leeuwarden, 3Medical Psychology, Leiden University Medical Center, Leiden, 4NIVEL, the Netherlands Institute for Health Services Research, Utrecht, the Netherlands Purpose: Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity. The aim of the ADolescent Adherence Patient Tool (ADAPT study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control. Intervention: The ADAPT intervention consists of an interactive smartphone application (app connected to a desktop application for health care providers, in this study, the community pharmacist. The app contains several functions to improve adherence as follows: 1 a questionnaire function to rate asthma symptoms and monitor these over time; 2 short movie clips with medication and disease information; 3 a medication reminder; 4 a chat function with peers; and 5 a chat function with the pharmacist. The pharmacist receives data from the patient’s app through the desktop application, which enables the pharmacist to send information and feedback to the patient. Study design: The ADAPT intervention is tested in a community pharmacy-based cluster randomized controlled trial in the Netherlands, aiming to include 352 adolescents with asthma. The main outcome is adherence, measured by patient’s self-report and refill adherence calculated from pharmacy dispensing records. In addition, asthma control, illness perceptions, medication beliefs, and asthma-related quality of life are measured. Conclusion: This study will provide in

  12. The influence of social networks on self-management support: a metasynthesis.

    Science.gov (United States)

    Vassilev, Ivaylo; Rogers, Anne; Kennedy, Anne; Koetsenruijter, Jan

    2014-07-15

    There is increasing recognition that chronic illness management (CIM) is not just an individual but a collective process where social networks can potentially make a considerable contribution to improving health outcomes for people with chronic illness. However, the mechanisms (processes, activities) taking place within social networks are insufficiently understood. The aim of this review was to focus on identifying the mechanisms linking social networks with CIM. Here we consider network mechanisms as located within a broader social context that shapes practices, behaviours, and the multiplicity of functions and roles that network members fulfil. A systematic search of qualitative studies was undertaken on Medline, Embase, and Web for papers published between 1st January 2002 and 1st December 2013. Eligible for inclusion were studies dealing with diabetes, and with conditions or health behaviours relevant for diabetes management; and studies exploring the relationship between social networks, self-management, and deprivation. 25 papers met the inclusion criteria. A qualitative metasynthesis was undertaken and the review followed a line of argument synthesis. The main themes identified were: 1) sharing knowledge and experiences in a personal community; 2) accessing and mediation of resources; 3) self-management support requires awareness of and ability to deal with network relationships. These translated into line of argument synthesis in which three network mechanisms were identified. These were network navigation (identifying and connecting with relevant existing resources in a network), negotiation within networks (re-shaping relationships, roles, expectations, means of engagement and communication between network members), and collective efficacy (developing a shared perception and capacity to successfully perform behaviour through shared effort, beliefs, influence, perseverance, and objectives). These network mechanisms bring to the fore the close

  13. Predicting quality of life and self-management from dyadic support and overprotection after myocardial infarction.

    Science.gov (United States)

    Joekes, Katherine; Maes, Stan; Warrens, Matthijs

    2007-11-01

    Using a self-regulatory framework, this study aims to identify how couples perceive a partner's support style after myocardial infarction (MI), and whether this predicts the patient's health-related quality of life (HR-QoL) and self-management (S-M) 9 months later. This longitudinal dyadic study includes 73 couples (86% of patients were men), recruited from two cardiac rehabilitation programmes in the Netherlands. Mean age of patients was 54.8 (SD=9.6) and of partners 52.5 (SD=9.8). Participants were interviewed and completed questionnaires at baseline (T1). Repeat questionnaires were returned by 69 and 67 couples after 3 (T2) and 9 months (T3), respectively. Support by partners is conceptualized in this study as 'active engagement' (AE), which involves the extent to which a partner engages the patient in conversations which focus on emotional support and problem solving. Levels of AE do not change over time, nor do they differ between members of the dyad. Levels of overprotection (OP) diminish with time, whilst patients consistently perceive more OP than partners report providing. Patients' experience of goal hindrance (at T3) due to the MI is associated with a decreased HR-QoL at T3 (controlling for baseline measures). The perception of having a supportive (AE) partner at T1 contributes to enhanced patient HR-QoL at each subsequent time point, although not to physical functioning. Perceiving a partner as overprotective (at T1) predicts worsened physical functioning in patients (at T3). Improvements in S-M at T3 (controlling for baseline measures) are reported by patients whose partner displays active engagement at T1. Cardiac rehabilitation should aim to redress the experience of goal disturbance and advise partners on how to provide support.

  14. Sodium Restriction in Patients With CKD : A Randomized Controlled Trial of Self-management Support

    NARCIS (Netherlands)

    Meuleman, Yvette; Hoekstra, Tiny; Dekker, Friedo W.; Navis, Gerjan; Vogt, Liffert; van der Boog, Paul J. M.; Bos, Willem Jan W.; van Montfrans, Gert A.; van Dijk, Sandra

    Background: To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Study Design: Open randomized controlled trial. Setting & Participants: Patients with moderately decreased kidney function from 4 hospitals in the Netherlands.

  15. Outcomes at 18 Months From a Community Health Worker and Peer Leader Diabetes Self-Management Program for Latino Adults.

    Science.gov (United States)

    Spencer, Michael S; Kieffer, Edith C; Sinco, Brandy; Piatt, Gretchen; Palmisano, Gloria; Hawkins, Jaclynn; Lebron, Alana; Espitia, Nicolaus; Tang, Tricia; Funnell, Martha; Heisler, Michele

    2018-04-27

    This study evaluated the effectiveness of a community health worker (CHW) diabetes self-management education (DSME) program, followed by two different approaches to maintain improvements in HbA 1c and other clinical and patient-centered outcomes over 18 months. The study randomized 222 Latino adults with type 2 diabetes and poor glycemic control from a federally qualified health center to 1 ) a CHW-led, 6-month DSME program or 2 ) enhanced usual care (EUC). After the 6-month program, participants randomized to the CHW-led DSME were further randomized to 1 ) 12 months of CHW-delivered monthly telephone outreach (CHW-only) or 2 ) 12 months of weekly group sessions delivered by peer leaders (PLs) with telephone outreach to those unable to attend (CHW+PL). The primary outcome was HbA 1c . Secondary outcomes were blood pressure, lipid levels, diabetes distress, depressive symptoms, understanding of diabetes self-management, and diabetes social support. Assessments were conducted at baseline and at 6, 12, and 18 months. Participants in the CHW intervention at the 6-month follow-up had greater decreases in HbA 1c (-0.45; 95% CI -0.87, -0.03; P diabetes distress (-0.3; 95% CI -0.6, -0.03; P diabetes distress at 12 and 18 months. CHW+PL participants also had significantly fewer depressive symptoms at 18 months compared with EUC (-2.2; 95% CI -4.1, -0.3; P diabetes social support and in understanding of diabetes self-management at 6 months relative to EUC, but these intervention effects were not sustained at 18 months. This study demonstrates the effectiveness of a 6-month CHW intervention on key diabetes outcomes and of a volunteer PL program in sustaining key achieved gains. These are scalable models for health care centers in low-resource settings for achieving and maintaining improvements in key diabetes outcomes. © 2018 by the American Diabetes Association.

  16. Using a Collaborative Process to Develop Goals and Self-Management Interventions to Support Young Adults with Disabilities at Work

    Science.gov (United States)

    Nittrouer, Christine L.; Shogren, Karrie A.; Pickens, Julie L.

    2016-01-01

    Purpose: This study examined the impact of using a collaborative process with person-centered teams and a functional assessment of problems in the workplace to design individualized goals and self-management interventions to support young adults with disabilities. These young adults had achieved employment through a customized employment process…

  17. [Coping with chronic illness and multiple medicines in older age: self-management support as an obligation in nursing].

    Science.gov (United States)

    Müller-Mundt, G; Schaeffer, D

    2011-02-01

    In later stages of chronic disease and especially in older age, chronically ill people are often dependent on multiple medicines. Coming to terms with complex medication regimes in everyday life is a challenging task. To provide the support actually needed, patient-centered interventions are essential, not only taking into account the patients' needs and preferences, but also promoting their ability to self manage their disease(s) and their medication regime. This paper outlines the results of a research project aimed at developing and evaluating an intervention to integrate self-management support into primary care, based on a qualitative exploration of the patients' and professionals' views. The findings stress that home care nurses should take an active part in self-management support but need to be prepared adequately. Therefore, a two-tier intervention was developed and evaluated in a prospective control study, consisting of a qualified training and guidelines for practice. The intervention serves to expand the nurses' professional competence to provide the needed individually tailored self-management support in home care.

  18. The development and psychometric validation of the self-efficacy and performance in self-management support (SEPSS) Instrument

    NARCIS (Netherlands)

    V. Duprez (Veerle); S.M. van Hooft (Susanne); J. Dwarswaard (Jolanda); A.L. van Staa (AnneLoes); A. Van Hecke (Ann); M.M.H. Strating (Mathilde)

    2016-01-01

    markdownabstract__Aim:__ To develop and psychometrically test the self-efficacy and performance in self-management support (SEPSS) instrument. __Background:__ Facilitating persons with a chronic condition to take an active role in the management of their condition, implicates that nurses acquire

  19. Contribution of partner support in self-management of rheumatoid arthritis patients : An application of the theory of planned behavior

    NARCIS (Netherlands)

    Strating, Mathilde M.H.; van Schuur, Wijbrandt H.; Suurmeijer, Theo P.B.M.

    The aim of this exploratory study was to test the applicability of a model derived from the Theory of Planned Behavior on self-management. In this model social support from the partner, attitude and self-efficacy are determinants of intention, and intention and self-efficacy are determinants of

  20. The development and psychometric validation of the self-efficacy and performance in self-management support (SEPSS) Instrument

    NARCIS (Netherlands)

    Dr. J. Dwarswaard; A. van Hecke; Dr. S.M. van Hooft; M.M.H. Strating; Dr. A.L. van Staa; V. Duprez

    2015-01-01

    Facilitating persons with a chronic condition to take an active role in the management of their condition, implicates that nurses acquire new competencies. An instrument that can validly and reliably measure nurses’ performance and their perceived capacity to perform self-management support

  1. Preparing to implement a self-management program for back pain in new york city senior centers: what do prospective consumers think?

    Science.gov (United States)

    Townley, Sarah; Papaleontiou, Maria; Amanfo, Leslie; Henderson, Charles R; Pillemer, Karl; Beissner, Katherine; Reid, M C

    2010-03-01

    Prior to testing the feasibility/potential efficacy of a newly developed self-management pain program for seniors with back pain, this study sought to: 1) determine prospective consumers' prior exposure to self-management pain programs, 2) determine their willingness to participate in the new program, and 3) ascertain perceived barriers/facilitators to program participation. Cross-sectional survey. Six senior centers located in New York City. We enrolled a race/ethnicity stratified (African American, Hispanic, or non-Hispanic White) sample of 90 subjects who were ages 60 years or older and had chronic back pain. While 60% of non-Hispanic Whites reported prior participation in a self-management pain program, fewer Hispanic (23%) and African Americans (20%) participants reported prior participation. Most participants (80%) were strongly willing to participate in the new program. Multivariate analyses revealed that only pain intensity had a trend toward significance (P = 0.07), with higher pain scores associated with greater willingness to participate. Few barriers to participation were identified, however, respondents felt that tailoring the course to best meet the needs of those with physical disabilities, providing flexibility in class timing, and informing individuals about program benefits prior to enrollment could help maximize program reach. No race/ethnicity differences were identified with respect to willingness to participate or program participation barriers. These data support efforts to disseminate self-management pain programs in older populations, particularly minority communities. The recommendations made by participants can help to guide implementation efforts of the newly developed pain program and may help to enhance both their reach and success.

  2. Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes.

    Science.gov (United States)

    Bernhard, Gerda; Ose, Dominik; Baudendistel, Ines; Seidling, Hanna M; Stützle, Marion; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

    2017-04-01

    Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients' self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients' needs and priorities and guide patient-centered interventions to support patients' self-management activities. Community and social support networks operating in patients' lives need to be engaged in the self-management support.

  3. Supporting self management of type 2 diabetes: is there a role for the community pharmacist?

    Directory of Open Access Journals (Sweden)

    Dhippayom T

    2015-07-01

    Full Text Available Teerapon Dhippayom,1 Ines Krass21Pharmaceutical Care Research Unit, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; 2Faculty of Pharmacy, The University of Sydney, Camperdown, NSW, AustraliaBackground: Evidence supports the efficacy of pharmacy services in type 2 diabetes (T2D. However, little is known about consumer perspectives on the role of community pharmacists in diabetes care. The objectives of this study were to identify potential unmet needs and explore preferences for pharmacist-delivered support for T2D.Methods: A qualitative study using focus groups was conducted in Sydney, Australia. Patients with T2D who were members of the Australian Diabetes Council in Sydney, Australia, were recruited through a survey on medication use in T2D. Five focus groups with a total of 32 consumers with T2D were recorded, transcribed, and thematically analyzed.Results: The key themes were 1 the experiences of diabetes services received, 2 the potential to deliver self-management services, and 3 the suggested role of pharmacist in supporting diabetes management. Gaps in understanding and some degree of nonadherence to self-management signaled a potential for self-management support delivered by pharmacists. However, consumers still perceive that the main role of pharmacists in diabetes care centers on drug management services, with some enhancements to support adherence and continuity of supply. Barriers to diabetes care services included time constraints and a perceived lack of interest by pharmacists.Conclusion: Given the unmet needs in diabetes self-management, opportunities exist for pharmacists to be involved in diabetes care. The challenge is for pharmacists to upgrade their diabetes knowledge and skills, organize their workflow, and become proactive in delivering diabetes care support.Keywords: diabetes care, community pharmacy, community pharmacist, self-management, preference

  4. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial.

    Science.gov (United States)

    Bucknall, C E; Miller, G; Lloyd, S M; Cleland, J; McCluskey, S; Cotton, M; Stevenson, R D; Cotton, P; McConnachie, A

    2012-03-06

    To determine whether supported self management in chronic obstructive pulmonary disease (COPD) can reduce hospital readmissions in the United Kingdom. Randomised controlled trial. Community based intervention in the west of Scotland. Patients admitted to hospital with acute exacerbation of COPD. Participants in the intervention group were trained to detect and treat exacerbations promptly, with ongoing support for 12 months. The primary outcome was hospital readmissions and deaths due to COPD assessed by record linkage of Scottish Morbidity Records; health related quality of life measures were secondary outcomes. 464 patients were randomised, stratified by age, sex, per cent predicted forced expiratory volume in 1 second, recent pulmonary rehabilitation attendance, smoking status, deprivation category of area of residence, and previous COPD admissions. No difference was found in COPD admissions or death (111/232 (48%) v 108/232 (47%); hazard ratio 1.05, 95% confidence interval 0.80 to 1.38). Return of health related quality of life questionnaires was poor (n=265; 57%), so that no useful conclusions could be made from these data. Pre-planned subgroup analysis showed no differential benefit in the primary outcome relating to disease severity or demographic variables. In an exploratory analysis, 42% (75/150) of patients in the intervention group were classified as successful self managers at study exit, from review of appropriateness of use of self management therapy. Predictors of successful self management on stepwise regression were younger age (P=0.012) and living with others (P=0.010). COPD readmissions/deaths were reduced in successful self managers compared with unsuccessful self managers (20/75 (27%) v 51/105 (49%); hazard ratio 0.44, 0.25 to 0.76; P=0.003). Supported self management had no effect on time to first readmission or death with COPD. Exploratory subgroup analysis identified a minority of participants who learnt to self manage; this group had a

  5. Reducing the risks of diabetes complications through diabetes self-management education and support.

    Science.gov (United States)

    Kent, Dan; D'Eramo Melkus, Gail; Stuart, Patricia Mickey W; McKoy, June M; Urbanski, Patti; Boren, Suzanne Austin; Coke, Lola; Winters, Janis E; Horsley, Neil L; Sherr, Dawn; Lipman, Ruth

    2013-04-01

    People with diabetes are at risk of developing complications that contribute to substantial morbidity and mortality. In 2011, the American Association of Diabetes Educators convened an invitational Reducing Risks Symposium, during which an interdisciplinary panel of 11 thought leaders examined current knowledge about the reduction and prevention of diabetes-related risks and translated evidence into diabetes care and self-management education. Symposium participants reviewed findings from the literature and engaged in a moderated roundtable discussion. This report summarizes the discussion and presents recommendations to incorporate into practice to improve outcomes. The objective of the symposium was to develop practical advice for diabetes educators and other members of the diabetes care team regarding the reduction of diabetes-related risks. Optimal diabetes management requires patients to actively participate in their care, which occurs most effectively with a multidisciplinary team. Diabetes education is an integral part of this team approach because it not only helps the patient understand diabetes, its progression, and possible complications, but also provides guidance and encouragement to the patient to engage in proactive risk-reduction decisions for optimal health. A variety of tools are available to help the diabetes educator develop an individualized, patient-centered plan for risk reduction. More research is needed regarding intervention efficacy, best practices to improve adherence, and quantification of benefits from ongoing diabetes support in risk reduction. Diabetes educators are urged to stay abreast of evolving models of care and to build relationships with health care providers both within and beyond the diabetes care team.

  6. The Effectiveness of Self-Management Programs on Self-Efficacy in Patients With Sickle Cell Disease

    Directory of Open Access Journals (Sweden)

    Ahmadi

    2014-07-01

    Full Text Available Background Patients with sickle cell disease suffer from various complications during their lifetime. In order to cope with the disease, they must adapt themselves to a complex set of behaviors that promote self-management and prevent complications associated with the disease. Chronic disease self-management programs are a combination of strategies that increase self-efficacy and promote self-management behaviors. Objectives This study aimed to determine the effectiveness of self-management programs on self-efficacy in patients with sickle cell disease. Patients and Methods In this quasi-experimental study, 69 patients with sickle cell disease who were referred to the Thalassemia Clinic of Ahvaz Shafa Hospital were entered into the study through the census method. Then, the self-management program was implemented using the 5A method for 12 weeks. The Levels of pre and post intervention self-efficacy were assessed using the sickle cell self-efficacy scale (SCSES, while descriptive statistics, paired t-test and Wilcoxon test were used to analyze the data. Results Before the intervention, the majority of subjects (50.7% had moderate self-efficacy, whereas after the intervention, the majority of patients (81.2% showed high self-efficacy. The overall scores and scores of the post-intervention self-efficacy sub-groups were significantly increased (P < 0.001. Conclusions The results of this study showed that self-management interventions are effective in promoting self-efficacy in patients with sickle cell disease. Thus, the use of self-management programs is advisable to change behaviors and promote self-efficacy in such patients.

  7. Understanding preferences for type 2 diabetes mellitus self-management support through a patient-centered approach: a 2-phase mixed-methods study.

    Science.gov (United States)

    Lopez, Janice M S; Katic, Bozena J; Fitz-Randolph, Marcy; Jackson, Richard A; Chow, Wing; Mullins, C Daniel

    2016-07-18

    Patients with type 2 diabetes mellitus (T2DM) who participate in diabetes management programs have been shown to have better glycemic control and slower disease progression, although program participation remains low. In the USA, increasing participation in diabetes management support programs may also directly impact provider reimbursement, as payments are increasingly based on patient-centered measures. However, little is known about factors that may enhance patient participation. This study aimed at further understanding what is important in diabetes management support from the patients' perspective and at assessing the utilization of various types of diabetes-management programs. A two-phase mixed-methods study was conducted of adult US members of PatientsLikeMe®, an online research network of patients. Phase 1 comprised qualitative interviews with 10 individuals to inform the online survey's contents, aided by literature review. During phase 2, this online survey was completed by 294 participants who reported on their diabetes goals and preferences for T2DM self-management support programs. The majority of the respondents were not participating in any program (65 %), but most had goals of improving diet (77 %), weight loss (71 %), and achieving stable blood glucose levels (71 %). Among those currently participating in programs, clinic, hospital-based, or other health-care professional programs were the most commonly used (51 %). The most preferred type of support was diet/weight-loss support (62 %), while doctors or nurses (61 %) and dietitians (55 %) were the most preferred sources of diabetes support. The low participation in diabetes self-management programs revealed in this study underscores the need for strategies to improve patient engagement. The results revealed support types and formats that patients with T2DM prefer and need. These findings may help improve patient engagement by guiding the future design of more effective diabetes management

  8. Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management.

    Science.gov (United States)

    Öberg, Ulrika; Orre, Carl Johan; Isaksson, Ulf; Schimmer, Robyn; Larsson, Håkan; Hörnsten, Åsa

    2017-09-28

    Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care. The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management. Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis. Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes. The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care. © 2017 Nordic College of Caring Science.

  9. Development of a supported self-management intervention for adults with type 2 diabetes and a learning disability.

    Science.gov (United States)

    House, Allan; Latchford, Gary; Russell, Amy M; Bryant, Louise; Wright, Judy; Graham, Elizabeth; Stansfield, Alison; Ajjan, Ramzi

    2018-01-01

    Although supported self-management is a well-recognised part of chronic disease management, it has not been routinely used as part of healthcare for adults with a learning disability. We developed an intervention for adults with a mild or moderate learning disability and type 2 diabetes, building on the principles of supported self-management with reasonable adjustments made for the target population. In five steps, we:Clarified the principles of supported self-management as reported in the published literatureIdentified the barriers to effective self-management of type 2 diabetes in adults with a learning disabilityReviewed existing materials that aim to support self-management of diabetes for people with a learning disabilitySynthesised the outputs from the first three phases and identified elements of supported self-management that were (a) most relevant to the needs of our target population and (b) most likely to be acceptable and useful to themImplemented and field tested the intervention. The final intervention had four standardised components: (1) establishing the participant's daily routines and lifestyle, (2) identifying supporters and their roles, (3) using this information to inform setting realistic goals and providing materials to the patient and supporter to help them be achieved and (4) monitoring progress against goals.Of 41 people randomised in a feasibility RCT, thirty five (85%) completed the intervention sessions, with over three quarters of all participants (78%) attending at least three sessions.Twenty-three out of 40 (58%) participants were deemed to be very engaged with the sessions and 12/40 (30%) with the materials; 30 (73%) participants had another person present with them during at least one of their sessions; 15/41 (37%) were reported to have a very engaged main supporter, and 18/41 (44%) had a different person who was not their main supporter but who was engaged in the intervention implementation. The intervention was feasible to

  10. A randomised trial of the Flinders Program to improve patient self-management competencies in a range of chronic conditions: study rationale and protocol

    Directory of Open Access Journals (Sweden)

    Malcolm W. Battersby

    2010-03-01

    Full Text Available BackgroundSupporting self management is seen as an important healthservice strategy in dealing with the large and increasing healthburden of chronic conditions. Several types of selfmanagementprograms are available. Evidence to datesuggests that disease-specific and lay-led self managementprograms provide only part of the support needed forimproved outcomes. The Flinders Program is promising as ageneric self management intervention, which can becombined with targeted disease-specific and lay-ledinterventions, but it has yet to be evaluated for a range ofchronic conditions using a rigorous controlled trial design. Thispaper gives the rationale for a randomised controlled trial andprocess evaluation of the Flinders Program of chroniccondition self-management in community practice, and detailsand justifies the design of such a study.MethodThe design for a randomised trial and associated processevaluation, suited to evaluation of a complex and behaviouralintervention as it is applied in actual practice, is presented andjustified.ConclusionA randomised trial of the Flinders Program is required and afunctional design is presented. Results from this trial,currently underway, will test the effectiveness of the FlindersProgram in improving patient competencies in selfmanagementof chronic conditions in practice conditions.A process evaluation alongside the trial will exploresystem, provider and patient factors associated withgreater and lesser Program effectiveness.

  11. Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach.

    Science.gov (United States)

    Shegog, Ross; Begley, Charles E

    2017-01-01

    Epilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M) behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules), managing their seizures (e.g., responding to seizure episodes), managing their safety (e.g., monitoring and avoiding environmental seizure triggers), and managing their co-morbid conditions (e.g., anxiety, depression). The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET) is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years) and their health-care provider regarding the patient's epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient's needs, and increase the patient's self-efficacy to achieve those goals. The purpose of this paper is to describe the application of intervention mapping (IM) to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1); matrices of program objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); a functional MINDSET program prototype (IM Step 4); plans for implementation (IM Step 5); and evaluation (IM Step 6). IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.

  12. Clinic-Based Mobile Health Decision Support to Enhance Adult Epilepsy Self-Management: An Intervention Mapping Approach

    Directory of Open Access Journals (Sweden)

    Ross Shegog

    2017-10-01

    Full Text Available IntroductionEpilepsy is a neurological disorder involving recurrent seizures. It affects approximately 5 million people in the U.S. To optimize their quality of life people with epilepsy are encouraged to engage in self-management (S-M behaviors. These include managing their treatment (e.g., adhering to anti-seizure medication and clinical visit schedules, managing their seizures (e.g., responding to seizure episodes, managing their safety (e.g., monitoring and avoiding environmental seizure triggers, and managing their co-morbid conditions (e.g., anxiety, depression. The clinic-based Management Information Decision Support Epilepsy Tool (MINDSET is a decision-support system founded on theory and empirical evidence. It is designed to increase awareness by adult patients (≥18 years and their health-care provider regarding the patient’s epilepsy S-M behaviors, facilitate communication during the clinic visit to prioritize S-M goals and strategies commensurate with the patient’s needs, and increase the patient’s self-efficacy to achieve those goals.MethodsThe purpose of this paper is to describe the application of intervention mapping (IM to develop, implement, and formatively evaluate the clinic-based MINDSET prototype and in developing implementation and evaluation plans. Deliverables comprised a logic model of the problem (IM Step 1; matrices of program objectives (IM Step 2; a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3; a functional MINDSET program prototype (IM Step 4; plans for implementation (IM Step 5; and evaluation (IM Step 6. IM provided a logical and systematic approach to developing and evaluating clinic-based decision support toward epilepsy S-M.

  13. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

    NARCIS (Netherlands)

    Elissen, A.M.J.; Nolte, E.; Knai, C.; Brunn, M.; Chevreul, K.; Conklin, A.; Durand-Zaleski, I.; Erler, A.; Flamm, M.; Frølich, A.; Fullerton, B.; Jacobsen, R.; Saz-Parkinson, Z.; Sarria-Santamera, A.; Sönnichsen, A.; Vrijhoef, H.J.M.

    2013-01-01

    Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In

  14. Design Thinking for mHealth Application Co-Design to Support Heart Failure Self-Management.

    Science.gov (United States)

    Woods, Leanna; Cummings, Elizabeth; Duff, Jed; Walker, Kim

    2017-01-01

    Heart failure is a prevalent, progressive chronic disease costing in excess of $1billion per year in Australia alone. Disease self-management has positive implications for the patient and decreases healthcare usage. However, adherence to recommended guidelines is challenging and existing literature reports sub-optimal adherence. mHealth applications in chronic disease education have the potential to facilitate patient enablement for disease self-management. To the best of our knowledge no heart failure self-management application is available for safe use by our patients. In this paper, we present the process established to co-design a mHealth application in support of heart-failure self-management. For this development, an interdisciplinary team systematically proceeds through the phases of Stanford University's Design Thinking process; empathise, define, ideate, prototype and test with a user-centred philosophy. Using this clinician-led heart failure app research as a case study, we describe a sequence of procedures to engage with local patients, carers, software developers, eHealth experts and clinical colleagues to foster rigorously developed and locally relevant patient-facing mHealth solutions. Importantly, patients are engaged in each stage with ethnographic interviews, a series of workshops and multiple re-design iterations.

  15. Bridges self-management program for people with stroke in the community: A feasibility randomized controlled trial.

    Science.gov (United States)

    McKenna, Suzanne; Jones, Fiona; Glenfield, Pauline; Lennon, Sheila

    2015-07-01

    Enabling self-management behaviors is considered important in order to develop coping strategies and confidence for managing life with a long-term condition. However, there is limited research into stroke-specific self-management interventions. The aim of this randomized controlled trial was to evaluate the feasibility of delivering the Bridges stroke self-management program in addition to usual stroke rehabilitation compared with usual rehabilitation only. Participants recruited from the referrals to a community stroke team were randomly allocated to the Bridges stroke self-management program, receiving either one session of up to one-hour per week over a six-week period in addition to usual stroke rehabilitation, or usual rehabilitation only. Feasibility was measured using a range of methods to determine recruitment and retention; adherence to the program; suitability and variability of outcome measures used; application and fidelity of the program; and acceptability of the program to patients, carers and professionals. Twenty-five people were recruited to the study over a 13-month period. Eight out of the 12 participants in the Bridges stroke self-management program received all six sessions; there was one withdrawal from the study. There were changes in outcomes between the two groups. Participants who received the Bridges stroke self-management program appeared to have a greater change in self-efficacy, functional activity, social integration and quality of life over the six-week intervention period and showed less decline in mood and quality of life at the three-month follow-up. Professionals found the program acceptable to use in practice, and feedback from participants was broadly positive. The findings from this study appear promising, but questions remain regarding the feasibility of delivering the Bridges stroke self-management program in addition to usual rehabilitation. The dose response of receiving the program cannot be ruled out, and the next stage

  16. Psychometric properties of the Iranian version of resources and support for chronic illness self-management scale in patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Elham Shakibazadeh

    2012-01-01

    Full Text Available Background: This article is a report of psychometric testing of the Farsi version of Resources and Support for Chronic Illness Self-management (RSSM scale. Methods: In this cross-sectional study, a convenience sample of 160 patients with type 2 diabetes, registered with the Charity Foundation for Special Diseases′ team-focused diabetes clinic, were recruited (response rate=83.7%; n=134. Participants older than 18 years who had active medical files in the system completed the questionnaire. Content validity was established using translation and back-translation procedures, pilot testing of the instrument, and getting views of the expert panel. Construct validity was determined using explanatory factor analysis. Internal consistency was ascertained using Cronbach′s alpha. The stability was confirmed using intra-class correlation coefficients. Results: Using exploratory factor analysis, a five-factor model emerged, which explained 75.24% of the total variance. Internal consistency reliability was sufficient (α=0.70; range=0.66 - 0.87. The intra-class correlation coefficient was 0.74 - 0.81 for individual items. Conclusion: The RSSM-Farsi seems to be a valid and reliable instrument to measure outcomes of diabetes self-management education programs in Farsi. The RSSM-Farsi version scale could be a useful, comprehensive, and culturally sensitive scale for assessing resources and support for self-management between type 2 diabetic patients.

  17. Self-management support interventions that are clinically linked and technology enabled: can they successfully prevent and treat diabetes?

    Science.gov (United States)

    Kaufman, Neal D; Woodley, Paula D Patnoe

    2011-05-01

    Patients with diabetes need a complex set of services and supports. The challenge of integrating these services into the diabetes regimen can be successfully overcome through self-management support interventions that are clinically linked and technology enabled: self-management support because patients need help mastering the knowledge, attitudes, skills, and behaviors so necessary for good outcomes; interventions because comprehensive theory-based, evidence-proven, long-term, longitudinal interventions work better than direct-to-consumer or nonplanned health promotion approaches; clinically linked because patients are more likely to adopt new behaviors when the approach is in the context of a trusted therapeutic relationship and within an effective medical care system; and technology enabled because capitalizing on the amazing power of information technology leads to the delivery of cost-effective, scalable, engaging solutions that prevent and manage diabetes. © 2011 Diabetes Technology Society.

  18. Digital Health Interventions for Adults With Type 2 Diabetes: Qualitative Study of Patient Perspectives on Diabetes Self-Management Education and Support.

    Science.gov (United States)

    Pal, Kingshuk; Dack, Charlotte; Ross, Jamie; Michie, Susan; May, Carl; Stevenson, Fiona; Farmer, Andrew; Yardley, Lucy; Barnard, Maria; Murray, Elizabeth

    2018-01-29

    The prevalence of type 2 diabetes is increasing globally, and health services in many countries are struggling with the morbidity, mortality, and costs associated with the complications of this long-term condition. Diabetes self-management education (DSME) and behavioral support can reduce the risks of developing diabetes-related complications and improve glycemic control. However, their uptake is low. Digital health interventions (DHI) can provide sustained support and may overcome challenges associated with attending diabetes self-management sessions. They have the potential for delivery at multiple locations at convenient times, anonymity, and presentation of content in attractive and tailored formats. This study investigates the needs and wants of patients with type 2 diabetes to inform the development of digital self-management education and support. The objective of this study was to explore patient perspectives on unmet needs for self-management and support and the role of DHI in adults living with type 2 diabetes. This study used a qualitative approach based on data generated from 4 focus groups with 20 patients. The data generated by the focus groups illustrated the significant burden that the diagnosis of diabetes places on many patients and the negative impacts on their emotional well-being, work, social life, and physical health. Although patients' experiences of the health care services varied, there was agreement that even the best services were unable to meet all users' needs to support the emotional regulation, psychological adjustment, and behavioral changes needed for successful self-management. By focusing on medical management and information provision, existing health care services and education programs may not be adequately meeting all the needs of patients with type 2 diabetes. DHIs have the potential to improve access to DSME and behavioral support and extend the range of content offered by health services to fit with a wider range of

  19. Telehealth for diabetes self-management education and support in an underserved, free clinic population: A pilot study.

    Science.gov (United States)

    Threatt, Tiffaney B; Ward, Eileen D

    Primary study objectives were to (1) describe mean change in A1c from baseline of a free clinic population enrolled in telehealth diabetes self-management education and support (DSME/S) services and (2) to compare change in A1C and other clinical outcomes measures with free clinic patients enrolled in a traditional face-to-face DSME/S program. An exploratory study design and comparative evaluation of telehealth DSME/S services in a free clinic population was used. Baseline clinical measures were collected upon referral. Diabetes educators met with patients individually over 2-3 months. Clinical outcomes measures were collected within 6 months of program completion. Data from the telehealth group was assessed individually and compared to a free clinic traditional DSME/S program population. Twelve patients completed a telehealth free clinic DSME/S pilot program with a mean ± SD change in A1C from baseline of -1.03 ± 1.53% (P = 0.050). Mean ± SD change in A1C from baseline in the free clinic population participating in traditional face-to-face DSME/S services was -1.42 ± 1.80% (P = 0.001). No significant differences in secondary outcomes measures, including body mass index and blood pressure, were revealed among the study populations. Expanding access to care in populations faced with challenges of socioeconomics, limited education, and lower health literacy is a step toward reducing health disparities and positively affecting care. Mean A1C can be improved with telehealth DSME/S services in an underserved, free clinic population. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  20. The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review.

    Science.gov (United States)

    Whitehead, Lisa; Jacob, Elisabeth; Towell, Amanda; Abu-Qamar, Ma'en; Cole-Heath, Amanda

    2018-01-01

    To explore the contribution of family members in promoting and supporting the self-management of chronic conditions amongst adult family members. The prevalence of chronic disease continues to grow globally. The role of the family in chronic condition management and support for self-management has received little attention. A systematic review of qualitative literature using the Joanna Briggs Institute approach for qualitative systematic reviews. Ovid (MEDLINE, CINAHL and PsycINFO) were searched for the period of database inception-2016. The QARI (Qualitative Assessment and Review Instrument) critical appraisal instrument was used to assess the quality of each study. Using the Joanna Briggs Institute-QARI data extraction tool, findings related to the family role in the self-management of chronic conditions were extracted and each finding rated according to Joanna Briggs Institute-QARI levels of credibility. Findings were categorised and synthesised to produce a final set of aggregated findings. Families were key in constructing an environment that was conducive to family engagement and support. Adaptation within the family included maintaining cohesion between family members, normalisation and contextualisation of the chronic condition. Whilst evidence on the value of the family in promoting positive health outcomes is clear, research on how families can specifically support the self-management of chronic conditions is emerging. Family adaptability has been found to be the most powerful predictor of carer depression. Families may need support to change their home and family organisation to adapt to the challenges they face overtime. Change in roles and subsequent adaptation can be stressful, even for those family members at a distance. Nurses working in hospital and community settings can play an important role in assessing how families are adapting to living with chronic illness and to explore strategies to cope with challenges in the home setting. © 2017 John

  1. Development and Validation of an Online Program for Promoting Self-Management among Korean Patients with Chronic Hepatitis B

    Directory of Open Access Journals (Sweden)

    Jinhyang Yang

    2013-01-01

    Full Text Available The hepatitis B virus is second only to tobacco as a known human carcinogen. However, chronic hepatitis B usually does not produce symptoms and people feel healthy even in the early stages of live cancer. Therefore, chronically infected people should perceive it as a serious health problem and move on to appropriate health behaviour. The purpose of this paper is to develop and validate an online program for promoting self-management among Korean patients with chronic hepatitis B. The online program was developed using a prototyping approach and system developing life cycle method, evaluated by users for their satisfaction with the website and experts for the quality of the site. To evaluate the application of the online program, knowledge and self-management compliance of the subjects were measured and compared before and after the application of the online program. There were statistically significant increases in knowledge and self-management compliance in the user group. An online program with high accessibility and applicability including information, motivation, and behavior skill factors can promote self-management of the patient with chronic hepatitis B. Findings from this study allow Korean patients with chronic hepatitis B to engage in proactive and effective health management in the community or clinical practice.

  2. Exploring the perspectives of clinical professionals and support staff on implementing supported self-management for asthma in UK general practice: an IMP2ART qualitative study.

    Science.gov (United States)

    Morrow, Susan; Daines, Luke; Wiener-Ogilvie, Sharon; Steed, Liz; McKee, Lorna; Caress, Ann-Louise; Taylor, Stephanie J C; Pinnock, Hilary

    2017-07-18

    Despite an overwhelming evidence base, supported self-management of asthma is poorly implemented into routine practice. Strategies for implementation must address organisational routines, as well as provide resources for patients and training to improve professionals' skills. We aimed to explore the priority that primary care practices attach to asthma self-management, to describe their existing asthma management routines, and to generate innovative implementation strategies. We recruited 33 participants (23 general practitioners; seven nurses; three administrative staff) from 14 general practices. The 12 interviews and three focus groups were transcribed, coded and analysed thematically. Supported self-management was largely a nurse-led task within clinic-based annual reviews. Barriers included poor attendance at asthma clinics, lack of time, demarcation of roles, limited access to a range of tailored resources, and competing agendas in consultation, often due to multimorbidity. Suggestions for initiatives to improve the provision of supported self-management included emphasising the evidence for benefit (to influence prioritisation), improving teamwork (including team-based education), organisational strategies (including remote consulting) which need to fit within existing practice routines. Technology offers some potential solutions (e.g., improved templates, 'app'-based plans), but must be integrated with the practice information technology systems. Building on these insights, we will now develop a theoretically-based implementation strategy that will address patient, professional, and organisational buy-in, provide team-based education and offer a range of practical options and tools, which can be adapted and integrated within existing routines of individual practices.OVERCOMING THE ORGANISATIONAL BARRIERS TO IMPLEMENTING ASTHMA SELF-MANAGEMENT: Understanding the routines of primary care practices can suggest strategies to implement supported self-management

  3. Effectiveness of a self-management program for dual sensory impaired seniors in aged care settings: study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Roets-Merken, Lieve M; Graff, Maud J L; Zuidema, Sytse U; Hermsen, Pieter G J M; Teerenstra, Steven; Kempen, Gertrudis I J M; Vernooij-Dassen, Myrra J F J

    2013-10-07

    Five to 25 percent of residents in aged care settings have a combined hearing and visual sensory impairment. Usual care is generally restricted to single sensory impairment, neglecting the consequences of dual sensory impairment on social participation and autonomy. The aim of this study is to evaluate the effectiveness of a self-management program for seniors who acquired dual sensory impairment at old age. In a cluster randomized, single-blind controlled trial, with aged care settings as the unit of randomization, the effectiveness of a self-management program will be compared to usual care. A minimum of 14 and maximum of 20 settings will be randomized to either the intervention cluster or the control cluster, aiming to include a total of 132 seniors with dual sensory impairment. Each senior will be linked to a licensed practical nurse working at the setting. During a five to six month intervention period, nurses at the intervention clusters will be trained in a self-management program to support and empower seniors to use self-management strategies. In two separate diaries, nurses keep track of the interviews with the seniors and their reflections on their own learning process. Nurses of the control clusters offer care as usual. At senior level, the primary outcome is the social participation of the seniors measured using the Hearing Handicap Questionnaire and the Activity Card Sort, and secondary outcomes are mood, autonomy and quality of life. At nurse level, the outcome is job satisfaction. Effectiveness will be evaluated using linear mixed model analysis. The results of this study will provide evidence for the effectiveness of the Self-Management Program for seniors with dual sensory impairment living in aged care settings. The findings are expected to contribute to the knowledge on the program's potential to enhance social participation and autonomy of the seniors, as well as increasing the job satisfaction of the licensed practical nurses. Furthermore, an

  4. Methods for streamlining intervention fidelity checklists: an example from the chronic disease self-management program.

    Science.gov (United States)

    Ahn, SangNam; Smith, Matthew Lee; Altpeter, Mary; Belza, Basia; Post, Lindsey; Ory, Marcia G

    2014-01-01

    Maintaining intervention fidelity should be part of any programmatic quality assurance (QA) plan and is often a licensure requirement. However, fidelity checklists designed by original program developers are often lengthy, which makes compliance difficult once programs become widely disseminated in the field. As a case example, we used Stanford's original Chronic Disease Self-Management Program (CDSMP) fidelity checklist of 157 items to demonstrate heuristic procedures for generating shorter fidelity checklists. Using an expert consensus approach, we sought feedback from active master trainers registered with the Stanford University Patient Education Research Center about which items were most essential to, and also feasible for, assessing fidelity. We conducted three sequential surveys and one expert group-teleconference call. Three versions of the fidelity checklist were created using different statistical and methodological criteria. In a final group-teleconference call with seven national experts, there was unanimous agreement that all three final versions (e.g., a 34-item version, a 20-item version, and a 12-item version) should be made available because the purpose and resources for administering a checklist might vary from one setting to another. This study highlights the methodology used to generate shorter versions of a fidelity checklist, which has potential to inform future QA efforts for this and other evidence-based programs (EBP) for older adults delivered in community settings. With CDSMP and other EBP, it is important to differentiate between program fidelity as mandated by program developers for licensure, and intervention fidelity tools for providing an "at-a-glance" snapshot of the level of compliance to selected program indicators.

  5. Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support

    DEFF Research Database (Denmark)

    Mejdahl, Caroline; Nielsen, Berit Kjærside; Hjøllund, Niels Henrik Ingvar

    2016-01-01

    Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The ...... to strengthen patient involvement and securing benefit from PROs.......Rationale, aims and objectives: Patient-reported outcomes (PROs) are being implemented in clinical practice across different healthcare settings with varying purposes. Involving patients in reporting outcomes may increase their attention to symptoms and thereby support their self......-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients complete a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PROs influenced the interaction between patients and clinicians...

  6. Diabetes rehabilitation : development and first results of a Multidisciplinary Intensive Education Program for patients with prolonged self-management difficulties

    NARCIS (Netherlands)

    Keers, JC; Blaauwwiekel, EE; Hania, M; Bouma, J; Scholten-Jaegers, SMHJ; Sanderman, R; Links, TP

    For a number of diabetes patients regular care may be insufficient. A Multidisciplinary Intensive Education Program (MIEP), based on the empowerment approach, has been developed to help patients obtain their treatment goals (adequate self-management, glycemic control and quality of life). The aim of

  7. Generalization and maintenance of a self-management program for drooling in children with neurodevelopmental disabilities: A second case series

    NARCIS (Netherlands)

    Burg, J.J.W. van der; Sohier, J.; Jongerius, P.H.

    2018-01-01

    In this case series (n = 10) with a non-concurrent multiple baseline design, a self-management program was shown to be effective during inpatient training in eight participants with oral-motor problems and normal intelligence or mild intellectual disabilities. They were taught to perform a

  8. I just have diabetes : children’s need for diabetes self-management support and how a social robot can accommodate their needs

    NARCIS (Netherlands)

    Blanson Henkemans, O.A.; Hoondert, V.; Schrama-Groot, F.; Looije, R.; Alpay, L.L.; Neerincx, M.A.

    2012-01-01

    Children with type 1 diabetes need to self-manage their illness to minimize its impact on their long-term health. However, because children are still developing cognitively and emotionally, self-management is challenging. The European FP7 project, ALIZ-E, looks at how social robots can support

  9. Recruiting seniors with chronic low back pain for a randomized controlled trial of a self-management program.

    Science.gov (United States)

    Groupp, Elyse; Haas, Mitchell; Fairweather, Alisa; Ganger, Bonnie; Attwood, Michael

    2005-02-01

    To identify recruitment challenges and elucidate specific strategies that enabled recruitment of seniors for a randomized trial on low back pain comparing the Chronic Disease Self-management Program of the Stanford University to a 6-month wait-list control group. Recruitment for a randomized controlled trial. Community-based program offered at 12 locations. Community-dwelling seniors 60 years and older with chronic low back pain of mechanical origin. Passive recruitment strategies included advertisement in local and senior newspapers, in senior e-mail newsletters and listservs, in local community centers and businesses. Active strategies included meeting seniors at health fairs, lectures to the public and organizational meetings, and the help of trusted professionals in the community. A total of 100 white and 20 African American seniors were recruited. The program seemed to have the most appeal to white, middle-class older adults, educated through high school level. Advertisement failed to attract any participants to the program. Successful strategies included interaction with seniors at health fairs and lectures on health care, especially when the program was endorsed by a trusted community professional. Generating interest in the self-management program required keen communication skills because the idea of "self-management" was met with a myriad of responses, ranging from disinterest to disbelief. Generating interest also required active participation within the communities. Initial contacts had to be established with trusted professionals, whose endorsement enabled the project managers to present the concept of self-management to the seniors. More complex recruitment strategies were required for this study involving the self-management approach to back pain than for studies involving treatment.

  10. Development and feasibility of an evidence-informed self-management education program in pediatric concussion rehabilitation.

    Science.gov (United States)

    Hunt, Anne W; De Feo, Luciano; Macintyre, Jennifer; Greenspoon, Dayna; Dick, Talia; Mah, Katherine; Paniccia, Melissa; Provvidenza, Christine; Reed, Nick

    2016-08-17

    Concussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth. Synthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum. The program was implemented and evaluated in a children's rehabilitation hospital within a universal health care system. A retrospective secondary analysis of anonymous data from a program evaluation survey was used to evaluate program feasibility, to identify features of importance to program participants and to assess changes in participants' knowledge. The program, "Concussion & You" includes a comprehensive, evidence informed, population specific curriculum that teaches participants practical strategies for management of return to school and play, sleep, nutrition, relaxation and energy conservation. A 'wheel of health' is used to facilitate participants' self-management action plan. Results from eighty-seven participant surveys indicate that the program is feasible and participant knowledge increased in all areas of the program with the highest changes reported in knowledge about sleep hygiene, rest and energy conservation. Findings indicate that "Concussion & You" is a feasible program that is acceptable to youth and their families, and fills a health system service gap.

  11. Self-management programs for Aboriginal and Torres Strait Islander Peoples with chronic conditions: A rapid review.

    Science.gov (United States)

    Moore, Ellie; Lawn, Sharon; Oster, Candice; Morello, Andrea

    2017-01-01

    Objectives Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. Methods A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. Results Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. Discussion Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives.

  12. Integrating community health workers into a patient-centered medical home to support disease self-management among Vietnamese Americans: lessons learned.

    Science.gov (United States)

    Wennerstrom, Ashley; Bui, Tap; Harden-Barrios, Jewel; Price-Haywood, Eboni G

    2015-01-01

    There is evidence that patient-centered medical homes (PCMHs) and community health workers (CHWs) improve chronic disease management. There are few models for integrating CHWs into PCMHs in order to enhance disease self-management support among diverse populations. In this article, we describe how a community-based nonprofit agency, a PCMH, and academic partners collaborated to develop and implement the Patient Resource and Education Program (PREP). We employed CHWs as PCMH care team members to provide health education and support to Vietnamese American patients with uncontrolled diabetes and/or hypertension. We began by conducting focus groups to assess patient knowledge, desire for support, and availability of community resources. Based on findings, we developed PREP with CHW guidance on cultural tailoring of educational materials and methods. CHWs received training in core competencies related to self-management support principles and conducted the 4-month intervention for PCMH patients. Throughout the program, we conducted process evaluation through structured team meetings and patient satisfaction surveys. We describe successes and challenges associated with PREP delivery including patient recruitment, structuring/documenting visits, and establishing effective care team integration, work flow, and communication. Strategies for mitigating these issues are presented, and we make recommendations for other PCMHs seeking to integrate CHWs into care teams. © 2014 Society for Public Health Education.

  13. Implementation of a diabetes self-management education program in primary care for adults using shared medical appointments.

    Science.gov (United States)

    Sanchez, Iris

    2011-01-01

    The purpose of this study was to implement diabetes self-management education in primary care using the Chronic Care Model and shared medical appointments (SMA) to provide evidence-based interventions to improve process and measure outcomes. A quality improvement project using the Plan-Do-Check-Act cycle was implemented in a primary care setting in South Texas to provide diabetes self-management education for adults. Biological measures were evaluated in 70 patients at initiation of the project and thereafter based on current practice guidelines. The results of the project were consistent with the literature regarding the benefits, sustainability, and viability of SMA. As compared with that in studies presented in the literature, the patient population who participated in SMA had similar outcomes regarding improvement in A1C, self-management skills, and satisfaction. SMA are an innovative system redesign concept with the potential to provide comprehensive and coordinated care for patients with multiple and chronic health conditions while still being an efficient, effective, financially viable, and sustainable program. As the incidence and prevalence of diabetes increase, innovative models of care can meet the growing demand for access and utilization of diabetes self-management education programs. Programs focusing on chronic conditions to improve outcomes can be replicated by health care providers in primary care settings. SMA can increase revenue and productivity, improve disease management, and increase provider and patient satisfaction.

  14. Self-management programs based on the social cognitive theory for Koreans with chronic disease: a systematic review.

    Science.gov (United States)

    Jang, Yeonsoo; Yoo, Hyera

    2012-02-01

    Self-management programs based on social cognitive theory are useful to improve health care outcomes for patients with chronic diseases in Western culture. The purpose of this review is to identify and synthesize published research on the theory to enhance self-efficacy in disease management and examine its applicability to Korean culture regarding the learning strategies used. Ultimately, it was to identify the optimal use of these learning strategies to improve the self-efficacy of Korean patients in self-management of their hypertension and diabetic mellitus. The authors searched the Korean and international research databases from January 2000 to September 2009. Twenty studies were selected and reviewed. The most frequently used learning strategies of social cognitive theory was skill mastery by practice and feedback (N = 13), followed by social or verbal persuasion by group members (N = 7) and, however, observation learning and reinterpretation of symptoms by debriefing or discussion were not used any of the studies. Eight studies used only one strategy to enhance self-efficacy and six used two. A lack of consistency regarding the content and clinical efficacy of the self-efficacy theory-based self-management programs is found among the reviewed studies on enhancing self-efficacy in Koreans with hypertension and diabetes mellitus. Further research on the effectiveness of these theory-based self-management programs for patients with chronic diseases in Korea and other countries is recommended.

  15. Supporting the self-management of hypertension: Patients' experiences of using a mobile phone-based system.

    Science.gov (United States)

    Hallberg, I; Ranerup, A; Kjellgren, K

    2016-02-01

    Globally, hypertension is poorly controlled and its treatment consists mainly of preventive behavior, adherence to treatment and risk-factor management. The aim of this study was to explore patients' experiences of an interactive mobile phone-based system designed to support the self-management of hypertension. Forty-nine patients were interviewed about their experiences of using the self-management system for 8 weeks regarding: (i) daily answers on self-report questions concerning lifestyle, well-being, symptoms, medication intake and side effects; (ii) results of home blood-pressure measurements; (iii) reminders and motivational messages; and (iv) access to a web-based platform for visualization of the self-reports. The audio-recorded interviews were analyzed using qualitative thematic analysis. The patients considered the self-management system relevant for the follow-up of hypertension and found it easy to use, but some provided insight into issues for improvement. They felt that using the system offered benefits, for example, increasing their participation during follow-up consultations; they further perceived that it helped them gain understanding of the interplay between blood pressure and daily life, which resulted in increased motivation to follow treatment. Increased awareness of the importance of adhering to prescribed treatment may be a way to minimize the cardiovascular risks of hypertension.

  16. What follow-up care and self-management support do patients with type 2 diabetes want after their first acute coronary event? A qualitative study.

    Science.gov (United States)

    Kasteleyn, Marise J; Gorter, Kees J; van Puffelen, Anne L; Heijmans, Monique; Vos, Rimke C; Jansen, Hanneke; Rutten, Guy E H M

    2014-10-01

    Despite diabetes patients' efforts to control their disease, many of them are confronted with an acute coronary event. This may evoke depressive feelings and self-management may be complicated. According to the American Diabetes Association, the transition from hospital to home after an acute coronary event (ACE) is a high-risk time for diabetes patients; it should be improved. Before developing an intervention for diabetes patients with an ACE in the period after discharge from hospital, we want to gain a detailed understanding of patients' views, perceptions and feelings in this respect. Qualitative design. Two semi-structured focus groups were conducted with 14 T2DM patients (71% male, aged 61-77 years) with a recent ACE. One focus group with partners (67% male, aged 64-75 years) was held. All interviews were transcribed verbatim and analyzed by two independent researchers. Patients believed that coping with an ACE differs between patients with and without T2DM. They had problems with physical exercise, sexuality and pharmacotherapy. Patients and partners were neither satisfied with the amount of information, especially on the combination of T2DM and ACE, nor with the support offered by healthcare professionals after discharge. Participants would appreciate tailored self-management support after discharge from hospital. Patients with T2DM and their partners lack tailored support after a first ACE. Our findings underpin the ADA recommendations to improve the transition from hospital to home. The results of our study will help to determine the exact content of a self-management support program delivered at home to help this specific group of patients to cope with both conditions. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  17. Diabetes Self-Management Education Programs in Nonmetropolitan Counties - United States, 2016.

    Science.gov (United States)

    Rutledge, Stephanie A; Masalovich, Svetlana; Blacher, Rachel J; Saunders, Magon M

    2017-04-28

    Diabetes self-management education (DSME) is a clinical practice intended to improve preventive practices and behaviors with a focus on decision-making, problem-solving, and self-care. The distribution and correlates of established DSME programs in nonmetropolitan counties across the United States have not been previously described, nor have the characteristics of the nonmetropolitan counties with DSME programs. July 2016. DSME programs recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators (i.e., active programs) as of July 2016 were shared with CDC by both organizations. The U.S. Census Bureau's census geocoder was used to identify the county of each DSME program site using documented addresses. County characteristic data originated from the U.S. Census Bureau, compiled by the U.S. Department of Agriculture's Economic Research Service into the 2013 Atlas of Rural and Small-Town America data set. County levels of diagnosed diabetes prevalence and incidence, as well as the number of persons with diagnosed diabetes, were previously estimated by CDC. This report defined nonmetropolitan counties using the rural-urban continuum code from the 2013 Atlas of Rural and Small-Town America data set. This code included six nonmetropolitan categories of 1,976 urban and rural counties (62% of counties) adjacent to and nonadjacent to metropolitan counties. In 2016, a total of 1,065 DSME programs were located in 38% of the 1,976 nonmetropolitan counties; 62% of nonmetropolitan counties did not have a DSME program. The total number of DSME programs for nonmetropolitan counties with at least one DSME program ranged from 1 to 8, with an average of 1.4 programs. After adjusting for county-level characteristics, the odds of a nonmetropolitan county having at least one DSME program increased as the percentage insured increased (adjusted odds ratio [AOR] = 1.10, 95% confidence interval [CI] = 1.08-1.13), the percentage with a high

  18. Development and Pilot Study of Group-Based Dietary Self-Management Program for Community Dwellers with Hypertension

    Directory of Open Access Journals (Sweden)

    Arfiza Ridwan

    2012-08-01

    Full Text Available Background: In most countries worldwide, hypertension is considered as an important problem. Moreover, an increasing trend in the prevalence and incidence has been reported in most countries. This increasing trend requires an innovative approach to improve the lifestyle modification of hypertensive sufferers including their dietary behaviors. Objective: This developmental research aims to develop a program for improving the dietary behaviors of community dwellers with hypertension. Method: The process of this program development includes a literature review related to the self-management programs for hypertension, and dietary behavior outcomes, expert validation, and pilot testing. Result: The setting, strategies, duration, and outcome measurement from the literature review were taken into consideration to develop the new program. The newly developed group-based self-management program consists of: 1 the sharing and reflecting of individual current dietary behavior, 2 group educational session, 3 individual comparison of behavior and reflection of obstacles, 4 individual goal setting, and 5 follow up. In the educational session, the DASH eating plan is used as the reference as it is commonly used in studies about diet for hypertension. Key words: hypertension, self-management, group based program, dietary behaviors.

  19. A Systematic Review of Biopsychosocial Training Programs for the Self-Management of Emotional Stress: Potential Applications for the Military

    Science.gov (United States)

    Clausen, Shawn S.; Jonas, Wayne B.; Walter, Joan A. G.

    2013-01-01

    Combat-exposed troops and their family members are at risk for stress reactions and related disorders. Multimodal biopsychosocial training programs incorporating complementary and alternative self-management techniques have the potential to reduce stress-related symptoms and dysfunction. Such training can preempt or attenuate the posttraumatic stress response and may be effectively incorporated into the training cycle for deploying and redeploying troops and their families. A large systematic review was conducted to survey the literature on multimodal training programs for the self-management of emotional stress. This report is an overview of the randomized controlled trials (RCTs) identified in this systematic review. Select programs such as mindfulness-Based Stress Reduction, Cognitive Behavioral Stress Management, Autogenic Training, Relaxation Response Training, and other meditation and mind-body skills practices are highlighted, and the feasibility of their implementation within military settings is addressed. PMID:24174982

  20. A Systematic Review of Biopsychosocial Training Programs for the Self-Management of Emotional Stress: Potential Applications for the Military

    Directory of Open Access Journals (Sweden)

    Cindy Crawford

    2013-01-01

    Full Text Available Combat-exposed troops and their family members are at risk for stress reactions and related disorders. Multimodal biopsychosocial training programs incorporating complementary and alternative self-management techniques have the potential to reduce stress-related symptoms and dysfunction. Such training can preempt or attenuate the posttraumatic stress response and may be effectively incorporated into the training cycle for deploying and redeploying troops and their families. A large systematic review was conducted to survey the literature on multimodal training programs for the self-management of emotional stress. This report is an overview of the randomized controlled trials (RCTs identified in this systematic review. Select programs such as mindfulness-Based Stress Reduction, Cognitive Behavioral Stress Management, Autogenic Training, Relaxation Response Training, and other meditation and mind-body skills practices are highlighted, and the feasibility of their implementation within military settings is addressed.

  1. A systematic review of biopsychosocial training programs for the self-management of emotional stress: potential applications for the military.

    Science.gov (United States)

    Crawford, Cindy; Wallerstedt, Dawn B; Khorsan, Raheleh; Clausen, Shawn S; Jonas, Wayne B; Walter, Joan A G

    2013-01-01

    Combat-exposed troops and their family members are at risk for stress reactions and related disorders. Multimodal biopsychosocial training programs incorporating complementary and alternative self-management techniques have the potential to reduce stress-related symptoms and dysfunction. Such training can preempt or attenuate the posttraumatic stress response and may be effectively incorporated into the training cycle for deploying and redeploying troops and their families. A large systematic review was conducted to survey the literature on multimodal training programs for the self-management of emotional stress. This report is an overview of the randomized controlled trials (RCTs) identified in this systematic review. Select programs such as mindfulness-Based Stress Reduction, Cognitive Behavioral Stress Management, Autogenic Training, Relaxation Response Training, and other meditation and mind-body skills practices are highlighted, and the feasibility of their implementation within military settings is addressed.

  2. "In this together": Social identification predicts health outcomes (via self-efficacy) in a chronic disease self-management program.

    Science.gov (United States)

    Cameron, James E; Voth, Jennifer; Jaglal, Susan B; Guilcher, Sara J T; Hawker, Gillian; Salbach, Nancy M

    2018-03-05

    Self-management programs are an established approach to helping people cope with the challenges of chronic disease, but the psychological mechanisms underlying their effectiveness are not fully understood. A key assumption of self-management interventions is that enhancing people's self-efficacy (e.g., via the development of relevant skills and behaviours) encourages adaptive health-related behaviors and improved health outcomes. However, the group-based nature of the programs allows for the possibility that identification with other program members is itself a social psychological platform for positive changes in illness-related confidence (i.e., group-derived efficacy) and physical and mental health. The researchers evaluated this hypothesis in a telehealth version of a chronic disease self-management program delivered in 13 rural and remote communities in northern Ontario, Canada (September 2007 to June 2008). Participants were 213 individuals with a self-reported physician diagnosis of chronic lung disease, heart disease, stroke, or arthritis. Measures of social identification, group-derived efficacy, and individual efficacy were administered seven weeks after baseline, and mental and physical health outcomes (health distress, psychological well-being, depression, vitality, pain, role limits, and disability) were assessed at four months. Structural equation modeling indicated that social identification was a positive predictor of group-derived efficacy and (in turn) individual self-efficacy (controlling for baseline), which was significantly associated with better physical and mental health outcomes. The results are consistent with growing evidence of the value of a social identity-based approach in various health and clinical settings. The success of chronic disease self-management programs could be enhanced by attending to and augmenting group identification during and after the program. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Self-management support for chronic pain in primary care: a cross-sectional study of patient experiences and nursing roles.

    Science.gov (United States)

    Lukewich, Julia; Mann, Elizabeth; VanDenKerkhof, Elizabeth; Tranmer, Joan

    2015-11-01

    The aim of this study was to describe chronic pain self-management from the perspective of individuals living with chronic pain in the context of primary care nursing. Self-management is a key chronic pain treatment modality and support for self-managing chronic pain is mainly provided in the context of primary care. Although nurses are optimally suited to facilitate self-management in primary care, there is a need to explore opportunities for optimizing their roles. Two cross-sectional studies. The Chronic Pain Self-Management Survey was conducted in 2011-2012 to explore the epidemiology and self-management of chronic pain in Canadian adults. The questionnaire was distributed to 1504 individuals in Ontario. In 2011, the Primary Care Nursing Roles Survey was distributed to 1911 primary care nurses in Ontario to explore their roles and to determine the extent to which chronic disease management strategies, including support for self-management, were implemented in primary care. Few respondents to the pain survey identified nurses as being the 'most helpful' facilitator of self-management while physicians were most commonly cited. Seventy-six per cent of respondents used medication to manage their chronic pain. Few respondents to the nursing survey worked in practices with specific programmes for individuals with chronic pain. Individuals with chronic pain identified barriers and facilitators to self-managing their pain and nurses identified barriers and facilitators to optimizing their role in primary care. There are several opportunities for primary care practices to facilitate self-management of chronic pain, including the optimization of the primary care nursing role. © 2015 John Wiley & Sons Ltd.

  4. Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

    Science.gov (United States)

    Kanchense, Jane Handina Murigwa

    2006-08-01

    The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for

  5. Internet-based self-management in asthma

    NARCIS (Netherlands)

    Meer, Victor van der

    2010-01-01

    This thesis describes the role of internet-based support in the delivery of an asthma self management program. First, the compliance and reliability of home lung function monitoring, one of the key features of asthma self-management, was studied and appeared to be high over a 4-week period. Second,

  6. Diabetes self-management education and support delivered by mobile health (m-health) interventions for adults with type 2 diabetes mellitus

    NARCIS (Netherlands)

    Boels, Anne Meike; Vos, Rimke C.; Metzendorf, Maria-Inti; Rutten, Guy E.H.M.

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of diabetes self-management education and support delivered by mobile health interventions in adults with type 2 diabetes mellitus.

  7. Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status

    DEFF Research Database (Denmark)

    Van Hecke, Ann; Heinen, Maud; Fernández-Ortega, Paz

    2017-01-01

    of patients with a low socio-economic status. No differences were found for interventions developed based on health behaviour theoretical models. CONCLUSION: Limited evidence was found for self-management support interventions in chronically ill patients with low socio-economic status. Essential......AIM: To assess the quality of evidence and determine the effect of patient-related and economic outcomes of self-management support interventions in chronically ill patients with a low socio-economic status. BACKGROUND: Integrated evidence on self-management support interventions in chronically ill...... people with low socio-economic status is lacking. DESIGN: Systematic literature review. DATA SOURCES: Cochrane database of trials, PubMed, CINAHL, Web of Science, PsycINFO and Joanna Briggs Institute Library were searched (2000-2013). Randomized controlled trials addressing self-management support...

  8. Building Bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke.

    Science.gov (United States)

    Jones, Fiona; Pöstges, Heide; Brimicombe, Lucinda

    2016-10-14

    Programmes providing self-management support for patients and families are gaining attention and have shown promising outcomes with regards to reducing long-term unmet needs post stroke. However, notions of what good self-management support looks like can differ depending on professional opinion, individual preferences, skills and experiences of patients and their families as well as on how care and rehabilitation is organised in a particular healthcare setting. This resonates with the perspective of patient-centred care, according to which the meaning of good care is not universal, but rather jointly shaped between healthcare professionals and patients in everyday interactions. While self-management support is continuously co-produced in care and rehabilitation practices, most self-management programmes are typically provided as an 'add-on' to existing statutory care. This paper aims to deepen the understanding of how self-management support can be made an integral part of everyday care and rehabilitation using Bridges methodology. The authors provide a self-reflective account on 'Bridges' an integrated approach to self-management support, which is used by healthcare professionals within acute and community stroke rehabilitation across the UK, and in some parts of New Zealand and Australia. Bridges is based on self-efficacy principles, but has a central aim of professionals sharing decision-making and expertise with patients and families in every healthcare interaction. Methodologically, the co-production of a Bridges support package with local healthcare professionals and patients is critical. The authors present the values articulated by the support package and how it engages professionals, patients and Bridges training facilitators in a continuous process of adjusting and re-adjusting situated self-management support practices. Our reflections reveal the need to consider development and implementation of self-management support as one and the same on

  9. An integrative review of e-learning in the delivery of self-management support training for health professionals.

    Science.gov (United States)

    Lawn, Sharon; Zhi, Xiaojuan; Morello, Andrea

    2017-10-10

    E-learning involves delivery of education through Information and Communication Technology (ITC) using a wide variety of instructional designs, including synchronous and asynchronous formats. It can be as effective as face-to-face training for many aspects of health professional training. There are, however, particular practices and skills needed in providing patient self-management support, such as partnering with patients in goal-setting, which may challenge conventional practice norms. E-learning for the delivery of self-management support (SMS) continuing education to existing health professionals is a relatively new and growing area with limited studies identifying features associated with best acquisition of skills in self-management support. An integrative literature review examined what is known about e-learning for self-management support. This review included both qualitative and quantitative studies that focused on e-learning provided to existing health professionals for their continuing professional development. Papers were limited to those published in English between 2006 and 2016. Content analysis was used to organize and focus and describe the findings. The search returned 1505 articles, with most subsequently excluded based on their title or abstract. Fifty-two full text articles were obtained and checked, with 42 excluded because they did not meet the full criteria. Ten peer-reviewed articles were included in this review. Seven main themes emerged from the content analysis: participants and professions; time; package content; guiding theoretical framework; outcome measures; learning features or formats; and learning barriers. These themes revealed substantial heterogeneity in instructional design and other elements of e-learning applied to SMS, indicating that there is still much to understand about how best to deliver e-learning for SMS skills development. Few e-learning approaches meet the need for high levels of interactivity, reflection

  10. [Development and Effects of a Motivational Interviewing Self-management Program for Elderly Patients with Diabetes Mellitus].

    Science.gov (United States)

    Kang, Hye Yeon; Gu, Mee Ock

    2015-08-01

    This study was conducted to develop and test the effects of a motivational interviewing self-management program for use with elderly patients with diabetes mellitus. A non-equivalent control group pretest-posttest design was used. The participants were 42 elderly diabetic patients (experimental group: 21, control group: 21). The motivational interviewing self-management program for elders with diabetes mellitus developed in this study consisted of a 12-week program in total (8 weeks for group motivational interviewing and education and 4 weeks for individual motivational interviewing on the phone). Data were collected between February 13 and May 3, 2013 and were analyzed using t-test, paired t-test, and repeated measure ANOVA with SPSS/WIN 18.0. For the experimental group, significant improvement was found for self-efficacy, self-care behavior, glycemic control and quality of life (daily life satisfaction, influence of disease) as compared to the control group. The study findings indicate that the motivational interviewing self-management program is effective and can be recommended as a nursing intervention for elderly patients with diabetes mellitus.

  11. Implementation of customized health information technology in diabetes self management programs.

    Science.gov (United States)

    Alexander, Susan; Frith, Karen H; O'Keefe, Louise; Hennigan, Michael A

    2011-01-01

    The project was a nurse-led implementation of a software application, designed to combine clinical and demographic records for a diabetes education program, which would result in secure, long-term record storage. Clinical information systems may be prohibitively expensive for small practices and require extensive training for implementation. A review of the literature suggests that the use of simple, practice-based registries offer an economical method of monitoring the outcomes of diabetic patients. The database was designed using a common software application, Microsoft Access. The theory used to guide implementation and staff training was Rogers' Diffusion of Innovations theory (1995). Outcomes after a 3-month period included incorporation of 100% of new clinical and demographic patient records into the database and positive changes in staff attitudes regarding software applications used in diabetes self-management training. These objectives were met while keeping project costs under budgeted amounts. As a function of the clinical nurse specialist (CNS) researcher role, there is a need for CNSs to identify innovative and economical methods of data collection. The success of this nurse-led project reinforces suggestions in the literature for less costly methods of data maintenance in small practice settings. Ongoing utilization and enhancement have resulted in the creation of a robust database that could aid in the research of multiple clinical issues. Clinical nurse specialists can use existing evidence to guide and improve both their own practice and outcomes for patients and organizations. Further research regarding specific factors that predict efficient transition of informatics applications, how these factors vary according to practice settings, and the role of the CNS in implementation of such applications is needed.

  12. An international randomized study of a home-based self-management program for severe COPD: the COMET.

    Science.gov (United States)

    Bourbeau, Jean; Casan, Pere; Tognella, Silvia; Haidl, Peter; Texereau, Joëlle B; Kessler, Romain

    2016-01-01

    Most hospitalizations and costs related to COPD are due to exacerbations and insufficient disease management. The COPD patient Management European Trial (COMET) is investigating a home-based multicomponent COPD self-management program designed to reduce exacerbations and hospital admissions. Multicenter parallel randomized controlled, open-label superiority trial. Thirty-three hospitals in four European countries. A total of 345 patients with Global initiative for chronic Obstructive Lung Disease III/IV COPD. The program includes extensive patient coaching by health care professionals to improve self-management (eg, develop skills to better manage their disease), an e-health platform for reporting frequent health status updates, rapid intervention when necessary, and oxygen therapy monitoring. Comparator is the usual management as per the center's routine practice. Yearly number of hospital days for acute care, exacerbation number, quality of life, deaths, and costs.

  13. Impact of following self-management program for presternal keloids in combination of surgery and radiation therapy

    International Nuclear Information System (INIS)

    Miyashita, Tsuguhiro; Tateno, Atsushi; Kumazaki, Tatsuo; Hyakusoku, Hiko; Horiuchi, Junichi

    1999-01-01

    The combination therapy of surgical removal and the post-operative irradiation is thought as a gold standard therapy for intractable keloid. However, even when both methods were used, presternal keloids had a high incidence of recurrence. We reviewed 40 patients with presternal keloids who were treated with surgical removal and postoperative irradiation. Patients age range was 9 to 81 years (average 31.5 years, median 25 years), and the male to female ratio was 21:19. A comparative study was performed on recurrence rates by patients' age, sex, and keloid size, and with or without a self-management program that we designed. Overall relapse rate was 48%, which included minimal or partial recurrences. Of all recurrence, 57% occurred within six months and 84% within a year. The recurrence rates were 62% in male and 32% in female (P=0.057), 58% in those whose ages were less than thirty and 29% in those whose ages were thirty or greater (P=0.079), and 54% when the size of keloid was under 8 cm and 33% in 8 cm or more (P=0.240). A significant difference of recurrence rates was revealed just between the first half (67%) and the second half (32%) of therapeutic periods performed without or with the postoperative self-management program, respectively (P=0.028). It is suggested that the following application of our self-management program is useful for therapy in presternal keloids treated with surgical resection and radiation therapy. Keloids of young or male cases were exhibiting a tendency to recur. These patients should be treated with a strict self-management program. (author)

  14. Integrating Robot Support Functions into Varied Activities at Returning Hospital Visits: Supporting Child’s Self-Management of Diabetes

    NARCIS (Netherlands)

    Looije, L.; Neerincx, M.A.; Peters, J.K.; Blanson Henkemans, O.

    2016-01-01

    Persistent progress in the self-management of their disease is important and challenging for children with diabetes. The European ALIZ-e project developed and tested a set of core functions for a social robot that may help to establish such progress. These functions were studied in different set-ups

  15. Challenges and strategies for coping with scleroderma: implications for a scleroderma-specific self-management program.

    Science.gov (United States)

    Milette, Katherine; Thombs, Brett D; Maiorino, Kristina; Nielson, Warren R; Körner, Annett; Peláez, Sandra

    2018-05-09

    The purpose of this study was to explore challenges faced by patients with systemic sclerosis, also called scleroderma, in coping with their disease and the strategies they used to face those challenges. Five focus groups were held with scleroderma patients (4 groups, n = 34) and health care professionals who have experience treating scleroderma (1 group, n = 8). Participants' discussions were recorded, transcribed and analyzed using thematic analysis. Participants reported challenges accessing information (e.g., knowledgeable specialists), dealing with negative emotions (e.g., stress due to misunderstandings with loved ones), and accessing resources (e.g., helpful products or devices). Strategies for overcoming challenges were also discussed (e.g., advocating for own needs). When faced with significant challenges while coping with scleroderma, patients develop strategies to manage better and improve their quality of life. To help them cope, patients would benefit from easier access to supportive interventions, including tailored scleroderma self-management programs. Although the challenges experienced by patients with scleroderma are unique, findings from this study might help better understand patients' perspectives regarding coping and disease management for other chronic diseases as well. Implications for Rehabilitation People living with rare diseases, including the rare autoimmune disease scleroderma, face unique challenges and often do not have access to disease-specific educational or other support resources. People with scleroderma report that they face challenges in accessing information, including knowledgeable healthcare providers; managing difficult social interactions and negative emotions; and accessing resources. Strategies employed by scleroderma patients to overcome these challenges include seeking connections to other people with scleroderma or scleroderma patient organizations, actively seeking out local resources, and learning to

  16. Effectiveness of a group-based self-management program for people with chronic fatigue syndrome: a randomized controlled trial.

    Science.gov (United States)

    Pinxsterhuis, Irma; Sandvik, Leiv; Strand, Elin Bolle; Bautz-Holter, Erik; Sveen, Unni

    2017-01-01

    To evaluate the effectiveness of a group-based self-management program for people with chronic fatigue syndrome. A randomized controlled trial. Four mid-sized towns in southern Norway and two suburbs of Oslo. A total of 137 adults with chronic fatigue syndrome. A self-management program including eight biweekly meetings of 2.5 hours duration. The control group received usual care. Primary outcome measure: Medical Outcomes Study-Short Form-36 physical functioning subscale. Fatigue severity scale, self-efficacy scale, physical and mental component summary of the Short Form-36, and the illness cognition questionnaire (acceptance subscale). Assessments were performed at baseline, and at six-month and one-year follow-ups. At the six-month follow-up, a significant difference between the two groups was found concerning fatigue severity ( p = 0.039) in favor of the control group, and concerning self-efficacy in favor of the intervention group ( p = 0.039). These significant differences were not sustained at the one-year follow-up. No significant differences were found between the groups concerning physical functioning, acceptance, and health status at any of the measure points. The drop-out rate was 13.9% and the median number of sessions attended was seven (out of eight). The evaluated self-management program did not have any sustained effect, as compared with receiving usual care.

  17. Cost-Effectiveness of the Hepatitis C Self-Management Program

    Science.gov (United States)

    Groessl, Erik J.; Sklar, Marisa; Laurent, Diana D.; Lorig, Kate; Ganiats, Theodore G.; Ho, Samuel B.

    2017-01-01

    Background. Despite the emergence of new hepatitis C virus (HCV) antiviral medications, many people with chronic HCV know little about their disease, are at risk for transmitting HCV to others, and/or are not considered good treatment candidates. Self-management interventions can educate HCV-infected persons, improve their quality of life, and…

  18. The Hepatitis C Self-Management Program: Sustainability of Primary Outcomes at 1 Year

    Science.gov (United States)

    Groessl, Erik J.; Ho, Samuel B.; Asch, Steven M.; Stepnowsky, Carl J.; Laurent, Diana; Gifford, Allen L.

    2013-01-01

    Objective: Chronic hepatitis C infection afflicts millions of people worldwide. Although antiviral treatments are increasingly effective, many hepatitis C virus (HCV) patients avoid treatment, do not complete or respond to treatment, or have contraindications. Self-management interventions are one option for promoting behavioral changes leading to…

  19. The experience of living with diabetes following a self-management program based on motivational interviewing

    DEFF Research Database (Denmark)

    Rosenbek Minet, Lisbeth K; Lønvig, Else-Marie; Henriksen, Jan Erik

    2011-01-01

    conducted seven focus group interviews, each comprising 3 to 5 participants diagnosed with type 1 or type 2 diabetes. Data analysis based on a phenomenological method revealed three main themes concerning diabetes self-management: becoming a self-regulating practitioner, managing the rules of self...

  20. Standardising the Lay: Logics of Change in Programs of Disease Self-management

    DEFF Research Database (Denmark)

    Juul Nielsen, Annegrete; Grøn, Lone

    2012-01-01

    -managing patient is intended as a challenge to traditional medical authority by introducing lay methods of knowing disease. Rather than a meeting between authoritative professionals and vulnerable patients, the self-managing patient seeks to open up new spaces for a meeting between experts. The present paper...

  1. Self-management for obesity and cardio-metabolic fitness: Description and evaluation of the lifestyle modification program of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Coates Alison M

    2008-10-01

    Full Text Available Abstract Background Sustainable lifestyle modification strategies are needed to address obesity and cardiovascular risk factors. Intensive, individualised programs have been successful, but are limited by time and resources. We have formulated a group-based lifestyle education program based upon national diet and physical activity (PA recommendations to manage obesity and cardio-metabolic risk factors. This article describes the content and delivery of this program, with information on compliance and acceptability. Methods Overweight/obese adults (n = 153 with metabolic syndrome were recruited from the community and randomly allocated to intervention (INT or control (CON. Written copies of Australian national dietary and PA guidelines were provided to all participants. INT took part in a 16-week lifestyle program which provided a curriculum and practical strategies on 1 dietary and PA information based on national guidelines, 2 behavioural self-management tools, 3 food-label reading, supermarkets tour and cooking, 4 exercise sessions, and 5 peer-group support. Compliance was assessed using attendance records and weekly food/PA logs. Participants' motivations, perceived benefits and goals were assessed through facilitated discussion. Program acceptability feedback was collected through structured focus groups. Results Although completion of weekly food/PA records was poor, attendance at information/education sessions (77% overall and exercise participation (66% overall was high, and compared with CON, multiple markers of body composition and cardio-metabolic health improved in INT. Participants reported that the most useful program components included food-label reading, cooking sessions, and learning new and different physical exercises, including home-based options. Participants also reported finding self-management techniques helpful, namely problem solving and short-term goal setting. The use of a group setting and supportive 'peer' leaders

  2. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions.

    Science.gov (United States)

    Solberg, Hilde Strøm; Steinsbekk, Aslak; Solbjør, Marit; Granbo, Randi; Garåsen, Helge

    2014-11-08

    Development of more self-management support programmes in primary health care has been one option used to enhance positive outcomes in chronic disease management. At present, research results provide no consensus on what would be the best way to develop support programmes into new settings. The aim of the present study was therefore to explore users' and health professionals' perceptions of what would be the vital elements in a self - management support programme applicable in primary health care, how to account for them, and why. Four qualitative, semi-structured focus group interviews were conducted in Central Norway. The informants possessed experience in development, provision, or participation in a self-management support programme. Data was analysed by the Systematic Text Condensation method. The results showed an overall positive expectation to the potential benefits of development of a self-management support programme in primary health care. Despite somewhat different arguments and perspectives, the users and the health professionals had a joint agreement on core characteristics; a self-management support programme in primary health care should therefore be generic, not disease specific, and delivered in a group- based format. A special focus should be on the everyday- life of the participants. The most challenging aspect was a present lack of competence and experience among health professionals to moderate self-management support programmes. The development and design of a relevant and applicable self-management support programme in primary health care should balance the interests of the users with the possibilities and constraints within each municipality. It would be vital to benefit from the closeness of the patients' every-day life situations. The user informants' perception of a self-management support programme as a supplement to regular medical treatment represented an expanded understanding of the self-management support concept. An exploring

  3. Implementation of the Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Process Evaluation of a Randomized Controlled Trial.

    Science.gov (United States)

    Boots, Lizzy Mm; de Vugt, Marjolein E; Smeets, Claudia Mj; Kempen, Gertrudis Ijm; Verhey, Frans Rj

    2017-12-19

    Caring for a family member with dementia puts caregivers at risk of overburdening. Electronic health (eHealth) support for caregivers offers an opportunity for accessible tailored interventions. The blended care self-management program "Partner in Balance" (PiB) for early-stage dementia caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored Web-based modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability and interpretation of results. The aim of this study was to describe the process evaluation from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to determine internal and external validity before the effect analysis and aid future implementation. Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from logistical research data, coach questionnaires (n=13), and interviews with coaches (n=10) and participants (n=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis. The participation rate of eligible caregivers was 51.9% (80/154). Recruitment barriers were lack of computer and lack of need for support. Young age and employment were considered recruitment facilitators. All coaches attended training and supervision in blended care self-management. Deviations from the structured protocol were reported on intervention time, structure, and feedback. Coaches described an intensified relationship with the caregiver post intervention. Caregivers appreciated the tailored content and positive feedback. The blended structure increased their openness. The discussion forum was appreciated less. Overall, personal goals were attained after the program (T>50). Implementation barriers included lack of financing

  4. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches.

    Science.gov (United States)

    Elissen, Arianne; Nolte, Ellen; Knai, Cécile; Brunn, Matthias; Chevreul, Karine; Conklin, Annalijn; Durand-Zaleski, Isabelle; Erler, Antje; Flamm, Maria; Frølich, Anne; Fullerton, Birgit; Jacobsen, Ramune; Saz-Parkinson, Zuleika; Sarria-Santamera, Antonio; Sönnichsen, Andreas; Vrijhoef, Hubertus

    2013-03-26

    Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals' views on the implementation of self-management support in practice. Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients' medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.

  5. Feasibility of a mobile and web-based intervention to support self-management in outpatients with cancer pain.

    Science.gov (United States)

    Hochstenbach, Laura M J; Zwakhalen, Sandra M G; Courtens, Annemie M; van Kleef, Maarten; de Witte, Luc P

    2016-08-01

    Cancer pain is a prevalent and distressing symptom. To enhance self-management in outpatients, a multi-component intervention was developed, integrating patient self-management and professional care through healthcare technology. This article describes feasibility of the intervention in everyday practice. Patients with moderate to severe cancer pain (n = 11) and registered nurses specialized in pain and palliative care (n = 3) participated in a four-week study. The intervention involved daily monitoring, graphical feedback, education, and advice by means of a mobile application for patients and a web application for nurses. Learnability, usability and desirability were measured in patients with a 20-item questionnaire (1-5 scale), higher scores indicating better feasibility. Patients' adherence was based on completion rates from server logs. Single semi-structured interviews with patients and a focus group interview with nurses provided insight into experiences. Questionnaire findings confirmed learnability (4.8), usability (4.8) and desirability (4.6) of the application for patients. Average completion rates were 76.8% for pain monitoring, 50.4% for medication monitoring and 100% for education sessions. Interviews revealed that patients were pleased with the simplicity of the mobile application and appreciated different components. Nurses agreed upon the added value and were mostly positive about the possibilities of the web application. Patients and nurses provided ideas for improvements relating to the content and technical performance of the intervention. Study results demonstrate feasibility of the intervention in everyday practice. Provided that content-related and technical adjustments are made, the intervention enables patients with cancer pain to practice self-management and nurses to remotely support these patients. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  6. Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort.

    Science.gov (United States)

    Khan, Ainee; Dickens, Andrew P; Adab, Peymane; Jordan, Rachel E

    2017-07-20

    Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided. CALL FOR

  7. Reduction of sickness absence by an occupational health care management program focusing on self-efficacy and self-management.

    Science.gov (United States)

    Linden, Michael; Muschalla, Beate; Hansmeier, Thomas; Sandner, Gabriele

    2014-01-01

    The aim of occupational health care management programs (OHMP) is to improve the health status of employees, increase work ability and reduce absence time. This includes better coping abilities, work-related self-efficacy and self-management which are important abilities that should be trained within OHMPs. To study the effectiveness of an OHMP including special interventions to enhance self-efficacy and self-management. Employees from the German Federal Pension Agency. Effects of an OHMP on sickness absence was studied by comparing an intervention group and two control groups. A core feature of the OHMP were group sessions with all members of working teams, focussing on self-efficacy and self management of the individual participant as well as the team as a group (focus groups). Participants in the OHMP were asked for their subjective evaluation of the focus groups. Rates of sickness absence were taken from the routine data of the employer. Participants of the OHMP indicated that they had learned better ways of coping and communication and that they had generated intentions to make changes in their working situation. The rate of sickness absence in the intervention group decreased from 9.26% in the year before the OHMP to 7.93% in the year after the program, while there was in the same time anincrease of 7.9% and 10.7% in the two control groups. The data suggest that OHMP with focus on self-efficacy and self management of individuals and teams are helpful in reducing work absenteeism.

  8. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps in a Medicaid managed care plan: study protocol

    Directory of Open Access Journals (Sweden)

    Ratanawongsa Neda

    2012-01-01

    Full Text Available Abstract Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps. Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252, primary outcomes will be

  9. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol

    Science.gov (United States)

    2012-01-01

    Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps). Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and

  10. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol.

    Science.gov (United States)

    Ratanawongsa, Neda; Handley, Margaret A; Quan, Judy; Sarkar, Urmimala; Pfeifer, Kelly; Soria, Catalina; Schillinger, Dean

    2012-01-26

    Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps). This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and functional status with

  11. Supporting self-management of obesity using a novel game architecture.

    Science.gov (United States)

    Giabbanelli, Philippe J; Crutzen, Rik

    2015-09-01

    Obesity has commonly been addressed using a 'one size fits all' approach centred on a combination of diet and exercise. This has not succeeded in halting the obesity epidemic, as two-thirds of American adults are now obese or overweight. Practitioners are increasingly highlighting that one's weight is shaped by myriad factors, suggesting that interventions should be tailored to the specific needs of individuals. Health games have potential to provide such tailored approach. However, they currently tend to focus on communicating and/or reinforcing knowledge, in order to suscitate learning in the participants. We argue that it would be equally, if not more valuable, that games learn from participants using recommender systems. This would allow treatments to be comprehensive, as games can deduce from the participants' behaviour which factors seem to be most relevant to his or her weight and focus on them. We introduce a novel game architecture and discuss its implications on facilitating the self-management of obesity. © The Author(s) 2014.

  12. Effectiveness of Teach-Back Self-Management Training Program on Happiness of Breast Cancer Patients

    Science.gov (United States)

    Ahmadidarrehsima, Sudabeh; Rahnama, Mozhgan; Afshari, Mahdi; Asadi Bidmeshki, Elahe

    2016-10-01

    Self-management training is one of the ways to empower patients to cope with disease. The aim of this before-and-after quasi-experimental study was to determine effects of a teach-back self-management training method on breast cancer patient happiness. Fifty breast cancer patients who visited the Park-e Neshat Limited Surgery Clinic in Kerman, Iran were randomly divided into intervention and control groups after convenience sampling and checking for inclusion eligibility. Data were collected using a demographic questionnaire and the Oxford Happiness Inventory before and after teach-back training and analyzed using SPSS 23. Findings showed no significant difference between mean happiness scores in the two groups before the intervention. However, after the intervention, the mean happiness score in the intervention group increased from 37.2 to 62.9, while it decreased from 41.4 to 29.8 in the control group. These changes were statistically significant (phappiness levels in breast cancer patients. Therefore, the use of this method is recommended to improve self-management and increase happiness. Creative Commons Attribution License

  13. Effect of a health coaching self-management program for older adults with multimorbidity in nursing homes

    Directory of Open Access Journals (Sweden)

    Park YH

    2014-07-01

    Full Text Available Yeon-Hwan Park,1,2 HeeKyung Chang31College of Nursing, 2The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea; 3Seoul Women’s College of Nursing, Seoul, South KoreaBackground and aims: Although a growing number of older people are suffering from multimorbidity, most of the health problems related to multimorbidity can be improved by self-management. The aim of this study was to examine the effectiveness of a health coaching self-management program for older adults with multimorbidity in nursing homes. Methods: Older adults with multimorbidity from one nursing home in Korea were randomly allocated to either an intervention group (n=22 or conventional group (n=21. Participants in the intervention group met face to face with the researchers twice a week for 8 weeks, during which time the researchers engaged them in goal setting and goal performance using the strategies in the health coaching self-management program. Regular care was provided to the other participants in the conventional group. Results: Participants in the intervention group had significantly better outcomes in exercise behaviors (P=0.015, cognitive symptom management (P=0.004, mental stress management/relaxation (P=0.023, self-rated health (P=0.002, reduced illness intrusiveness (P<0.001, depression (P<0.001, and social/role activities limitations (P<0.001. In addition, there was a significant time-by-group interaction in self-efficacy (P=0.036. According to the goal attainment scales, their individual goals of oral health and stress reduction were achieved.Conclusion: The health coaching self-management program was successfully implemented in older adults with multimorbidity in a nursing home. Further research is needed to develop and evaluate the long-term effects of an intervention to enhance adherence to self-management and quality of life for older adults with multimorbidity.Keywords: chronic diseases, nursing intervention, older adults

  14. Sodium Restriction in Patients With CKD: A Randomized Controlled Trial of Self-management Support.

    Science.gov (United States)

    Meuleman, Yvette; Hoekstra, Tiny; Dekker, Friedo W; Navis, Gerjan; Vogt, Liffert; van der Boog, Paul J M; Bos, Willem Jan W; van Montfrans, Gert A; van Dijk, Sandra

    2017-05-01

    To evaluate the effectiveness and sustainability of self-managed sodium restriction in patients with chronic kidney disease. Open randomized controlled trial. Patients with moderately decreased kidney function from 4 hospitals in the Netherlands. Regular care was compared with regular care plus an intervention comprising education, motivational interviewing, coaching, and self-monitoring of blood pressure (BP) and sodium. Primary outcomes were sodium excretion and BP after the 3-month intervention and at 6-month follow-up. Secondary outcomes were protein excretion, kidney function, antihypertensive medication, self-efficacy, and health-related quality of life (HRQoL). At baseline, mean sodium excretion rate was 163.6±64.9 (SD) mmol/24 h; mean estimated glomerular filtration rate was 49.7±25.6mL/min/1.73m 2 ; median protein excretion rate was 0.8 (IQR, 0.4-1.7) g/24 h; and mean 24-hour ambulatory systolic and diastolic BPs were 129±15 and 76±9mmHg, respectively. Compared to regular care only (n=71), at 3 months, the intervention group (n=67) showed reduced sodium excretion rate (mean change, -30.3 [95% CI, -54.7 to -5.9] mmol/24 h), daytime ambulatory diastolic BP (mean change, -3.4 [95% CI, -6.3 to -0.6] mmHg), diastolic office BP (mean change, -5.2 [95% CI, -8.4 to -2.1] mmHg), protein excretion (mean change, -0.4 [95% CI, -0.7 to -0.1] g/24h), and improved self-efficacy (mean change, 0.5 [95% CI, 0.1 to 0.9]). At 6 months, differences in sodium excretion rates and ambulatory BPs between the groups were not significant, but differences were detected in systolic and diastolic office BPs (mean changes of -7.3 [95% CI, -12.7 to -1.9] and -3.8 [95% CI, -6.9 to -0.6] mmHg, respectively), protein excretion (mean changes, -0.3 [95% CI, -0.6 to -0.1] g/24h), and self-efficacy (mean change, 0.5 [95% CI, 0.0 to 0.9]). No differences in kidney function, medication, and HRQoL were observed. Nonblinding, relatively low response rate, and missing data

  15. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial.

    Science.gov (United States)

    van Gaalen, Johanna L; Bakker, Moira J; van Bodegom-Vos, Leti; Snoeck-Stroband, Jiska B; Assendelft, Willem J J; Kaptein, Ad A; van der Meer, Victor; Taube, Christian; Thoonen, Bart P; Sont, Jacob K

    2012-11-21

    Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS): dissemination of the IBSM program; intermediate strategy (IS): MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals); and extended strategy (ES): IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions) are primarily targeted at general practices, randomisation will occur at practice level.In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations); self-management related outcomes (health education impact, medication adherence, and illness perceptions); and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption. Follow-up is six months per patient. This study

  16. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    Directory of Open Access Journals (Sweden)

    van Gaalen Johanna L

    2012-11-01

    Full Text Available Abstract Background Internet-based self-management (IBSM support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical practice. Methods/design This study is a three-arm cluster randomized trial with a cluster pre-randomisation design and 12 months follow-up per practice comparing the following three IBSM implementation strategies: minimum strategy (MS: dissemination of the IBSM program; intermediate strategy (IS: MS + start-up support for professionals (i.e., support in selection of the appropriate population and training of professionals; and extended strategy (ES: IS + additional training and ongoing support for professionals. Because the implementation strategies (interventions are primarily targeted at general practices, randomisation will occur at practice level. In this study, we aim to evaluate 14 primary care practices per strategy in the Leiden-The Hague region, involving 140 patients per arm. Patients aged 18 to 50 years, with a physician diagnosis of asthma, prescription of inhaled corticosteroids, and/or montelukast for ≥3 months in the previous year are eligible to participate. Primary outcome measures are the proportion of referred patients that participate in IBSM, and the proportion of patients that have clinically relevant improvement in the asthma-related quality of life. The secondary effect measures are clinical outcomes (asthma control, lung function, usage of airway treatment, and presence of exacerbations; self-management related outcomes (health education impact, medication adherence, and illness perceptions; and patient utilities. Process measures are the proportion of practices that participate in IBSM and adherence of professionals to implementation strategies. Cost-effective measurements are medical costs and healthcare consumption

  17. Evaluating self-management behaviors of diabetic patients in a telehealthcare program: longitudinal study over 18 months.

    Science.gov (United States)

    Chen, Lichin; Chuang, Lee-Ming; Chang, Chia-Hsiun; Wang, Chiou-Shiang; Wang, I-Ching; Chung, Yufang; Peng, Hui-Yu; Chen, Hui-Chuen; Hsu, Yu-Ling; Lin, Yu-Sheng; Chen, Huang-Jen; Chang, Tieng-Chun; Jiang, Yi-Der; Lee, Hung-Chang; Tan, Ching-Ting; Chang, Hsin-Lu; Lai, Feipei

    2013-12-09

    Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors. The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels. A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not. There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (Pproblem solving (Pvalue of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month

  18. Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study.

    Science.gov (United States)

    Koetsenruijter, Jan; van Lieshout, Jan; Vassilev, Ivaylo; Portillo, Mari Carmen; Serrano, Manuel; Knutsen, Ingrid; Roukova, Poli; Lionis, Christos; Todorova, Elka; Foss, Christina; Rogers, Anne; Wensing, Michel

    2014-03-04

    Long-term conditions pose major challenges for healthcare systems. Optimizing self-management of people with long-term conditions is an important strategy to improve quality of life, health outcomes, patient experiences in healthcare, and the sustainability of healthcare systems. Much research on self-management focuses on individual competencies, while the social systems of support that facilitate self-management are underexplored. The presented study aims to explore the role of social systems of support for self-management and quality of life, focusing on the social networks of people with diabetes and community organisations that serve them. The protocol concerns a cross-sectional study in 18 geographic areas in six European countries, involving a total of 1800 individuals with diabetes and 900 representatives of community organisations. In each country, we include a deprived rural area, a deprived urban area, and an affluent urban area. Individuals are recruited through healthcare practices in the targeted areas. A patient questionnaire comprises measures for quality of life, self-management behaviours, social network and social support, as well as individual characteristics. A community organisations' survey maps out interconnections between community and voluntary organisations that support patients with chronic illness and documents the scope of work of the different types of organisations. We first explore the structure of social networks of individuals and of community organisations. Then linkages between these social networks, self-management and quality of life will be examined, taking deprivation and other factors into account. This study will provide insight into determinants of self-management and quality of life in individuals with diabetes, focusing on the role of social networks and community organisations.

  19. The effectiveness of self-management support interventions for men with long-term conditions: a systematic review and meta-analysis.

    Science.gov (United States)

    Galdas, Paul; Fell, Jennifer; Bower, Peter; Kidd, Lisa; Blickem, Christian; McPherson, Kerri; Hunt, Kate; Gilbody, Simon; Richardson, Gerry

    2015-03-20

    To assess the effectiveness of self-management support interventions in men with long-term conditions. A quantitative systematic review with meta-analysis. The Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by sex. Data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted using the Cochrane Risk of Bias Tool. Meta-analysis was conducted to compare the effects of interventions in men, women, and mixed-sex sub-groups. 40 RCTs of self-management support interventions in men, and 20 eligible RCTs where an analysis by sex was reported, were included in the review. Meta-analysis suggested that physical activity, education, and peer support-based interventions have a positive impact on quality of life in men. However, there is currently insufficient evidence to make strong statements about whether self-management support interventions show larger, similar or smaller effects in men compared with women and mixed-sex groups. Clinicians may wish to consider whether certain types of self-management support (eg, physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Managing 'difficult emotions' and family life: exploring insights and social support within online self-management training.

    Science.gov (United States)

    Sanders, C; Rogers, A; Gardner, C; Kennedy, A

    2011-06-01

    Previous research has demonstrated how the Internet can foster emotional support and provide a 'private' space for discussing sensitive issues. Whilst the family has been located as a primary source of support, empirical research on the dynamics of close personal relationships in chronic illness experience remains a challenge. To explore the role of family relationships in supporting self-care and the nature of social support exchanged within an online self-management training course. Qualitative thematic and narrative analysis of online discussion boards. Postings for 218 participants, divided between 11 groups were included for a course section that focused on 'difficult emotions'. Participants exchanged a high degree of emotional support and revealed much about their 'real life' relationships. The latter highlighted the complexities of managing illness within family contexts alongside additional pressures of daily life such as caring commitments and work roles. The private interactive space created within the course allowed insights into the dynamics of family life associated with illness management that are challenging to research. Simultaneously, collective support was developed amongst this group of predominantly working women. The article points to the implications for such interventions and associated evaluative research beyond this selective group.

  1. Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Azzurra Massimi

    Full Text Available The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs and patients reported outcomes (PROs, with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP and diastolic (DBP blood pressure reduction (10 studies-3,881 patients and HbA1c reduction (7 studies-2,669 patients were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06, DBP -1.42 (95% CI -1.42--0.49 and HbA1c -0.15 (95% CI -0.32-0.01 in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP or CVD (DBP, if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.

  2. Randomised feasibility study of a novel experience-based internet intervention to support self-management in chronic asthma.

    Science.gov (United States)

    Newhouse, Nikki; Martin, Angela; Jawad, Sena; Yu, Ly-Mee; Davoudianfar, Mina; Locock, Louise; Ziebland, Sue; Powell, John

    2016-12-28

    To determine the feasibility of a randomised controlled trial (RCT) assessing the effects of an experience-based website as a resource for the self-management of chronic asthma. Feasibility, single-blind RCT in 2 regions of England. Randomisation used computer-generated random number sequence in a 1:1 ratio, after baseline data collection, to website access for 2 weeks. Adults (age ≥18 years), with clinically diagnosed asthma as coded in their primary care electronic record, prescribed inhaled corticosteroids for at least 3 months in the previous year, were recruited from 9 general practices. The EXPERT asthma intervention is an interactive PC/laptop/tablet/smartphone compatible website designed with extensive input from adults with asthma. It provides experience-based information and aims to support subjective perception of self-efficacy, self-management and improve health status. Primary outcomes were consent/recruitment, website usage and completion of outcome measures. Secondary outcomes included Partners in Health (PIH) questionnaire, the Chronic Disease Self-Efficacy Scale, the SF36 and the E-Health Impact Questionnaire. Participant blinding postrandomisation was not possible. The analysis was blind to allocation. Recruitment target exceeded. 148 participants randomised (73 intervention group). Age range 19-84 years; 59% female. 121 of 148 (84%; 62 intervention group) followed up. The median number of logins was 2 (IQR 2-3, range 1-48). Minimal differences of change from baseline between groups; both showed improvement in health state or management of their condition with no significant differences between arms. No adverse events. Recruitment and retention confirmed feasibility. The trends towards improved outcomes suggest that further research on digital interventions based on exposure to others' personal experiences may be of value in the self-management of chronic asthma. ISRCTN29549695; Results. Published by the BMJ Publishing Group Limited. For

  3. Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease.

    Science.gov (United States)

    Lakshminarayana, Rashmi; Wang, Duolao; Burn, David; Chaudhuri, K Ray; Galtrey, Clare; Guzman, Natalie Valle; Hellman, Bruce; Ben James; Pal, Suvankar; Stamford, Jon; Steiger, Malcolm; Stott, R W; Teo, James; Barker, Roger A; Wang, Emma; Bloem, Bastiaan R; van der Eijk, Martijn; Rochester, Lynn; Williams, Adrian

    2017-01-01

    consultation (0.15, 95% CI 0.03 to 0.27; p  = 0.0110). The change in non-motor symptoms was -0.82 (95% CI -1.75 to 0.10; p  = 0.0822). 72% of participants in the Parkinson's tracker app group continued to use and engage with the application throughout the 16-week trial period. The Parkinson's tracker app can be an effective and novel way of enhancing self-reported medication adherence and quality of clinical consultation by supporting self-management in Parkinson's disease in patients owning smartphones. Further work is recommended to determine whether the benefits of the intervention are maintained beyond the 16 week study period.

  4. Usage and users of online self-management programs for adult patients with atopic dermatitis and food allergy: an explorative study.

    Science.gov (United States)

    van Os-Medendorp, Harmieke; van Leent-de Wit, Ilse; de Bruin-Weller, Marjolein; Knulst, André

    2015-05-23

    variable revealed that adding the self-management domain "social integration and support" to the model led to an R(2) of .13. The modules with information about the disease, diagnosis, and treatment were most visited. Most hits were on the information parts of the modules (55-58%), followed by exercises (30-32%). The online self-management programs "Living with eczema" and "Living with food allergy" were used by patients in addition to the usual face-to-face care. Almost 60% of all referred patients logged in, with an average of three log-ins. All modules seemed to be relevant, but there is room for improvement in the use of the training. Age, quality of life, and lower social integration and support were related to the use of the training, but only part of the variance in use could be explained by these variables.

  5. Arthritis self-management education programs: a meta-analysis of the effect on pain and disability.

    Science.gov (United States)

    Warsi, Asra; LaValley, Michael P; Wang, Philip S; Avorn, Jerry; Solomon, Daniel H

    2003-08-01

    Some reports suggest that education programs help arthritis patients better manage their symptoms and improve function. This review of the published literature was undertaken to assess the effect of such programs on pain and disability. Medline and HealthSTAR were searched for the period 1964-1998. The references of each article were then hand-searched for further publications. Studies were included in the meta-analysis if the intervention contained a self-management education component, a concurrent control group was included, and pain and/or disability were assessed as end points. Two authors reviewed each study. The methodologic attributes and efficacy of the interventions were assessed using a standardized abstraction tool, and the magnitude of the results was converted to a common measure, the effect size. Summary effect sizes were calculated separately for pain and disability. The search strategy yielded 35 studies, of which 17 met inclusion criteria. The mean age of study participants was 61 years, and 69% were female. On average, 19% of patients did not complete followup (range 0-53%). The summary effect size was 0.12 for pain (95% confidence interval [95% CI] 0.00, 0.24) and 0.07 for disability (95% CI 0.00, 0.15). Funnel plots indicated no significant evidence of bias toward the publication of studies with findings that showed reductions in pain or disability. The summary effect sizes suggest that arthritis self-management education programs result in small reductions in pain and disability.

  6. Co-creative development of an eHealth nursing intervention: Self-management support for outpatients with cancer pain.

    Science.gov (United States)

    Hochstenbach, Laura M J; Courtens, Annemie M; Zwakhalen, Sandra M G; Vermeulen, Joan; van Kleef, Maarten; de Witte, Luc P

    2017-08-01

    Co-creative methods, having an iterative character and including different perspectives, allow for the development of complex nursing interventions. Information about the development process is essential in providing justification for the ultimate intervention and crucial in interpreting the outcomes of subsequent evaluations. This paper describes a co-creative method directed towards the development of an eHealth intervention delivered by registered nurses to support self-management in outpatients with cancer pain. Intervention development was divided into three consecutive phases (exploration of context, specification of content, organisation of care). In each phase, researchers and technicians addressed five iterative steps: research, ideas, prototyping, evaluation, and documentation. Health professionals and patients were consulted during research and evaluation steps. Collaboration of researchers, health professionals, patients and technicians was positive and valuable in optimising outcomes. The intervention includes a mobile application for patients and a web application for nurses. Patients are requested to monitor pain, adverse effects and medication intake, while being provided with graphical feedback, education and contact possibilities. Nurses monitor data, advise patients, and collaborate with the treating physician. Integration of patient self-management and professional care by means of eHealth key into well-known barriers and seem promising in improving cancer pain follow-up. Nurses are able to make substantial contributions because of their expertise, focus on daily living, and their bridging function between patients and health professionals in different care settings. Insights from the intervention development as well as the intervention content give thought for applications in different patients and care settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Intermediate Outcomes of a Chronic Disease Self-Management Program for Spanish-Speaking Older Adults in South Florida, 2008–2010

    OpenAIRE

    Michael A. Melchior, PhD; Laura R. Seff, MBA; Elena Bastida, PhD; Ahmed N. Albatineh, PhD; Timothy F. Page, PhD; Richard C. Palmer, DrPH

    2013-01-01

    Introduction The prevalence and negative health effects of chronic diseases are disproportionately high among Hispanics, the largest minority group in the United States. Self-management of chronic conditions by older adults is a public health priority. The objective of this study was to examine 6-week differences in self-efficacy, time spent performing physical activity, and perceived social and role activities limitations for participants in a chronic disease self-management program for Span...

  8. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer.

    Science.gov (United States)

    Hanlon, Peter; Daines, Luke; Campbell, Christine; McKinstry, Brian; Weller, David; Pinnock, Hilary

    2017-05-17

    Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful

  9. Understanding who benefits at each step in an internet-based diabetes self-management program: application of a recursive partitioning approach.

    Science.gov (United States)

    Glasgow, Russell E; Strycker, Lisa A; King, Diane K; Toobert, Deborah J

    2014-02-01

    Efforts to predict success in chronic disease management programs have been generally unsuccessful. To identify patient subgroups associated with success at each of 6 steps in a diabetes self-management (DSM) program. Using data from a randomized trial, recursive partitioning with signal detection analysis was used to identify subgroups associated with 6 sequential steps of program success: agreement to participate, completion of baseline, initial website engagement, 4-month behavior change, later engagement, and longer-term maintenance. The study was conducted in 5 primary care clinics within Kaiser Permanente Colorado. Different numbers of patients participated in each step, including 2076, 544, 270, 219, 127, and 89. All measures available were used to address success at each step. Intervention. Participants were randomized to receive either enhanced usual care or 1 of 2 Internet-based DSM programs: 1) self-administered, computer-assisted self-management and 2) the self-administered program with the addition of enhanced social support. Two sets of potential predictor variables and 6 dichotomous outcomes were created. Signal detection analysis differentiated successful and unsuccessful subgroups at all but the final step. Different patient subgroups were associated with success at these different steps. Demographic factors (education, ethnicity, income) were associated with initial participation but not with later steps, and the converse was true of health behavior variables. Analyses were limited to one setting, and the sample sizes for some of the steps were modest. Signal detection and recursive partitioning methods may be useful for identifying subgroups that are more or less successful at different steps of intervention and may aid in understanding variability in outcomes.

  10. Changing practice to support self-management and recovery in mental illness: application of an implementation model.

    Science.gov (United States)

    Harris, Melanie; Jones, Phil; Heartfield, Marie; Allstrom, Mary; Hancock, Janette; Lawn, Sharon; Battersby, Malcolm

    2015-01-01

    Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.

  11. A Framework to Assist Health Professionals in Recommending High-Quality Apps for Supporting Chronic Disease Self-Management: Illustrative Assessment of Type 2 Diabetes Apps.

    Science.gov (United States)

    Hale, Kelli; Capra, Sandra; Bauer, Judith

    2015-09-14

    This paper presents an approach to assist health professionals in recommending high quality apps for supporting chronic disease self-management. Most app reviews focus on popularity, aesthetics, functionality, usability, and information quality. There is no doubt these factors are important in selecting trustworthy apps which are appealing to users, but behavioral theory may be also be useful in matching the apps to user needs. The framework developed aims to be methodologically sound, capable of selecting popular apps which include content covered by evidence-based programs, consistent with behavioral theory, as well as a patient-centered approach for matching apps to patients' individual needs. A single disease-type 2 diabetes-was selected to illustrate how the framework can be applied as this was deemed to represent the types of strategies used in many chronic diseases. A systematic approach based on behavioral theory and recommendations from best practice guidelines was developed for matching apps to patients' needs. In March 2014, a series of search strategies was used to identify top-rated iPhone and Android health apps, representing 29 topics from five categories of type 2 diabetes self-management strategies. The topics were chosen from published international guidelines for the management of diabetes. The senior author (KH) assessed the most popular apps found that addressed these topics using the Behavioral Theory Content Survey (BTS), which is based on traditional behavioral theory. A tool to assist decision making when using apps was developed and trialed with health professionals for ease of use and understanding. A total of 14 apps were assessed representing all five topic categories of self-management. Total theoretical scores (BTS scores) were less than 50 on a 100-point scale for all apps. Each app scored less than 50% of the total possible BTS score for all four behavioral theories and for most of the 20 behavioral strategies; however, apps scored

  12. Virtual intervention to support self-management of antiretroviral therapy among people living with HIV.

    Science.gov (United States)

    Côté, José; Godin, Gaston; Ramirez-Garcia, Pilar; Rouleau, Geneviève; Bourbonnais, Anne; Guéhéneuc, Yann-Gaël; Tremblay, Cécile; Otis, Joanne

    2015-01-06

    Living with human immunodeficiency virus (HIV) necessitates long-term health care follow-up, particularly with respect to antiretroviral therapy (ART) management. Taking advantage of the enormous possibilities afforded by information and communication technologies (ICT), we developed a virtual nursing intervention (VIH-TAVIE) intended to empower HIV patients to manage their ART and their symptoms optimally. ICT interventions hold great promise across the entire continuum of HIV patient care but further research is needed to properly evaluate their effectiveness. The objective of the study was to compare the effectiveness of two types of follow-up--traditional and virtual--in terms of promoting ART adherence among HIV patients. A quasi-experimental study was conducted. Participants were 179 HIV patients on ART for at least 6 months, of which 99 were recruited at a site offering virtual follow-up and 80 at another site offering only traditional follow-up. The primary outcome was medication adherence and the secondary outcomes were the following cognitive and affective variables: self-efficacy, attitude toward medication intake, symptom-related discomfort, stress, and social support. These were evaluated by self-administered questionnaire at baseline (T0), and 3 (T3) and 6 months (T6) later. On average, participants had been living with HIV for 14 years and had been on ART for 11 years. The groups were highly heterogeneous, differing on a number of sociodemographic dimensions: education, income, marital status, employment status, and living arrangements. Adherence at baseline was high, reaching 80% (59/74) in the traditional follow-up group and 84% (81/97) in the virtual follow-up group. A generalized estimating equations (GEE) analysis was run, controlling for sociodemographic characteristics at baseline. A time effect was detected indicating that both groups improved in adherence over time but did not differ in this regard. Improvement at 6 months was significantly

  13. Working together to promote diabetes control : A practical guide for diabetes health care providers in establishing a working alliance to achieve self-management support

    NARCIS (Netherlands)

    Jones, Allan; Vallis, Michael; Cooke, Debbie; Pouwer, F.

    2016-01-01

    The quality of the "patient-carer" relationship is the foundation of self-management support and has been shown to influence treatment outcome in relation to psychological and somatic illness, including diabetes. It has long been accepted within applied psychology that the quality of the

  14. "Recovery" in bipolar disorder: how can service users be supported through a self-management intervention? A qualitative focus group study.

    Science.gov (United States)

    Todd, Nicholas J; Jones, Steven H; Lobban, Fiona A

    2012-04-01

    Bipolar disorder (BD) is a chronic and recurrent affective disorder. Recovery is defined as the process by which people can live fulfilling lives despite experiencing symptoms. To explore how an opportunistically recruited group of service users with BD experience recovery and self-management to understand more about how a service users' recovery may be supported. Twelve service users with BD took part in a series of focus groups. Service users' responses to questions about their personal experiences of self-management and recovery were analysed. Focus groups were transcribed verbatim and thematic analysis ([ Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101]) was employed to identify common themes in the data. Four key themes were identified: (1) Recovery is not about being symptom free; (2) Recovery requires taking responsibility for your own wellness; (3) Self-management: building on existing techniques; (4) Overcoming barriers to recovery: negativity, stigma and taboo. Service users with BD have provided further support for the concept of recovery and have suggested a number of ways recovery can be supported. A self-management approach informed by the recovery literature has been proposed as a way to support service users' recovery.

  15. Implementation strategies of internet-based asthma self-management support in usual care. Study protocol for the IMPASSE cluster randomized trial

    NARCIS (Netherlands)

    van Gaalen, J.L.; Bakker, M.J.; Bodegom-Vos, L. van; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Kaptein, A.A.; van der Meer, V.; Taube, C.; Thoonen, B.P.A.; Sont, J.K.; for the, I.s.g.

    2012-01-01

    ABSTRACT: BACKGROUND: Internet-based self-management (IBSM) support cost-effectively improves asthma control, asthma related quality of life, number of symptom-free days, and lung function in patients with mild to moderate persistent asthma. The current challenge is to implement IBSM in clinical

  16. Uptake and Effects of the e-Vita Personal Health Record with Self-Management Support and Coaching, for Type 2 Diabetes Patients Treated in Primary Care

    NARCIS (Netherlands)

    van Vugt, M.; de Wit, M.; Sieverink, Floor; Roelofsen, Y.; Hendriks, S.H.; Bilo, H.J.G.; Snoek, F.J.

    2016-01-01

    We studied the use, uptake, and effects of e-Vita, a personal health record, with self-management support and personalized asynchronized coaching, for type 2 diabetes patients treated in primary care. Patients were invited by their practice nurse to join the study aimed at testing use and effects of

  17. Effects of the First Line Diabetes Care (FiLDCare) self-management education and support project on knowledge, attitudes, perceptions, self-management practices and glycaemic control: a quasi-experimental study conducted in the Northern Philippines.

    Science.gov (United States)

    Ku, Grace Marie V; Kegels, Guy

    2014-08-11

    To investigate the effects of implementing a context-adapted diabetes self-management education and support (DSME/S) project based on chronic care models in the Philippines, on knowledge, attitudes, self-management practices, adiposity/obesity and glycaemia of people with diabetes. Prospective quasi-experimental before-after study. 203 people with type 2 diabetes mellitus from two local government units in the Northern Philippines fulfilling set criteria. Context-adapted DSME/S was given to a cohort of people with diabetes by trained pre-existing local government healthcare personnel. Changes in knowledge, attitudes and self-management practices, body mass index, waist circumference, waist-hip ratio (WHR) and glycosylated haemoglobin (HbA1c) were measured 1 year after full project implementation. Non-parametric and parametric descriptive and inferential statistics including logistic regression analysis were done. Complete data were collected from 164 participants. Improvements in glycaemia, waist circumference, WHR, knowledge, some attitudes, adherence to medications and exercise, and an increase in fear of diabetes were significant. Reductions in HbA1c, regardless of level of control, were noted in 60.4%. Significant increase in knowledge (pability to control blood glucose (p=0.004) and adherence to medications (p=0.001) were noted among those whose glycaemia improved. Significant differences between the subgroups whose HbA1c improved and those whose HbA1c deteriorated include male gender (p=0.042), shorter duration of diabetes (p=0.001) and increased perceived ability to control blood glucose (p=0.042). Significant correlates to improved glycaemia were male gender (OR=2.655; p=0.034), duration of diabetes >10 years (OR=0.214; p=0.003) and fear of diabetes (OR=0.490; p=0.048). Context-adapted DSME/S introduced in resource-constrained settings and making use of established human resources for health may improve knowledge, attitudes, self-management practices

  18. Community Program Improves Quality of Life and Self-Management in Older Adults with Diabetes Mellitus and Comorbidity.

    Science.gov (United States)

    Markle-Reid, Maureen; Ploeg, Jenny; Fraser, Kimberly D; Fisher, Kathryn A; Bartholomew, Amy; Griffith, Lauren E; Miklavcic, John; Gafni, Amiram; Thabane, Lehana; Upshur, Ross

    2018-02-01

    To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. Multisite, single-blind, parallel, pragmatic, randomized controlled trial. Four communities in Ontario, Canada. Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159). Client-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. Quality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Other secondary outcome measures were the Generalized Anxiety Disorder Scale, Center for Epidemiologic Studies Depression Scale (CES-D-10), Summary of Diabetes Self-Care Activities (SDSCA), Self-Efficacy for Managing Chronic Disease, and healthcare costs. Morbidity burden was high (average of eight comorbidities). Intention-to-treat analyses using analysis of covariance showed a group difference favoring the intervention for the MCS (mean difference = 2.68, 95% confidence interval (CI) = 0.28-5.09, P = .03), SDSCA (mean difference = 3.79, 95% CI = 1.02-6.56, P = .01), and CES-D-10 (mean difference = -1.45, 95% CI = -0.13 to -2.76, P = .03). No group differences were seen in PCS score, anxiety, self-efficacy, or total healthcare costs. Participation in a 6-month community-based intervention improved quality of life and self-management and reduced depressive symptoms in older adults with T2DM and comorbidity without increasing total healthcare costs.

  19. Managing fatigue after cancer treatment: development of RESTORE, a web-based resource to support self-management.

    Science.gov (United States)

    Foster, C; Calman, L; Grimmett, C; Breckons, M; Cotterell, P; Yardley, L; Joseph, J; Hughes, S; Jones, R; Leonidou, C; Armes, J; Batehup, L; Corner, J; Fenlon, D; Lennan, E; Morris, C; Neylon, A; Ream, E; Turner, L; Richardson, A

    2015-08-01

    The aim of this study is to co-create an evidence-based and theoretically informed web-based intervention (RESTORE) designed to enhance self-efficacy to live with cancer-related fatigue (CRF) following primary cancer treatment. A nine-step process informed the development of the intervention: (1) review of empirical literature; (2) review of existing patient resources; (3) establish theoretical framework; (4) establish design team with expertise in web-based interventions, CRF and people affected by cancer; (5) develop prototype intervention; (6) user testing phase 1; (7) refinement of prototype; (8) user testing phase 2; and (9) develop final intervention. Key stakeholders made a critical contribution at every step of intervention development, and user testing, which involved an iterative process and resulted in the final intervention. The RESTORE intervention has five sessions; sessions 1 and 2 include an introduction to CRF and goal setting. Sessions 3-5 can be tailored to user preference and are designed to cover areas of life where CRF may have an impact: home and work life, personal relationships and emotional adjustment. It is feasible to systematically 'co-create' an evidence-based and theory-driven web-based self-management intervention to support cancer survivors living with the consequences of cancer and its treatment. This is the first account of the development of a web-based intervention to support self-efficacy to manage CRF. An exploratory trial to test the feasibility and acceptability of RESTORE is now warranted. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Engaging faith-based resources to initiate and support diabetes self-management among African Americans: a collaboration of informal and formal systems of care.

    Science.gov (United States)

    Johnson, Patria; Thorman Hartig, Margaret; Frazier, Renee; Clayton, Mae; Oliver, Georgia; Nelson, Belinda W; Williams-Cleaves, Beverly J

    2014-11-01

    Diabetes for Life (DFL), a project of Memphis Healthy Churches (MHC) and Common Table Health Alliance (CTHA; formerly Healthy Memphis Common Table [HMCT]), is a self-management program aimed at reducing health disparities among African Americans with type 2 Diabetes Mellitus in Memphis and Shelby County, Tennessee. This program is one of five national projects that constitute The Alliance to Reduce Disparities in Diabetes, a 5-year grant-funded initiative of The Merck Foundation. Our purpose is to describe the faith-based strategies supporting DFL made possible by linking with an established informal health system, MHC, created by Baptist Memorial Health Care. The MHC network engaged volunteer Church Health Representatives as educators and recruiters for DFL. The components of the DFL project and the effect on chronic disease management for the participants will be described. The stages of DFL recruitment and implementation from an open-access to a closed model involving six primary care practices created a formal health system. The involvement of CTHA, a regional health collaborative, created the opportunity for DFL to expand the pool of health care providers and then recognize the core of providers most engaged with DFL patients. This collaboration between MHC and HMCT led to the organization of the formal health network. © 2014 Society for Public Health Education.

  1. Evaluation of a self-management patient education program for patients with fibromyalgia syndrome: study protocol of a cluster randomized controlled trial.

    Science.gov (United States)

    Musekamp, Gunda; Gerlich, Christian; Ehlebracht-König, Inge; Faller, Hermann; Reusch, Andrea

    2016-02-03

    Fibromyalgia syndrome (FMS) is a complex chronic condition that makes high demands on patients' self-management skills. Thus, patient education is considered an important component of multimodal therapy, although evidence regarding its effectiveness is scarce. The main objective of this study is to assess the effectiveness of an advanced self-management patient education program for patients with FMS as compared to usual care in the context of inpatient rehabilitation. We conducted a multicenter cluster randomized controlled trial in 3 rehabilitation clinics. Clusters are groups of patients with FMS consecutively recruited within one week after admission. Patients of the intervention group receive the advanced multidisciplinary self-management patient education program (considering new knowledge on FMS, with a focus on transfer into everyday life), whereas patients in the control group receive standard patient education programs including information on FMS and coping with pain. A total of 566 patients are assessed at admission, at discharge and after 6 and 12 months, using patient reported questionnaires. Primary outcomes are patients' disease- and treatment-specific knowledge at discharge and self-management skills after 6 months. Secondary outcomes include satisfaction, attitudes and coping competences, health-promoting behavior, psychological distress, health impairment and participation. Treatment effects between groups are evaluated using multilevel regression analysis adjusting for baseline values. The study evaluates the effectiveness of a self-management patient education program for patients with FMS in the context of inpatient rehabilitation in a cluster randomized trial. Study results will show whether self-management patient education is beneficial for this group of patients. German Clinical Trials Register, DRKS00008782 , Registered 8 July 2015.

  2. Impact of a chronic disease self-management program on health care utilization in rural communities: a retrospective cohort study using linked administrative data.

    Science.gov (United States)

    Jaglal, Susan B; Guilcher, Sara J T; Hawker, Gillian; Lou, Wendy; Salbach, Nancy M; Manno, Michael; Zwarenstein, Merrick

    2014-05-01

    Internationally, chronic disease self-management programs (CDSMPs) have been widely promoted with the assumption that confident, knowledgeable patients practicing self-management behavior will experience improved health and utilize fewer healthcare resources. However, there is a paucity of published data supporting this claim and the majority of the evidence is based on self-report. We used a retrospective cohort study using linked administrative health data. Data from 104 tele-CDSMP participants from 13 rural and remote communities in the province of Ontario, Canada were linked to administrative databases containing emergency department (ED) and physician visits and hospitalizations. Patterns of health care utilization prior to and after participation in the tele-CDSMP were compared. Poisson Generalized Estimating Equations regression was used to examine the impact of the tele-CDSMP on health care utilization after adjusting for covariates. There were no differences in patterns of health care utilization before and after participating in the tele-CDSMP. Among participants ≤ 66 years, however, there was a 34% increase in physician visits in the 12 months following the program (OR = 1.34, 95% CI 1.11-1.61) and a trend for decreased ED visits in those >66 years (OR = 0.59, 95% CI 0.33-1.06). This is the first study to examine health care use following participation in the CDSMP in a Canadian population and to use administrative data to measure health care utilization. Similar to other studies that used self-report measures to evaluate health care use we found no differences in health care utilization before and after participation in the CDSMP. Future research needs to confirm our findings and examine the impact of the CDSMP on health care utilization in different age groups to help to determine whether these interventions are more effective with select population groups.

  3. Using intervention mapping (IM) to develop a self-management program for employees with a chronic disease in the Netherlands

    NARCIS (Netherlands)

    Josephine Engels; F. van Dijk; Yvonne Heerkens; J. van der Gulden; S. Detaille

    2010-01-01

    Employees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic

  4. A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country

    Directory of Open Access Journals (Sweden)

    Estibaliz Gamboa Moreno

    2016-01-01

    Full Text Available Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT effects. Methods. Ten health centers (HCs participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8–15 people. The ability of each HC in forming up to 2 groups, participants’ compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394.

  5. A Controlled Pilot Trial of PainTracker Self-Manager, a Web-Based Platform Combined With Patient Coaching, to Support Patients' Self-Management of Chronic Pain.

    Science.gov (United States)

    Sullivan, Mark; Langford, Dale J; Davies, Pamela Stitzlein; Tran, Christine; Vilardaga, Roger; Cheung, Gifford; Yoo, Daisy; McReynolds, Justin; Lober, William B; Tauben, David; Vowles, Kevin E

    2018-03-29

    The objective of this study was to develop and pilot test a chronic pain empowerment and self-management platform, derived from acceptance and commitment therapy, in a pain specialty setting. A controlled, sequential, nonrandomized study design was used to accommodate intervention development and to test the efficacy of the PainTracker Self-Manager (PTSM) intervention (Web-based educational modules and outcome tracking combined with tailored patient coaching sessions and provider guidance). Generalized estimating equations evaluated changes over time (baseline, 3 months, 6 months) in pain self-efficacy (primary outcome), chronic pain acceptance (activity engagement and pain willingness), perceived efficacy in patient-provider interactions, pain intensity and interference, and overall satisfaction with pain treatment (secondary outcomes) between intervention (n = 48) and usual care control groups (n = 51). The full study sample (N = 99) showed greater improvements over time (significant Group × Time interactions) in pain self-efficacy and satisfaction with pain treatment. Among study completers (n = 82), greater improvement in activity engagement as well as pain intensity and interference were also observed. These preliminary findings support the efficacy of the PTSM intervention in a pain specialty setting. Further research is needed to refine and expand the PTSM intervention and to test it in a randomized trial in primary care settings. We developed a Web-based patient empowerment platform that combined acceptance and commitment therapy-based educational modules and tailored coaching sessions with longitudinal tracking of treatments and patient-reported outcomes, named PTSM. Pilot controlled trial results provide preliminary support for its efficacy in improving pain self-efficacy, activity engagement, pain intensity and interference, and satisfaction with pain treatment. Copyright © 2018 The American Pain Society. Published by Elsevier Inc. All

  6. Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson's disease

    NARCIS (Netherlands)

    Lakshminarayana, R.; Wang, D.; Burn, D.; Chaudhuri, K.R.; Galtrey, C.; Guzman, N.V.; Hellman, B.; Ben, J.; Pal, S.; Stamford, J.; Steiger, M.; Stott, R.W.; Teo, J.; Barker, R.A.; Wang, E.; Bloem, B.R.; Eijk, M. van; Rochester, L.; Williams, A.

    2017-01-01

    The progressive nature of Parkinson's disease, its complex treatment regimens and the high rates of comorbid conditions make self-management and treatment adherence a challenge. Clinicians have limited face-to-face consultation time with Parkinson's disease patients, making it difficult to

  7. Dissemination of Chronic Disease Self-Management Education (CDSME) Programs in the United States: Intervention Delivery by Rurality.

    Science.gov (United States)

    Smith, Matthew Lee; Towne, Samuel D; Herrera-Venson, Angelica; Cameron, Kathleen; Kulinski, Kristie P; Lorig, Kate; Horel, Scott A; Ory, Marcia G

    2017-06-14

    Background : Alongside the dramatic increase of older adults in the United States (U.S.), it is projected that the aging population residing in rural areas will continue to grow. As the prevalence of chronic diseases and multiple chronic conditions among adults continues to rise, there is additional need for evidence-based interventions to assist the aging population to improve lifestyle behaviors, and self-manage their chronic conditions. The purpose of this descriptive study was to identify the geospatial dissemination of Chronic Disease Self-Management Education (CDSME) Programs across the U.S. in terms of participants enrolled, workshops delivered, and counties reached. These dissemination characteristics were compared across rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas, and non-metro areas not adjacent to metro areas). Methods : This descriptive study analyzed data from a national repository including efforts from 83 grantees spanning 47 states from December 2009 to December 2016. Counts were tabulated and averages were calculated. Results : CDSME Program workshops were delivered in 56.4% of all U.S. counties one or more times during the study period. Of the counties where a workshop was conducted, 50.5% were delivered in non-metro areas. Of the 300,640 participants enrolled in CDSME Programs, 12% attended workshops in non-metro adjacent areas, and 7% attended workshops in non-metro non-adjacent areas. The majority of workshops were delivered in healthcare organizations, senior centers/Area Agencies on Aging, and residential facilities. On average, participants residing in non-metro areas had better workshop attendance and retention rates compared to participants in metro areas. Conclusions : Findings highlight the established role of traditional organizations/entities within the aging services network, to reach remote areas and serve diverse participants (e.g., senior centers). To facilitate growth in rural areas

  8. Dissemination of Chronic Disease Self-Management Education (CDSME Programs in the United States: Intervention Delivery by Rurality

    Directory of Open Access Journals (Sweden)

    Matthew Lee Smith

    2017-06-01

    Full Text Available Background: Alongside the dramatic increase of older adults in the United States (U.S., it is projected that the aging population residing in rural areas will continue to grow. As the prevalence of chronic diseases and multiple chronic conditions among adults continues to rise, there is additional need for evidence-based interventions to assist the aging population to improve lifestyle behaviors, and self-manage their chronic conditions. The purpose of this descriptive study was to identify the geospatial dissemination of Chronic Disease Self-Management Education (CDSME Programs across the U.S. in terms of participants enrolled, workshops delivered, and counties reached. These dissemination characteristics were compared across rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas, and non-metro areas not adjacent to metro areas. Methods: This descriptive study analyzed data from a national repository including efforts from 83 grantees spanning 47 states from December 2009 to December 2016. Counts were tabulated and averages were calculated. Results: CDSME Program workshops were delivered in 56.4% of all U.S. counties one or more times during the study period. Of the counties where a workshop was conducted, 50.5% were delivered in non-metro areas. Of the 300,640 participants enrolled in CDSME Programs, 12% attended workshops in non-metro adjacent areas, and 7% attended workshops in non-metro non-adjacent areas. The majority of workshops were delivered in healthcare organizations, senior centers/Area Agencies on Aging, and residential facilities. On average, participants residing in non-metro areas had better workshop attendance and retention rates compared to participants in metro areas. Conclusions: Findings highlight the established role of traditional organizations/entities within the aging services network, to reach remote areas and serve diverse participants (e.g., senior centers. To facilitate growth in rural

  9. Usage and users of online self-management programs for adult patients with atopic dermatitis and food allergy : an explorative study

    NARCIS (Netherlands)

    van Os-Medendorp, Harmieke; van Leent-de Wit, Ilse; de Bruin-Weller, Marjolein; Knulst, André

    2015-01-01

    BACKGROUND: Two online self-management programs for patients with atopic dermatitis (AD) or food allergy (FA) were developed with the aim of helping patients cope with their condition, follow the prescribed treatment regimen, and deal with the consequences of their illness in daily life. Both

  10. Comorbidity and lack of education countered participation in the “Ready to Act” self-management program targeted people with early dysglycaemia

    DEFF Research Database (Denmark)

    Maindal, Helle Terkildsen; Skriver, Mette Vinther; Kirkevold, Marit

    2011-01-01

    is increasingly being offered in primary care. Due to nonparticipation in self-management programs, healthcare providers often miss the opportunity to provide the basic knowledge and skills resulting in uninformed selfmanagement decisions. Methods. A prospective cohort-study was conducted in 2010 within...

  11. The Effectiveness of the Instructional Programs Based on Self-Management Strategies in Acquisition of Social Skills by the Children with Intellectual Disabilities

    Science.gov (United States)

    Avcioglu, Hasan

    2012-01-01

    The purpose of this study is to evaluate the effectiveness of self-management skills training program, based on self-control strategies, on students with intellectual disabilities. A multiple-probe design across subjects single-subject research methodology was used in this study. Nine students with intellectual disabilities, whose ages are between…

  12. “I just have diabetes”: children’s need for diabetes self-management support and how a social robot can accommodate their needs

    Directory of Open Access Journals (Sweden)

    Blanson Henkemans OA

    2012-07-01

    Full Text Available Olivier A Blanson Henkemans, Vera Hoondert, Femke Schrama-Groot, Rosemarijn Looije, Laurence L Alpay, Mark A NeerincxTNO, Lifestyle, Leiden, The NetherlandsPurpose: Children with type 1 diabetes need to self-manage their illness to minimize its impact on their long-term health. However, because children are still developing cognitively and emotionally, self-management is challenging. The European FP7 project, ALIZ-E, looks at how social robots can support children aged 8–12 years with their diabetes self-management. To acquire user requirements for such a robot, we studied how diabetes self-management is organized for children and how they experience their illness and its management regarding their quality of life.Methods: We conducted semistructured interviews with diabetes caregivers (n = 6 and children 8–12 with type 1 diabetes (n = 9, and surveyed their parents (n = 9.Results: Results of the interviews with caregivers show that parents play a prominent role in diabetes self-management and, accordingly, children do not experience significant problems. However, because children develop a need for autonomy during puberty, it is important that they become more proficient in their self-management at an earlier age. Results of the interviews with children show that they accept diabetes as a part of their life and want to be seen as regular children. Also, children experience difficulties in unusual situations (eg, doing sports and vacationing and at school. The illness comes at the cost of the child’s mental well-being (eg, insecurity, fear, and worry and physical well-being (eg, listlessness and tiredness. Regarding social well-being, children enjoy attending diabetes camps and having friends with diabetes, due to a common understanding of their condition. Finally, parents are not always fully aware of how children experience their illness.Conclusion: Children could benefit from social robots offering motivation, training, and (parental

  13. Commissioning of self-management support for people with long-term conditions: an exploration of commissioning aspirations and processes.

    Science.gov (United States)

    Reidy, Claire; Kennedy, Anne; Pope, Catherine; Ballinger, Claire; Vassilev, Ivo; Rogers, Anne

    2016-07-15

    To explore how self-management support (SMS) is considered and conceptualised by Clinical Commissioning Groups (CCGs) and whether this is reflected in strategic planning and commissioning. SMS is an essential element of long-term condition (LTC) management and CCGs are responsible for commissioning services that are coordinated, integrated and link into patient's everyday lives. This focus provides a good test and exemplar for how commissioners communicate with their local population to find out what they need. A multisite, quasi-ethnographic exploration of 9 CCGs. National Health Service (NHS) CCGs in southern England, representing varied socioeconomic status, practice sizes and rural and urban areas. Content analysis of CCG forward plans for mention of SMS. Semistructured interviews with commissioners (n=10) explored understanding of SMS and analysed thematically. The practice of commissioning explored through the observations of Service User Researchers (n=5) attending Governing Body meetings (n=10, 30 hours). Observations illuminate the relative absence of SMS and gateways to active engagement with patient and public voices. Content analysis of plans point to tensions between local aspirations and those identified by NHS England for empowering patients by enhancing SMS services ('person-centred', whole systems). Interview data highlight disparities in the process of translating the forward plans into practice. Commissioners reference SMS as a priority yet details of local initiatives are notably absent with austerity (cost-containment) and nationally measured biomedical outcomes taking precedence. Commissioners conceptualise locally sensitive SMS as a means to improve health and reduce service use, but structural and financial constraints result in prioritisation of nationally driven outcome measures and payments relating to biomedical targets. Ultimately, there is little evidence of local needs driving SMS in CCGs. CCGs need to focus more on early strategic

  14. Cardiovascular Disease Self-Management: Pilot Testing of an mHealth Healthy Eating Program

    Directory of Open Access Journals (Sweden)

    Leila Pfaeffli Dale

    2014-03-01

    Full Text Available Cardiac rehabilitation (CR is crucial in the management of cardiovascular disease (CVD, yet attendance is poor. Mobile technology (mHealth offers a potential solution to increase reach of CR. This paper presents two development studies to determine mobile phone usage in adults with CVD and to evaluate the acceptability of an mHealth healthy eating CR program. Methods: CR attendees were surveyed to determine mobile phone usage rates. A second single-subject pilot study investigated perceptions of a 4-week theory-based healthy eating mHealth program and explored pre-post changes in self-efficacy. Results: 74 adults with CVD completed the survey (50/74 male; mean age 63 ± 10. Nearly all had mobile phones (70/74; 95% and used the Internet (69/74; 93%, and most were interested in receiving CR by text message (57/74; 77%. 20 participants took part in the healthy eating pilot study. Participants read all/most of the text messages, and most (19/20 thought using mobile technology was a good way to deliver the program. The website was not widely used as visiting the website was reported to be time consuming. Exploratory t-tests revealed an increase in heart healthy eating self-efficacy post program, in particular the environmental self-efficacy subset (Mean = 0.62, SD = 0.74, p = 0.001. Conclusions: Text messaging was seen as a simple and acceptable way to deliver nutrition information and behavior change strategies; however, future research is needed to determine the effectiveness of such programs.

  15. Smartphone self-monitoring to support self-management among people living with HIV: perceived benefits and theory of change from a mixed-methods randomized pilot study.

    Science.gov (United States)

    Swendeman, Dallas; Ramanathan, Nithya; Baetscher, Laura; Medich, Melissa; Scheffler, Aaron; Comulada, W Scott; Estrin, Deborah

    2015-05-01

    Self-monitoring by mobile phone applications offers new opportunities to engage patients in self-management. Self-monitoring has not been examined thoroughly as a self-directed intervention strategy for self-management of multiple behaviors and states by people living with HIV (PLH). PLH (n = 50), primarily African American and Latino, were recruited from 2 AIDS services organizations and randomly assigned to daily smartphone (n = 34) or biweekly Web-survey only (n = 16) self-monitoring for 6 weeks. Smartphone self-monitoring included responding to brief surveys on medication adherence, mental health, substance use, and sexual risk behaviors, and brief text diaries on stressful events. Qualitative analyses examine biweekly open-ended user-experience interviews regarding perceived benefits and barriers of self-monitoring, and to elaborate a theoretical model for potential efficacy of self-monitoring to support self-management for multiple domains. Self-monitoring functions include reflection for self-awareness, cues to action (reminders), reinforcements from self-tracking, and their potential effects on risk perceptions, motivations, skills, and behavioral activation states. Participants also reported therapeutic benefits related to self-expression for catharsis, nonjudgmental disclosure, and in-the-moment support. About one-third of participants reported that surveys were too long, frequent, or tedious. Some smartphone group participants suggested that daily self-monitoring was more beneficial than biweekly due to frequency and in-the-moment availability. About twice as many daily self-monitoring group participants reported increased awareness and behavior change support from self-monitoring compared with biweekly Web-survey only participants. Self-monitoring is a potentially efficacious disruptive innovation for supporting self-management by PLH and for complementing other interventions, but more research is needed to confirm efficacy, adoption, and sustainability.

  16. The long-term effects of the health coaching self-management program for nursing-home residents.

    Science.gov (United States)

    Park, Yeon-Hwan; Moon, Sun-Hee; Ha, Ji-Yeon; Lee, Min-Hye

    2017-01-01

    Little is known about whether a self-management program for nursing-home residents (NHR) with cognitive impairment is likely to have an impact on the care of this growing population. This study aimed to evaluate the effects of the health-coaching self-management program for NHR (HCSMP-NHR) on 1) self-efficacy and goal attainment scaling (GAS), 2) health status and quality of life (QoL) among older people, including those with cognitive impairment, in Korean nursing homes. This was a cluster-randomized controlled trial. Participants in the intervention group (n=43, mean age =80.91±7.65 years) received the HCSMP-NHR intervention, composed of group health education and individual coaching, for 8 weeks. Conventional care was provided to the conventional group (n=47, mean age =80.19±7.53 years) during the same period. The effects of the HCSMP-NHR were measured three times: at baseline, week 9, and week 20. The intervention group showed better results for self-efficacy ( P =0.007), health distress ( P =0.007), depression ( P <0.001), and QoL ( P =0.04) at week 9. Mean GAS score of the intervention group gradually increased from -0.38 to 0.74. The time × group interaction showed that the intervention group had significant improvements in QoL ( P =0.047), and significant reductions in health distress ( P =0.016) and depression ( P <0.001), while showing no deterioration in shortness of breath ( P <0.001). Our study findings indicate that the HCSMP-NHR improved self-efficacy and GAS and enhanced the health status and QoL of NHR with chronic conditions who also had mild-to-moderate cognitive impairment. Moreover, these effects were successfully maintained over the 5 months of the trial. Further research is needed to establish the optimum intervention period and to assess the possibility of nationwide implementation of the HCSMP-NHR.

  17. Evaluation of a self-management patient education program for patients with chronic heart failure undergoing inpatient cardiac rehabilitation: study protocol of a cluster randomized controlled trial.

    Science.gov (United States)

    Meng, Karin; Musekamp, Gunda; Seekatz, Bettina; Glatz, Johannes; Karger, Gabriele; Kiwus, Ulrich; Knoglinger, Ernst; Schubmann, Rainer; Westphal, Ronja; Faller, Hermann

    2013-08-23

    Chronic heart failure requires a complex treatment regimen on a life-long basis. Therefore, self-care/self-management is an essential part of successful treatment and comprehensive patient education is warranted. However, specific information on program features and educational strategies enhancing treatment success is lacking. This trial aims to evaluate a patient-oriented and theory-based self-management educational group program as compared to usual care education during inpatient cardiac rehabilitation in Germany. The study is a multicenter cluster randomized controlled trial in four cardiac rehabilitation clinics. Clusters are patient education groups that comprise HF patients recruited within 2 weeks after commencement of inpatient cardiac rehabilitation. Cluster randomization was chosen for pragmatic reasons, i.e. to ensure a sufficient number of eligible patients to build large-enough educational groups and to prevent contamination by interaction of patients from different treatment allocations during rehabilitation. Rehabilitants with chronic systolic heart failure (n = 540) will be consecutively recruited for the study at the beginning of inpatient rehabilitation. Data will be assessed at admission, at discharge and after 6 and 12 months using patient questionnaires. In the intervention condition, patients receive the new patient-oriented self-management educational program, whereas in the control condition, patients receive a short lecture-based educational program (usual care). The primary outcome is patients' self-reported self-management competence. Secondary outcomes include behavioral determinants and self-management health behavior (symptom monitoring, physical activity, medication adherence), health-related quality of life, and treatment satisfaction. Treatment effects will be evaluated separately for each follow-up time point using multilevel regression analysis, and adjusting for baseline values. This study evaluates the effectiveness of a

  18. Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study.

    Science.gov (United States)

    Song, Lixin; Dunlap, Kaitlyn L; Tan, Xianming; Chen, Ronald C; Nielsen, Matthew E; Rabenberg, Rebecca L; Asafu-Adjei, Josephine K; Koontz, Bridget F; Birken, Sarah A; Northouse, Laurel L; Mayer, Deborah K

    2018-02-26

    This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients' needs for information and care may improve effectiveness. This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs. We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment

  19. Friendship with a robot: Children's perception of similarity between a robot's physical and virtual embodiment that supports diabetes self-management.

    Science.gov (United States)

    Sinoo, Claudia; van der Pal, Sylvia; Blanson Henkemans, Olivier A; Keizer, Anouk; Bierman, Bert P B; Looije, Rosemarijn; Neerincx, Mark A

    2018-02-21

    The PAL project develops a conversational agent with a physical (robot) and virtual (avatar) embodiment to support diabetes self-management of children ubiquitously. This paper assesses 1) the effect of perceived similarity between robot and avatar on children's' friendship towards the avatar, and 2) the effect of this friendship on usability of a self-management application containing the avatar (a) and children's motivation to play with it (b). During a four-day diabetes camp in the Netherlands, 21 children participated in interactions with both agent embodiments. Questionnaires measured perceived similarity, friendship, motivation to play with the app and its usability. Children felt stronger friendship towards the physical robot than towards the avatar. The more children perceived the robot and its avatar as the same agency, the stronger their friendship with the avatar was. The stronger their friendship with the avatar, the more they were motivated to play with the app and the higher the app scored on usability. The combination of physical and virtual embodiments seems to provide a unique opportunity for building ubiquitous long-term child-agent friendships. an avatar complementing a physical robot in health care could increase children's motivation and adherence to use self-management support systems. Copyright © 2018 Elsevier B.V. All rights reserved.

  20. [Effectiveness of a self-management program using goal setting based on a G-AP for patients after a stroke].

    Science.gov (United States)

    Park, Min Gyeong; Ha, Yeongmi

    2014-10-01

    This study was conducted to develop a self-management program using goal setting for patients after a stroke. The program was based on a theory-based Goal setting and Action Planning framework (G-AP), and the effectiveness of the program was examined. A non-equivalent control group pretest-posttest design was used. The experimental group (n=30) received the self-management program using goal setting based on the G-AP over 7 weeks. The education was delivered individually with a specifically designed stroke workbook. The control group (n=30) received only patient information leaflets about stroke. There were significant differences between the two groups. Stroke knowledge, self-efficacy, and health behavior compliance were significantly higher (all pgoal setting based on a G-AP was found to be useful and beneficial for patients in stroke rehabilitation settings.

  1. Educating professionals to support self-management in people with asthma or diabetes: protocol for a systematic review and scoping exercise.

    Science.gov (United States)

    McCleary, Nicola; Andrews, Amanda; Morrow, Susan; Wiener-Ogilvie, Sharon; Fletcher, Monica; Steed, Liz; Taylor, Stephanie J C; Pinnock, Hilary

    2016-10-28

    Supported self-management for asthma helps people adjust their treatment in response to symptom changes. This improves day-to-day control and reduces the risk of asthma attacks and the need for emergency healthcare. However, implementation remains poor in routine clinical practice. This systematic review is part of a programme of work developing an intervention to help primary care practice teams embed self-management support into routine asthma care. The aim of the review is to synthesise the evidence regarding the effectiveness of educational interventions for professionals supporting self-management in people with asthma or diabetes (type 1 and type 2). These two conditions have the most robust evidence base for the effectiveness of implementing supported self-management. Electronic searches will be conducted in CENTRAL, MEDLINE, EMBASE, ISI Web of Science, CINAHL, PsycINFO, AMED, Global Health, WHO Global Health Library, ERIC, BNI, RDRB/CME and Google Scholar. Eligible studies are randomised controlled trials or controlled clinical trials published between 1990 and 2016 which evaluated professional education interventions facilitating asthma or diabetes supported self-management. Further relevant work will be identified from trial registries, citation searching and through contact with authors of included studies. This will be supplemented by scoping potentially relevant educational packages described in English language policy literature or health service websites. Screening, data extraction and risk of bias assessment (using the Cochrane Risk of Bias Tool) will be completed by two independent reviewers, with a third reviewer arbitrating where necessary. We plan a theoretically informed narrative synthesis of the aggregated data as heterogeneity is likely to preclude meta-analysis. Ethical approval is not required for this systematic review. The results will be described in a paper submitted for peer-reviewed publication and will inform the development of an

  2. The CHANGE program: comparing an interactive vs. prescriptive approach to self-management among university students with obesity.

    Science.gov (United States)

    Pearson, Erin S; Irwin, Jennifer D; Morrow, Don; Battram, Danielle S; Melling, C W James

    2013-02-01

    To assess the effectiveness of 2 self-management (SM) approaches on obesity via a 12-week telephone-based intervention. An interactive motivational interviewing administered via Co-Active Life Coaching (MI-via-CALC) and a structured lifestyle treatment following the LEARN Program for Weight Management were compared. A secondary purpose was to explore the experiences of participants qualitatively. University students 18-24 years of age with a body mass index ≥30 kg/m(2) (n = 45) were randomized to either the: 1) MI-via-CALC condition that involved working with a certified Co-Active coach to achieve personal goals through dialogue, or 2) LEARN Program that entailed learning from a trained specialist who provided scripted, education-based lessons pertaining to lifestyle, exercise, attitudes, relationships and nutrition. Food consumption patterns, anthropometric and lipid profiles were examined at baseline, mid- and immediately posttreatment, and 3 and 6 months after the program. A semistructured questionnaire was completed at all follow-ups. Analyses revealed a significant time effect for weight (p = 0.01) with the LEARN group decreasing more (M = -7.76 lb) than the MI-VIA-CALC group (M = -2.5 lb) between baseline and week 12. MI-via-CALC participants decreased caloric intake more (M = -662.76) than LEARN participants (M = -105.5) during this same period. The MI-via-CALC group focused on self-understanding, and self-responsibility as primary outcomes of their experience; the LEARN group stressed their appreciation of practical knowledge gained. Both conditions seem similarly effective and are warranted as SM treatments. The best fit and unique contributions of each approach should be considered when working with this population. Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  3. Efficacy of a disease management program focused on acquisition of self-management skills in pre-dialysis patients with diabetic nephropathy: 24 months follow-up.

    Science.gov (United States)

    Kazawa, Kana; Takeshita, Yae; Yorioka, Noriaki; Moriyama, Michiko

    2015-06-01

    We previously performed a preliminary 6-month controlled trial to examine the effect of a disease management education program on prolongation of the time to renal replacement therapy (RRT) and/or avoidance of RRT for patients with diabetic nephropathy. However, its duration was too short to follow the changes of renal function, so we performed the present study for 24 months. This was a two-group comparative study. The intervention group received self-management education from disease management nurses and was supported by the nurses in cooperation with their primary physicians for 12 months. Then this group was followed for a further 12 months. The control group received standard care and was followed for 24 months. Of the 31 subjects enrolled in each group, 26 subjects in the intervention group and 27 subjects in the control group were analyzed after excluding drop-outs. During the study period, 0 and 2 subjects in the intervention and the control group started RRT, respectively. In the intervention group, renal function was maintained, while significant worsening was observed in the control group. Hemoglobin A1c (HbA1c) improved in the intervention group, but became significantly worse in the control group. In the intervention group, all process indicators of behavior modification increased significantly after intervention. A well-designed disease management program might be useful for maintaining renal function and improving HbA1c in patients with diabetic nephropathy. It is considered that modification of patient behavior contributed to these results.

  4. Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives

    Directory of Open Access Journals (Sweden)

    Tatiana M. Davidson

    2015-11-01

    Full Text Available African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH compared to Non-Hispanic Whites. Medication non-adherence (MNA is the leading modifiable behavior to improved blood pressure (BP control. The Smartphone Medication Adherence Stops Hypertension (SMASH program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18 and Hispanic (20 uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM revealed statistically significant time-by-treatment interactions (p < 0.0001 indicating significant reductions in resting systolic blood pressure (SBP and diastolic blood pressure (DBP for the SMASH group vs. the standard care (SC control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH at month 1 (p < 0.001. At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003. Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

  5. Comprehensive Self-Management Strategies.

    Science.gov (United States)

    Bourbeau, J; Lavoie, K L; Sedeno, M

    2015-08-01

    In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers "case manager" to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Reduction in 2-year recurrent risk score and improved behavioral outcomes after participation in the "Beating Heart Problems" self-management program: results of a randomized controlled trial.

    Science.gov (United States)

    Murphy, Barbara M; Worcester, Marian U C; Higgins, Rosemary O; Elliott, Peter C; Le Grande, Michael R; Mitchell, Fiona; Navaratnam, Hema; Turner, Alyna; Grigg, Leeanne; Tatoulis, James; Goble, Alan J

    2013-01-01

    While behavior change can improve risk factor profiles and prognosis after an acute cardiac event, patients need assistance to achieve sustained lifestyle changes. We developed the "Beating Heart Problems" cognitive-behavioral therapy and motivational interviewing program to support patients to develop behavioral and cognitive self-management skills. We report the results of a randomized controlled trial of the program. Patients (n = 275) consecutively admitted to 2 Melbourne hospitals after acute myocardial infarction (32%), coronary artery bypass graft surgery (40%), or percutaneous coronary intervention (28%) were randomized to treatment (T; n = 139) or control (C; n = 136). T group patients were invited to participate in the 8-week group-based program. Patients underwent risk factor screening 6 weeks after hospital discharge (before randomization) and again 4 and 12 months later. At both the followups, T and C groups were compared on 2-year risk of a recurrent cardiac event and key behavioral outcomes, using both intention-to-treat and "completers only" analyses. Patients ranged in age from 32 to 75 years (mean = 59.0 years; SD - 9.1 years). Most patients (86%) were men. Compared with the C group patients, T group patients tended toward greater reduction in 2-year risk, at both the 4- and 12-month followups. Significant benefits in dietary fat intake and functional capacity were also evident. The "Beating Heart Problems" program showed modest but important benefit over usual care at 4 and, to a lesser extent, 12 months. Modifications to the program such as the inclusion of booster sessions and translation to online delivery are likely to improve outcomes.

  7. Online and mobile technologies for self-management in bipolar disorder: A systematic review.

    Science.gov (United States)

    Gliddon, Emma; Barnes, Steven J; Murray, Greg; Michalak, Erin E

    2017-09-01

    Internet (eHealth) and smartphone-based (mHealth) approaches to self-management for bipolar disorder are increasingly common. Evidence-based self-management strategies are available for bipolar disorder and provide a useful framework for reviewing existing eHealth/mHealth programs to determine whether these strategies are supported by current technologies. This review assesses which self-management strategies are most supported by technology. Based on 3 previous studies, 7 categories of self-management strategies related to bipolar disorder were identified, followed by a systematic literature review to identify existing eHealth and mHealth programs for this disorder. Searches were conducted by using PubMed, CINAHL, PsycINFO, EMBASE, and the Cochrane Database of Systematic Reviews for relevant peer-reviewed articles published January 2005 to May 2015. eHealth and mHealth programs were summarized and reviewed to identify which of the 7 self-management strategy categories were supported by eHealth or mHealth programs. From 1,654 publications, 15 papers were identified for inclusion. From these, 9 eHealth programs and 2 mHealth programs were identified. The most commonly supported self-management strategy categories were "ongoing monitoring," "maintaining hope," "education," and "planning for and taking action"; the least commonly supported categories were "relaxation" and "maintaining a healthy lifestyle." eHealth programs appear to provide more comprehensive coverage of self-management strategies compared with mHealth programs. Both eHealth and mHealth programs present a wide range of self-management strategies for bipolar disorder, although individuals seeking comprehensive interventions might be best served by eHealth programs, while those seeking more condensed and direct interventions might prefer mHealth programs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  8. mHealth medication and blood pressure self-management program in Hispanic hypertensives: a proof of concept trial

    Directory of Open Access Journals (Sweden)

    Sieverdes JC

    2013-10-01

    Full Text Available John C Sieverdes,1 Mathew Gregoski,1 Sachin Patel,1 Deborah Williamson,1 Brenda Brunner-Jackson,1 Judith Rundbaken,1 Eveline Treiber,1 Lydia Davidson,1 Frank A Treiber1,21Technology Applications Center for Healthful Lifestyles, College of Nursing, 2College of Medicine, Medical University of South Carolina, Charleston, SC, USAAbstract: Patient nonadherence to medication regimens and provider therapeutic inertia (failure to respond in timely manner to clinical data are two primary contributors to ineffective chronic disease management. This 3-month proof of concept trial used an iterative design approach guided by self-determination theory and the technology acceptance model to develop a culturally sensitive, patient-centered, and provider-centered mobile health medication and blood pressure self-management program. Cellular connected electronic medication trays provided reminder signals for patients to take medications and smartphone messaging reminded patients to take at-home blood pressures using a Bluetooth-enabled monitor. Providers were given bimonthly feedback. Motivational and reinforcement text and audio messages were sent based upon medication adherence rates and blood pressure levels. Ten Hispanics with uncontrolled essential hypertension were randomized to standard care and Smartphone Medication Adherence Stops Hypertension (SMASH intervention groups. Primary outcomes of provider and patient acceptability of the program were found to be high. Retention rates for the 3-month program were 100%, with mean ± standard deviation overall medication adherence for the SMASH group at 97.2% ± 2.8%, with all strongly believing the program helped them remember to take their medication. SMASH participants measured their blood pressure every 3 days 83.2% ± 6.0% of the time and completed 89.2% ± 19.06% of the expected readings. Nonparametric tests showed statistical significance for resting blood pressure changes between groups at months 2 (P = 0

  9. Understanding differences between caregivers and non-caregivers in completer rates of Chronic Disease Self-Management Program.

    Science.gov (United States)

    Shi, J; McCallion, P; Ferretti, L A

    2017-06-01

    The Chronic Disease Self-Management Program (CDSMP) was developed to advance participants' self-care of chronic illness and may be offered to both individuals with chronic conditions and their caregivers. Previous studies of CDSMP have identified multiple resulting health benefits for participants as well as factors associated with participants' completion rates. This study investigated differences on these issues between caregiving and non-caregiving participants. Secondary analysis using regression analysis to predict the outcome. Baseline data were collected directly from adult (over 18 years) participants of CDSMP workshops in New York State from 2012 to 2015 (n = 2685). Multi-level logistic regression analysis was used to compare the difference on completion of workshops (attended four or more of sessions) and contributing factors with the independent variable of whether participants provided care/assistance to a family member or friends with long-term illness or disability. Additional individual-level variables controlled for in the model were age, gender, race/ethnicity, living arrangement, education, the number of chronic conditions and disabilities; as were workshop-level characteristics of class size, language used, workshop leader experience, location urbanity and delivery site type. Participants who provided care to family or friends were 28% more likely to complete the workshop compared with those who did not (odds ratio = 1.279, P < 0.05). Different factors influenced the completion of CDSMP workshop for caregivers and non-caregivers. People who provide care to others appeared to have stronger motivation to complete the workshops with greater benefits. Agencies offering CDSMP should encourage caregivers to attend. Copyright © 2017. Published by Elsevier Ltd.

  10. The Effectiveness of Self Management Program on Pain, Fatigue, Depression, Anxiety, and Stress in Sickle Cell Patients: A Quasi-Experimental Study

    Directory of Open Access Journals (Sweden)

    Ahmadi

    2015-10-01

    Full Text Available Background Patients with sickle cell disease, who must manage serious and unpredictable complications related to their disease, particularly chronic pain, suffer from numerous psychosocial problems such as depression, anxiety, stress, and disruption of interpersonal relationships; these problems often lead to fatigue and poor quality of life. Objectives This study aimed to determine the effectiveness of self-management programs targeting pain, fatigue, depression, anxiety, and stress in sickle cell patients. Patients and Methods This was a quasi-experimental study; participants were 53 patients with sickle cell disease who were referred to the Thalassemia Clinic of Ahvaz Shafa Hospital. Participants were recruited by census in 2013. Participants received a self-management program that was implemented in five sessions over 12 weeks. Levels of fatigue, depression, anxiety, and stress were assessed before and 24 weeks after the intervention; pain was assessed during the intervention and at a 24 week post-intervention follow-up using the fatigue severity scale (FSS, DASS21, and a pain record. Descriptive statistics, Fisher’s exact test, Chi-square, independent t-tests, paired t-tests, repeated measures tests and correlations were used to analyze the data. Results Scores for fatigue, anxiety, depression, and stress after the intervention were significantly decreased compared to before the intervention (P < 0.001. Repeated measures testing showed that mean scores for frequency and duration of pain decreased significantly during the 12 weeks of intervention, as well as during the 24 weeks of follow-up (P < 0.001. Conclusions The results suggest the effectiveness of self-management programs on the reduction of pain, fatigue, anxiety, depression, and stress in sickle cell patients. Therefore, self-management programs are advisable in order to empower patients and assist their management of health-related problems.

  11. Self Managing the Consequences of Major Limb Trauma

    National Research Council Canada - National Science Library

    MacKenzie, Ellen J

    2008-01-01

    .... The intervention will build on widely accepted self-management programs developed for persons with arthritis as well as components of a face-to-face self-management program for civilians with long-standing limb loss...

  12. Health coaching in diabetes: empowering patients to self-manage.

    Science.gov (United States)

    Wong-Rieger, Durhane; Rieger, Francis P

    2013-02-01

    To effectively manage diabetes mellitus, patients must adhere to treatment recommendations and healthy lifestyle behaviors, but research shows many patients do not do this. Education is effective when combined with self-management support but peer-support programs do not lead to lasting changes. Health coaching, or professional support, can be highly effective if it focuses on developing self-efficacy and skills such as goal-setting, problem-solving and managing cognitive and emotional barriers. This overview discusses the benefits of patient self-management for chronic conditions such as diabetes, core competencies for health coaching, theoretical bases and principles of health coaching interventions, delivery methods and the evidence that health coaching works for diabetes self-management. Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  13. Development and testing of a mobile application to support diabetes self-management for people with newly diagnosed type 2 diabetes

    DEFF Research Database (Denmark)

    Petersen, Mira; Hempler, Nana F

    2017-01-01

    BACKGROUND: Numerous mobile applications have been developed to support diabetes-self-management. However, the majority of these applications lack a theoretical foundation and the involvement of people with diabetes during development. The aim of this study was to develop and test a mobile applic...... and implementation of the mobile health app were crucial to creating value for users. More attention should be paid to the training of professionals who introduce health apps. TRIAL REGISTRATION: Danish Data Protection Agency: 2012-58-0004. Registered 6 February 2016....

  14. Incorporating Cultural Perspectives into Diabetes Self-Management Programs for East Asian Immigrants: A Mixed-Study Review.

    Science.gov (United States)

    Park, Chorong; Nam, Soohyun; Whittemore, Robin

    2016-04-01

    It is important to understand East Asian immigrants (EAIs)' unique perspectives in managing diabetes in order to provide culturally-competent care. However, it is not known whether EAIs' perspectives are addressed in diabetes self-management interventions developed for EAIs. Therefore, a mixed-study review was conducted to identify EAIs' perspective from qualitative research (n = 9 studies) and to evaluate the components of EAI diabetes self-management interventions (n = 7). Themes from the qualitative synthesis demonstrated that EAIs have unique cultural values and traditional health beliefs while struggling with multi-contextual barriers due to immigration. The evaluation of EAI diabetes self-management interventions revealed that there was a lack of consensus on cultural strategies for EAIs' across the interventions. Addressing language barriers was the only factor consistently integrated in the cultural components of intervention by employing bilingual interventionists. EAIs' perspectives and experiences need to be incorporated in the future diabetes self-management interventions to better provide culturally-competent care.

  15. Aligning everyday life priorities with people's self-management support networks: an exploration of the work and implementation of a needs-led telephone support system.

    Science.gov (United States)

    Blickem, Christian; Kennedy, Anne; Jariwala, Praksha; Morris, Rebecca; Bowen, Robert; Vassilev, Ivaylo; Brooks, Helen; Blakeman, Tom; Rogers, Anne

    2014-06-17

    Recent initiatives to target the personal, social and clinical needs of people with long-term health conditions have had limited impact within primary care. Evidence of the importance of social networks to support people with long-term conditions points to the need for self-management approaches which align personal circumstances with valued activities. The Patient-Led Assessment for Network Support (PLANS) intervention is a needs-led assessment for patients to prioritise their health and social needs and provide access to local community services and activities. Exploring the work and practices of patients and telephone workers are important for understanding and evaluating the workability and implementation of new interventions. Qualitative methods (interviews, focus group, observations) were used to explore the experience of PLANS from the perspectives of participants and the telephone support workers who delivered it (as part of an RCT) and the reasons why the intervention worked or not. Normalisation Process Theory (NPT) was used as a sensitising tool to evaluate: the relevance of PLANS to patients (coherence); the processes of engagement (cognitive participation); the work done for PLANS to happen (collective action); the perceived benefits and costs of PLANS (reflexive monitoring). 20 patients in the intervention arm of a clinical trial were interviewed and their telephone support calls were recorded and a focus group with 3 telephone support workers was conducted. Analysis of the interviews, support calls and focus group identified three themes in relation to the delivery and experience of PLANS. These are: formulation of 'health' in the context of everyday life; trajectories and tipping points: disrupting everyday routines; precarious trust in networks. The relevance of these themes are considered using NPT constructs in terms of the work that is entailed in engaging with PLANS, taking action, and who is implicated this process. PLANS gives scope to align

  16. Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Walters, Julia A E; Courtney-Pratt, Helen; Cameron-Tucker, Helen; Nelson, Mark; Robinson, Andrew; Scott, Jenn; Turner, Paul; Walters, E Haydn; Wood-Baker, Richard

    2012-01-01

    The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

  17. Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS).

    Science.gov (United States)

    Hurley, Deirdre A; Murphy, Laura Currie; Hayes, David; Hall, Amanda M; Toomey, Elaine; McDonough, Suzanne M; Lonsdale, Chris; Walsh, Nicola E; Guerin, Suzanne; Matthews, James

    2016-04-26

    The Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice. This study describes the use of intervention mapping (IM) in the design of a theory-driven, group-based complex intervention to support self-management (SM) of patients with osteoarthritis (OA) and chronic low back pain (CLBP) in Ireland's primary care health system. The six steps of the IM protocol were systematically applied to develop the self-management of osteoarthritis and low back pain through activity and skills (SOLAS) intervention through adaptation of the Facilitating Activity and Self-management in Arthritis (FASA) intervention. A needs assessment including literature reviews, interviews with patients and physiotherapists and resource evaluation was completed to identify the programme goals, determinants of SM behaviour, consolidated definition of SM and required adaptations to FASA to meet health service and patient needs and the evidence. The resultant SOLAS intervention behavioural outcomes, performance and change objectives were specified and practical application methods selected, followed by organised programme, adoption, implementation and evaluation plans underpinned by behaviour change theory. The SOLAS intervention consists of six weekly sessions of 90-min education and exercise designed to increase participants' physical activity level and use of evidence-based SM strategies (i.e. pain self-management, pain coping, healthy eating for weight management and specific exercise) through targeting of individual determinants of SM behaviour (knowledge, skills, self-efficacy, fear, catastrophizing, motivation, behavioural regulation), delivered by a trained physiotherapist to groups of up to eight individuals using a needs supportive interpersonal style based on self-determination theory

  18. Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based intervention

    Directory of Open Access Journals (Sweden)

    Eide Erlend

    2011-02-01

    Full Text Available Abstract Background This pretrial study aimed to develop and test the usability of a four-week Internet intervention delivered by a Web-enabled mobile phone to support self-management of chronic widespread pain. Methods The intervention included daily online entries and individualized written feedback, grounded in a mindfulness-based cognitive behavioral approach. The participants registered activities, emotions and pain cognitions three times daily using the mobile device. The therapist had immediate access to this information through a secure Web site. The situational information was used to formulate and send a personalized text message to the participant with the aim of stimulating effective self-management of the current situation. Six women participated and evaluated the experience. Results The intervention was rated as supportive, meaningful and user-friendly by the majority of the women. The response rate to the daily registration entries was high and technical problems were few. Conclusion The results indicate a feasible intervention. Web-applications are fast becoming standard features of mobile phones and interventions of this kind can therefore be more available than before. Trial registration number ClinicalTrials.gov: NCT01236209

  19. Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.

    Science.gov (United States)

    Bengtsson, Ulrika; Kjellgren, Karin; Hallberg, Inger; Lundin, Mona; Mäkitalo, Åsa

    2018-03-01

    This paper reports on how the clinical consultation in primary care is performed under the new premises of patients' daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients' contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. A qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. Four primary health care centers in Sweden. Patients with hypertension (n = 20) and their health care professional (n = 7). The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients' contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Patients' contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients' and health care professionals' equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management Key points   The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to

  20. What role could community pharmacists in Malaysia play in diabetes self-management education and support? The views of individuals with type 2 diabetes.

    Science.gov (United States)

    Lee, E Lyn; Wong, Pei Se; Tan, Ming Yeong; Sheridan, Janie

    2018-04-01

    This study explored the experiences and views of individuals with type 2 diabetes mellitus (T2D) on their diabetes self-management and potential roles for community pharmacists in diabetes self-management education and support (DSME/S) in Malaysia. A qualitative study, using semi-structured, face-to-face interviews, was conducted with patients with T2D attending a primary care health clinic in Kuala Lumpur, Malaysia. The interviews were audio-recorded, transcribed verbatim and analysed inductively. Fourteen participants with T2D were interviewed. Data were coded into five main themes: experience and perception of diabetes self-management, constraints of the current healthcare system, perception of the community pharmacist and community pharmacies, perceived roles for community pharmacists in diabetes care, and challenges in utilising community pharmacies to provide DSME/S. There were misconceptions about diabetes management that may be attributed to a lack of knowledge. Although participants described potential roles for community pharmacists in education, medication review and continuity of care, these roles were mostly non-clinically oriented. Participants were not confident about community pharmacists making recommendations and changes to the prescribed treatment regimens. While participants recognised the advantages of convenience of a community pharmacy-based diabetes care service, they raised concerns over the retail nature and the community pharmacy environment for providing such services. This study highlighted the need to improve the care provision for people with T2D. Participants with T2D identified potential, but limited roles for community pharmacists in diabetes care. Participants expressed concerns that need to be addressed if effective diabetes care is to be provided from community pharmacies in Malaysia. © 2017 Royal Pharmaceutical Society.

  1. The effectiveness of a Supported Self-management task-shifting intervention for adult depression in Vietnam communities: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Murphy, Jill; Goldsmith, Charles H; Jones, Wayne; Oanh, Pham Thi; Nguyen, Vu Cong

    2017-05-05

    Depressive disorders are one of the leading causes of disease and disability worldwide. In Vietnam, although epidemiological evidence suggests that depression rates are on par with global averages, services for depression are very limited. In a feasibility study that was implemented from 2013 to 2015, we found that a Supported Self-management (SSM) intervention showed promising results for adults with depression in the community in Vietnam. This paper describes the Mental Health in Adults and Children: Frugal Innovations (MAC-FI) trial protocol that will assess the effectiveness of the SSM intervention, delivered by primary care and social workers, to community-based populations of adults with depression in eight Vietnamese provinces. The MAC-FI program will be assessed using a stepped-wedge, randomized controlled trial. Study participants are adults aged 18 years and over in eight provinces of Vietnam. Study participants will be screened at primary care centres and in the community by health and social workers using the Self-reporting Questionnaire-20 (SRQ-20). Patients scoring >7, indicating depression caseness, will be invited to participate in the study in either the SSM intervention group or the enhanced treatment as usual control group. Recruited participants will be further assessed using the World Health Organization's Disability Assessment Scale (WHODAS 2.0) and the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) Questionnaire for alcohol misuse. Intervention-group participants will receive the SSM intervention, delivered with the support of a social worker or social collaborator, for a period of 2 months. Control- group participants will receive treatment as usual and a leaflet with information about depression. SRQ-20, WHODAS 2.0 and CAGE scores will be taken by blinded outcome assessors at baseline, after 1 month and after 2 months. The primary analysis method will be intention-to-treat. This study has the potential to add to the knowledge base about

  2. Sustaining self-management in diabetes mellitus.

    Science.gov (United States)

    Mitchell-Brown, Fay

    2014-01-01

    Successful management of diabetes depends on the individual's ability to manage and control symptoms. Self-management of diabetes is believed to play a significant role in achieving positive outcomes for patients. Adherence to self-management behaviors supports high-quality care, which reduces and delays disease complications, resulting in improved quality of life. Because self-management is so important to diabetes management and involves a lifelong commitment for all patients, health care providers should actively promote ways to maintain and sustain behavior change that support adherence to self-management. A social ecological model of behavior change (McLeroy, Bibeau, Steckler, & Glanz, 1988) helps practitioners provide evidence-based care and optimizes patients' clinical outcomes. This model supports self-management behaviors through multiple interacting interventions that can help sustain behavior change. Diabetes is a complex chronic disease; successful management must use multiple-level interventions.

  3. Clinicians' beliefs and attitudes toward patient self-management in the Netherlands; translation and testing of the American Clinician Support for Patient Activation Measure (CS-PAM).

    Science.gov (United States)

    Rademakers, Jany; Jansen, Daphne; van der Hoek, Lucas; Heijmans, Monique

    2015-04-03

    The aim of this study was to test the Dutch version of the Clinician Support for Patient Activation Measure (CS-PAM), to explore the beliefs of Dutch clinicians about patients' self-management, and to establish whether there are differences in this respect between general practitioners and other primary care providers. The CS-PAM was translated in Dutch and data were collected in a sample of 489 general practitioners and other primary care providers. Statistical analyses (RASCH, Cronbach's α) were performed to establish the psychometric properties of the instrument. The psychometric scores of the Dutch CS-PAM were acceptable to good, and the difficulty level and structure was comparable to that of the original instrument. The average score of Dutch clinicians on the CS-PAM was 65.1 (SD 10.7), somewhat lower compared to their colleagues in the US (69; SD 12.1) and the UK (69, SD 12.8). Dutch general practitioners scored significantly lower on the CS-PAM compared to other primary care providers. The Dutch CS-PAM is a reliable instrument to measure beliefs of clinicians regarding patient self-management. Further validation studies are necessary to establish the distribution of scores in specific provider populations and to assess the clinical relevance of the instrument for different outcomes.

  4. Development of a self-management program for employees with complaints of the arm, neck, and/or shoulder: an intervention mapping approach.

    Science.gov (United States)

    Hutting, Nathan; Detaille, Sarah I; Engels, Josephine A; Heerkens, Yvonne F; Staal, J Bart; Nijhuis-van der Sanden, Maria Wg

    2015-01-01

    To develop a self-management program with an additional eHealth module, using the six steps of the intervention mapping (IM) protocol, to help employees with complaints of the arm, neck, and/or shoulder (CANS) cope with their problems. In Step 1 of the IM protocol, a needs assessment was performed consisting of a review of the Dutch multidisciplinary guidelines on CANS, and of focus group sessions with employees with CANS (n=15) and with relevant experts (n=17). After the needs assessment, the objectives of the intervention and the determinants of self-management at work were formulated (Step 2). Furthermore, theory-based intervention methods and practical strategies were selected (Step 3), and an intervention program (including the eHealth module) was developed (Step 4). Finally, plans for implementation and evaluation of the program were developed (Steps 5 and 6). Step 1 of the IM protocol revealed that employees with CANS should be stimulated to search for information about the cause of their complaints, about how to deal with their complaints, and in which manner they can influence their complaints themselves. In Step 2, the overall goal of the intervention was defined as "self-management behavior at work" with the aim to alleviate the perceived disability of the participants. Step 3 described how the intervention methods were translated into practical strategies, and goal setting was introduced as an important method for increasing self-efficacy. The product of Step 4 was the final program plan, consisting of 6-weekly group sessions of 2.5 hours each and an eHealth module. In Step 5, a recruitment plan and course materials were developed, a steering committee was set up, trainers were recruited, and the final program was tested. In Step 6, an evaluation plan was developed, which consists of a randomized controlled trial with a 12-month follow-up period and a qualitative evaluation (interviews) with some of the participants. This study resulted in a theory- and

  5. Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients.

    Science.gov (United States)

    Kennedy, Anne; Rogers, Anne; Chew-Graham, Carolyn; Blakeman, Thomas; Bowen, Robert; Gardner, Caroline; Lee, Victoria; Morris, Rebecca; Protheroe, Joanne

    2014-10-21

    Implementation of long-term condition management interventions rests on the notion of whole systems re-design, where incorporating wider elements of health care systems are integral to embedding effective and integrated solutions. However, most self-management support (SMS) evaluations still focus on particular elements or outcomes of a sub-system. A randomised controlled trial of a SMS intervention (WISE-Whole System Informing Self-management Engagement) implemented in primary care showed no effect on patient-level outcomes. This paper reports on a parallel process evaluation to ascertain influences affecting WISE implementation at patient, clinical and organisational levels. Normalisation Process Theory (NPT) provided a sensitising background and analytical framework. A multi-method approach using surveys and interviews with organisational stakeholders, practice staff and trial participants about impact of training and use of tools developed for WISE. Analysis was sensitised by NPT (coherence, cognitive participation, collective action and reflective monitoring). The aim was to identify what worked and what did not work for who and in what context. Interviews with organisation stakeholders emphasised top-down initiation of WISE by managers who supported innovation in self-management. Staff from 31 practices indicated engagement with training but patchy adoption of WISE tools; SMS was neither prioritised by practices nor fitted with a biomedically focussed ethos, so little effort was invested in WISE techniques. Interviews with 24 patients indicated no awareness of any changes following the training of practice staff; furthermore, they did not view primary care as an appropriate place for SMS. The results contribute to understanding why SMS is not routinely adopted and implemented in primary care. WISE was not embedded because of the perceived lack of relevance and fit to the ethos and existing work. Enacting SMS within primary care practice was not viewed as a

  6. Development and testing of a mobile application to support diabetes self-management for people with newly diagnosed type 2 diabetes: a design thinking case study.

    Science.gov (United States)

    Petersen, Mira; Hempler, Nana F

    2017-06-26

    Numerous mobile applications have been developed to support diabetes-self-management. However, the majority of these applications lack a theoretical foundation and the involvement of people with diabetes during development. The aim of this study was to develop and test a mobile application (app) supporting diabetes self-management among people with newly diagnosed type 2 diabetes using design thinking. The app was developed and tested in 2015 using a design-based research approach involving target users (individuals newly diagnosed with type 2 diabetes), research scientists, healthcare professionals, designers, and app developers. The research approach comprised three major phases: inspiration, ideation, and implementation. The first phase included observations of diabetes education and 12 in-depth interviews with users regarding challenges and needs related to living with diabetes. The ideation phrase consisted of four interactive workshops with users focusing on app needs, in which ideas were developed and prioritized. Finally, 14 users tested the app over 4 weeks; they were interviewed about usability and perceptions about the app as a support tool. A multifunctional app was useful for people with newly diagnosed type 2 diabetes. The final app comprised five major functions: overview of diabetes activities after diagnosis, recording of health data, reflection games and goal setting, knowledge games and recording of psychological data such as sleep, fatigue, and well-being. Users found the app to be a valuable tool for support, particularly for raising their awareness about their psychological health and for informing and guiding them through the healthcare system after diagnosis. The design thinking processes used in the development and implementation of the mobile health app were crucial to creating value for users. More attention should be paid to the training of professionals who introduce health apps. Danish Data Protection Agency: 2012-58-0004. Registered 6

  7. Using the theoretical domains framework to guide the development of a self-management program for individuals with spinal cord injury: Results from a national stakeholder advisory group.

    Science.gov (United States)

    Munce, Sarah E P; Allin, Sonya; Wolfe, Dalton L; Anzai, Karen; Linassi, Gary; Noonan, Vanessa K; Jaglal, Susan B

    2017-11-01

    To determine the implementation considerations for a targeted self-management program for individuals with spinal cord injury (SCI) from the perspective of a national stakeholder advisory group using the Theoretical Domains Framework (TDF) as a guide. Qualitative descriptive approach. Two focus groups held at the 6 th National Spinal Cord Injury Conference (October 2-4 th , 2014) in Toronto, Ontario, Canada. A total of 25 stakeholders from across Canada participated in focus groups or "brainstorming sessions". The stakeholders included 5 clinicians, 14 researchers, 3 policy makers, and 3 individuals with SCI. Not applicable. Not applicable. All 14 theoretical domains were identified in the brainstorming sessions. No new themes or domains were identified. The need to consider the theoretical domains of Knowledge, Skills, Reinforcement, Intentions, Goals (e.g. the readiness of the individual with SCI), Environmental Context and Resources (e.g. considerations for governance and ownership of the program and a business model for sustainability), as well as Social Influences (e.g. issues of privacy and security in the context of on-line delivery) was identified. The current study provides complementary results to our previous series of studies on the implementation considerations for the development of a targeted self-management program for individuals with SCI by emphasizing the health care professional/health policy perspective. It is anticipated that such a program could not only reduce secondary complications and subsequent inappropriate health care use but it may also improve the quality of life for individuals with SCI and their caregivers.

  8. The moderating effect of social cognitive factors on self-management activities and HbA1c in Thai adults with type-2 diabetes

    Directory of Open Access Journals (Sweden)

    Somsak Thojampa

    2017-01-01

    Conclusion: The diabetes self-management activities were more strongly associated with HbA1c under conditions of high social support, self-efficacy and health beliefs with Buddhist values. Future interventions for T2DM self-management programs should incorporate mechanisms to measure and support these factors.

  9. Use, acceptability and impact of booklets designed to support mental health self-management and help seeking in schools: results of a large randomised controlled trial in England.

    Science.gov (United States)

    Sharpe, Helen; Patalay, Praveetha; Vostanis, Panos; Belsky, Jay; Humphrey, Neil; Wolpert, Miranda

    2017-03-01

    Mental health booklets may provide a low-cost means of promoting mental health self-management and help seeking in schools. The aim of the study was to assess the (a) use, (b) acceptability and (c) impact of booklets for students in primary (10-11 years) and secondary school (12-13 years) alone and in conjunction with funding for targeted mental health support. This was a 2 × 2 factorial cluster randomized controlled trial, in which 846 schools in England were randomly allocated to receive/not receive: (1) booklets for students containing information on mental health self-management and help seeking, and (2) funding for mental health support as part of a national mental health initiative. 14,690 students (8139 primary, 6551 secondary) provided self-report on mental health, quality of life (baseline and 1 year follow-up) and help seeking (follow-up). (a) Approximately, 40 % primary school students and 20 % secondary school students reported seeing the booklets. (b) Of these, 87 % of primary school students reported that the booklet was 'very helpful' or 'quite helpful', compared with 73 % in secondary school. (c) There was no detectable impact of booklets on mental health, quality of life or help seeking, either alone or in conjunction with additional funding through the national mental health initiative. Lack of discernable impact of booklets underscores the need for caution in adopting such an approach. However, it is feasible that the impact was obscured by low uptake or that booklets may be more effective when used in a targeted way.

  10. Self-management of health care: multimethod study of using integrated health care and supportive housing to address systematic barriers for people experiencing homelessness.

    Science.gov (United States)

    Parsell, Cameron; Ten Have, Charlotte; Denton, Michelle; Walter, Zoe

    2017-04-07

    Objectives The aims of the present study were to examine tenants' experiences of a model of integrated health care and supportive housing and to identify whether integrated health care and supportive housing improved self-reported health and healthcare access. Methods The present study used a mixed-method survey design (n=75) and qualitative interviews (n=20) performed between September 2015 and August 2016. Participants were tenants of permanent supportive housing in Brisbane (Qld, Australia). Qualitative data were analysed thematically. Results Integrated health care and supportive housing were resources for tenants to overcome systematic barriers to accessing mainstream health care experienced when homeless. When homeless, people did not have access to resources required to maintain their health. Homelessness meant not having a voice to influence the health care people received; healthcare practitioners treated symptoms of poverty rather than considering how homelessness makes people sick. Integrated healthcare and supportive housing enabled tenants to receive treatment for health problems that were compounded by the barriers to accessing mainstream healthcare that homelessness represented. Conclusions Extending the evidence about housing as a social determinant of health, the present study shows that integrated health care and supportive housing enabled tenants to take control to self-manage their health care. In addition to homelessness directly contributing to ill health, the present study provides evidence of how the experience of homelessness contributes to exclusions from mainstream healthcare. What is known about the topic? People who are homeless experience poor physical and mental health, have unmet health care needs and use disproportionate rates of emergency health services. What does the paper add? The experience of homelessness creates barriers to accessing adequate health care. The provision of onsite multidisciplinary integrated health care in

  11. Supporting self-management after attending a structured education programme: a qualitative longitudinal investigation of type 1 diabetes patients’ experiences and views

    Directory of Open Access Journals (Sweden)

    Rankin David

    2012-08-01

    Full Text Available Abstract Background Structured education programmes for patients with diabetes and other chronic conditions are being widely adopted. However, follow-up studies suggest that course graduates may struggle to sustain the self-care practices taught on their courses over time. This study explored the support needs of patients with type 1 diabetes after attending a structured education programme promoting an empowerment approach and training in use of flexible intensive insulin therapy, a regimen now widely advocated and used to manage this condition. The objective was to inform future support offered to course graduates. Methods Repeat, in-depth interviews with 30 type 1 diabetes patients after attending Dose Adjustment for Normal Eating (DAFNE courses in the UK, and six and 12 months later. Data were analysed using an inductive, thematic approach. Results While the flexible intensive insulin treatment approach taught on DAFNE courses was seen as a logical and effective way of managing one’s diabetes, it was also considered more technically complex than other insulin regimens. To sustain effective disease self-management using flexible intensive insulin treatment over time, patients often expected, and needed, on-going input and support from health care professionals trained in the approach. This included: help determining insulin dose adjustments; reassurance; and, opportunities to trouble-shoot issues of concern. While some benefits were identified to receiving follow-up support in a group setting, most patients stated a preference or need for tailored and individualised support from appropriately-trained clinicians, accessible on an ‘as and when needed’ basis. Conclusions Our findings highlight potential limitations to group-based forms of follow-up support for sustaining diabetes self-management. To maintain the clinical benefits of structured education for patients with type 1 diabetes over time, course graduates may benefit from and

  12. Background and rationale for the Society of Behavioral Medicine's position statement: expand United States health plan coverage for diabetes self-management education and support.

    Science.gov (United States)

    Sharp, Lisa K; Fisher, Edwin B; Gerber, Ben S

    2015-09-01

    The Society of Behavioral Medicine (SBM) recognizes that diabetes self-management (DSM) education and support are fundamental to teaching people how to manage their diabetes and decrease disease-related complications. Implementation of the Patient Protection and Affordable Care Act provides an opportunity to expand DSM education and support to many people who are currently excluded from such services due to lack of insurance coverage, current policy barriers, or simple failure of healthcare systems to provide them. Extending the range and provision of such services could translate into reduced diabetic complications, a reduction in unnecessary healthcare utilization, and significant health-related cost savings on a national level. SBM recommends that public and private insurers be required to reimburse for 12 h of DSM education and support annually for anyone with diabetes. Further, SBM recognizes that a range of modes and providers of DSM education and support have been shown effective, and that patient preferences and resources may influence choice. To address this, SBM urges health organizations to increase and diversify approaches toward DSM education and support they offer.

  13. Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy.

    Science.gov (United States)

    Gaston-Johansson, Fannie; Fall-Dickson, Jane M; Nanda, Joy P; Sarenmalm, Elisabeth Kenne; Browall, Maria; Goldstein, Nancy

    2013-03-01

    This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment. Patients (n = 110) with stage II, III, or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were randomized to either CCSP treatment or control group. The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge. The CCSP components included educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery. Instruments administered at baseline included the following: Quality of Life Index-Cancer Version (QOLI-CV), State-Trait Anxiety Inventory, Beck Depression Inventory, and Coping Strategies Questionnaire. At 1-year follow-up, patients (n = 73) completed and returned the follow-up QOLI-CV. Patients were mainly ≥ 40 years of age, married, Caucasian, and diagnosed with advanced breast cancer. A model measuring effectiveness of CCSP on QOL (total and subscale) at 1-year follow-up showed that the CCSP group (n = 38) had significant improvement in overall QOL (p psychological/spiritual well-being (p psychological (51%) and sleep problems (60%). The CCSP improved QOL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.

  14. Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review.

    Science.gov (United States)

    Leitan, Nuwan D; Michalak, Erin E; Berk, Lesley; Berk, Michael; Murray, Greg

    2015-03-01

    Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals.

    Science.gov (United States)

    Coleman, Sophie; Briffa, N Kathryn; Carroll, Graeme; Inderjeeth, Charles; Cook, Nicola; McQuade, Jean

    2012-01-27

    Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis (OA) of the knee (the Osteoarthritis of the Knee Self-Management Program (OAK)) implemented by health care professionals would achieve and maintain clinically meaningful improvements in health-related outcomes compared with a control group. Medical practitioners referred 146 primary care patients with OA of the knee. Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded. Randomisation was to either a control group or the OAK group. The OAK group completed a 6-week self-management program. The control group had a 6-month waiting period before entering the OAK program. Assessments were taken at baseline, 8 weeks and 6 months. The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Function subscales on the Short Form 36 version 1 questionnaire (SF-36) Secondary outcomes were Visual Analogue Scale (VAS) pain, Timed Up & Go Test (TUG), knee range of motion and quadriceps and hamstring strength-isometric contraction. Responses to treatment (responders) and minimal clinically important improvements (MCIIs) were determined. In the OAK group, VAS pain improved from baseline to week 8 from mean (SEM) 5.21 (0.30) to 3.65 (0.29) (P ≤ 0.001). During this period, improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes: WOMAC Pain, Physical Function and Total dimensions, as well as SF-36 Physical Function, Role Physical, Body Pain, Vitality and Social Functioning domains. In addition, from baseline to week 8, the proportion of MCIIs was greater among the OAK group than the control group for all outcomes. For the period between baseline and month 6, WOMAC Pain, Physical Function and Total dimensions significantly improved in the OAK group

  16. Negotiated autonomy in diabetes self-management: the experiences of adults with intellectual disability and their support workers.

    Science.gov (United States)

    Whitehead, L C; Trip, H T; Hale, L A; Conder, J

    2016-02-02

    The basic human right of autonomy is underpinned by the ability to practice decision-making. The rights of people with disabilities to engage in autonomous decision-making are promoted as best practice and includes decisions around health and self-care. Little is known about autonomy in the field of long-term condition management. This paper explores how people with intellectual disabilities (ID) and their support workers experience and practice autonomy in relation to the management of diabetes. Semi-structured interviews were completed in residential and independent living settings with people living with an ID and type 1 (N = 8) or type 2 (N = 6) diabetes and their support workers (N = 17). The participant with ID's support worker was present as requested; however, the interviews were run separately with each participant rather than jointly. Thematic analysis was undertaken, and a constructivist lens informed both data collection and analysis. The analysis revealed a strong process of negotiated autonomy between people with ID and their support workers in relation to the daily management of diabetes. During times of transition, roles in relation to diabetes management were renegotiated, and the promotion of autonomy was prefaced within the context of risk and client safety. Goals to increase independence were drivers for negotiating greater autonomy. The successful negotiation of autonomy in relation to diabetes illustrates the potential for people with ID to play a key role in the management of long-term health conditions. The study highlights the primacy of developing decision-making skills among people with ID. Promoting opportunities for decision-making and an ethos of supported decision-making through person-centred planning are all vital in working towards enhancing autonomy. © 2016 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  17. Stop smoking support programs

    Science.gov (United States)

    Smokeless tobacco - stop smoking programs; Stop smoking techniques; Smoking cessation programs; Smoking cessation techniques ... You can find out about smoking cessation programs from: Your ... Your employer Your local health department The National Cancer ...

  18. "I'm still me - I'm still here!" Understanding the person's sense of self in the provision of self-management support for people with progressive neurological long-term conditions.

    Science.gov (United States)

    Kulnik, Stefan Tino; Hollinshead, Lucinda; Jones, Fiona

    2018-01-11

    There is increasing interest in tailoring self-management support, but little detail is available on the relevance and impact of such approaches for people with progressive neurological conditions. The aim of this study was to draw on individuals' experiences to inform the practice of self-management support for these groups. Community rehabilitation service users were purposively recruited and took part in in-depth qualitative interviews. Interviews were audio-recorded and transcribed. Data analysis was iterative and interpretative, taking a phenomenological approach. Strategies to enhance rigor were auditability, peer review, and researcher reflexivity. The sample consisted of 10 adults (age 20-79 years) who were living with a range of progressive neurological conditions. Individuals demonstrated resourcefulness in developing practice-based self-management strategies. Beyond practical strategies, interviewees' experiences were signified by reflecting on and upholding a sense of identity and a desire for purpose against the background of losses and gains over time. Linking with this overarching theme of "Sense of self" were aspects of "My body and mind", "Time", "Space", "Relationships", and "What I do". Self-management approaches for individuals with progressive neurological conditions will benefit from incorporating ways of recognizing, articulating, and supporting the person's sense of identity and purpose. Implications for rehabilitation Self-management approaches for people with progressive neurological conditions need to take account of individuals' wishes to contribute, connect with others, and be valued as a person. Person-centred self-management support can be realized through a broader approach than solely managing disease progression. The experiences and words of people with progressive neurological conditions can be used to inform meaningful evaluation of self-management support to drive service delivery by measuring what really matters

  19. Balance of Autonomic Nervous System Predicts Who Benefits from a Self-management Intervention Program for Irritable Bowel Syndrome.

    Science.gov (United States)

    Jarrett, Monica E; Cain, Kevin C; Barney, Pamela G; Burr, Robert L; Naliboff, Bruce D; Shulman, Robert; Zia, Jasmine; Heitkemper, Margaret M

    2016-01-31

    To determine if potential biomarkers can be used to identify subgroups of people with irritable bowel syndrome (IBS) who will benefit the most or the least from a comprehensive self-management (CSM) intervention. In a two-armed randomized controlled trial a CSM (n = 46) was compared to a usual care (n = 46) group with follow-up at 3 and 6 months post randomization. Biomarkers obtained at baseline included heart rate variability, salivary cortisol, interleukin-10 produced by unstimulated peripheral blood mononuclear cells, and lactulose/mannitol ratio. Linear mixed models were used to test whether these biomarkers predicted improvements in the primary outcomes including daily abdominal pain, Gastrointestinal Symptom score and IBS-specific quality of life. The nurse-delivered 8-session CSM intervention is more effective than usual care in reducing abdominal pain, reducing Gastrointestinal Symptom score, and enhancing quality of life. Participants with lower nighttime high frequency heart rate variability (vagal modulation) and increased low frequency/high frequency ratio (sympathovagal balance) had less benefit from CSM on abdominal pain. Salivary cortisol, IL-10, and lactulose/mannitol ratio were not statistically significant in predicting CSM benefit. Baseline symptom severity interacts with treatment, namely the benefit of CSM is greater in those with higher baseline symptoms. Cognitively-focused therapies may be less effective in reducing abdominal pain in IBS patients with higher sympathetic tone. Whether this a centrally-mediated patient characteristic or related to heightened arousal remains to be determined.

  20. Development of a self-management program for employees with complaints of the arm, neck, and/or shoulder: an intervention mapping approach

    Directory of Open Access Journals (Sweden)

    Hutting N

    2015-07-01

    Full Text Available Nathan Hutting,1,2 Sarah I Detaille,2,3 Josephine A Engels,2 Yvonne F Heerkens,2 J Bart Staal,1,4 Maria WG Nijhuis-van der Sanden1 1Radboud University Medical Center, Radboud Institute for Health Sciences, the Scientific Institute for Quality of Healthcare, 2Hogeschool van Arnhem en Nijmegen (HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Group Occupation and Health, 3HAN University of Applied Sciences, Department HAN Seneca, 4HAN University of Applied Sciences, Faculty of Health and Social Studies, Research Group Musculoskeletal Rehabilitation, Nijmegen, the Netherlands Purpose: To develop a self-management program with an additional eHealth module, using the six steps of the intervention mapping (IM protocol, to help employees with complaints of the arm, neck, and/or shoulder (CANS cope with their problems.Methods: In Step 1 of the IM protocol, a needs assessment was performed consisting of a review of the Dutch multidisciplinary guidelines on CANS, and of focus group sessions with employees with CANS (n=15 and with relevant experts (n=17. After the needs assessment, the objectives of the intervention and the determinants of self-management at work were formulated (Step 2. Furthermore, theory-based intervention methods and practical strategies were selected (Step 3, and an intervention program (including the eHealth module was developed (Step 4. Finally, plans for implementation and evaluation of the program were developed (Steps 5 and 6.Results: Step 1 of the IM protocol revealed that employees with CANS should be stimulated to search for information about the cause of their complaints, about how to deal with their complaints, and in which manner they can influence their complaints themselves. In Step 2, the overall goal of the intervention was defined as “self-management behavior at work” with the aim to alleviate the perceived disability of the participants. Step 3 described how the intervention

  1. Efficacy of 'Tailored Physical Activity' or 'Chronic Pain Self-Management Program' on return to work for sick-listed citizens: design of a randomised controlled trial.

    Science.gov (United States)

    Andersen, Lotte Nygaard; Juul-Kristensen, Birgit; Roessler, Kirsten Kaya; Herborg, Lene Gram; Sørensen, Thomas Lund; Søgaard, Karen

    2013-01-23

    Pain affects quality of life and can result in absence from work. Treatment and/or prevention strategies for musculoskeletal pain-related long-term sick leave are currently undertaken in several health sectors. Moreover, there are few evidence-based guidelines for such treatment and prevention. The aim of this study is to evaluate the efficacy of 'Tailored Physical Activity' or 'Chronic Pain Self-Management Program' for sick-listed citizens with pain in the back and/or the upper body. This protocol describes the design of a parallel randomised controlled trial on the efficacy of 'Tailored Physical Activity' or a 'Chronic Pain Self-management Program' versus a reference group for sick-listed citizens with complaints of pain in the back or upper body. Participants will have been absent from work due to sick-listing for 3 to 9 weeks at the time of recruitment. All interventions will be performed at the 'Health Care Center' in the Sonderborg Municipality, and a minimum of 138 participants will be randomised into one of the three groups.All participants will receive 'Health Guidance', a (1.5-hour) individualised dialogue focusing on improving ways of living, based on assessments of risk behavior, motivation for change, level of self-care and personal resources. In addition, the experimental groups will receive either 'Tailored Physical Activity' (three 50-minute sessions/week over 10 weeks) or 'Chronic Pain Self-Management Program' (2.5-hours per week over 6 weeks). The reference group will receive only 'Health Guidance'.The primary outcome is the participants' sick-listed status at 3 and 12 months after baseline. The co-primary outcome is the time it takes to return to work. In addition, secondary outcomes include anthropometric measurements, functional capacity and self-reported number of sick days, musculoskeletal symptoms, general health, work ability, physical capacity, kinesiophobia, physical functional status, interpersonal problems and mental disorders. There

  2. HIV Care Providers' Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study.

    Science.gov (United States)

    Swendeman, Dallas; Farmer, Shu; Mindry, Deborah; Lee, Sung-Jae; Medich, Melissa

    2016-10-01

    In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools.

  3. Working Together to Promote Diabetes Control: A Practical Guide for Diabetes Health Care Providers in Establishing a Working Alliance to Achieve Self-Management Support.

    Science.gov (United States)

    Jones, Allan; Vallis, Michael; Cooke, Debbie; Pouwer, François

    2016-01-01

    The quality of the "patient-carer" relationship is the foundation of self-management support and has been shown to influence treatment outcome in relation to psychological and somatic illness, including diabetes. It has long been accepted within applied psychology that the quality of the client-therapist relationship--termed the working alliance--is of central importance to treatment outcome and may account for a significant degree of the overall treatment effect. Diabetes healthcare providers have recently expressed a need for further training in communication techniques and in the psychological aspects of diabetes. Could we take a page from the psychological treatment manual on working alliance in therapy to guide the diabetes healthcare provider in their role of supporting the person with diabetes achieve and maintain better metabolic control? This paper examines the role of the working alliance in diabetes care and offers a practical guide to the diabetes healthcare provider in establishing a working alliance with the person with diabetes in managing diabetes.

  4. HIV Care Providers’ Attitudes regarding Mobile Phone Applications and Web-Based Dashboards to support Patient Self-Management and Care Coordination: Results from a Qualitative Feasibility Study

    Science.gov (United States)

    Swendeman, Dallas; Farmer, Shu; Mindry, Deborah; Lee, Sung-Jae; Medich, Melissa

    2016-01-01

    In-depth qualitative interviews were conducted with healthcare providers (HCPs) from five HIV medical care coordination teams in a large Los Angeles County HIV clinic, including physicians, nurses, and psychosocial services providers. HCPs reported on the potential utility, acceptability, and barriers for patient self-monitoring and notifications via mobile phones, and web-based dashboards for HCPs. Potential benefits included: 1) enhancing patient engagement, motivation, adherence, and self-management; and 2) improving provider-patient relationships and HCP care coordination. Newly diagnosed and patients with co-morbidities were highest priorities for mobile application support. Facilitators included universal mobile phone ownership and use of smartphones or text messaging. Patient-level barriers included concerns about low motivation and financial instability for consistent use by some patients. Organizational barriers, cited primarily by physicians, included concerns about privacy protections, easy dashboard access, non-integrated electronic records, and competing burdens in limited appointment times. Psychosocial services providers were most supportive of the proposed mobile tools. PMID:28066820

  5. Supporting health care professionals to improve the processes of shared decision making and self-management in a web-based intervention: randomized controlled trial.

    Science.gov (United States)

    Sassen, Barbara; Kok, Gerjo; Schepers, Jan; Vanhees, Luc

    2014-10-21

    Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited. Using the protocol of Intervention Mapping, a Web-based intervention directed at health care professionals was developed to complement and optimize health services in patient-centered care. The objective of the Web-based intervention was to increase health care professionals' intention and encouraging behavior toward patient self-management, following cardiovascular risk management guidelines. A randomized controlled trial was used to assess the effect of a theory-based intervention, using a pre-test and post-test design. The intervention website consisted of a module to help improve professionals' behavior, a module to increase patients' intention and risk-reduction behavior toward cardiovascular risk, and a parallel module with a support system for the health care professionals. Health care professionals (n=69) were recruited online and randomly allocated to the intervention group (n=26) or (waiting list) control group (n=43), and invited their patients to participate. The outcome was improved professional behavior toward health education, and was self-assessed through questionnaires based on the Theory of Planned Behavior. Social-cognitive determinants, intention and behavior were measured pre-intervention and at 1-year follow-up. The module to improve professionals' behavior was used by 45% (19/42) of the health care professionals in the intervention group. The module to support the health professional in encouraging behavior toward patients was used by 48% (20/42). The module to improve patients' risk-reduction behavior was provided to 44% (24/54) of patients. In 1 of every 5 patients, the guideline for cardiovascular risk management was used. The Web-based intervention was poorly used. In the intervention group, no differences in social-cognitive determinants, intention and behavior were found

  6. Web-based self-management with and without coaching for type 2 diabetes patients in primary care : Design of a randomized controlled trial

    NARCIS (Netherlands)

    van Vugt, Michael; de Wit, Maartje; Hendriks, Steven H.; Roelofsen, Yvonne; Bilo, Henk J. G.; Snoek, Frank J.

    2013-01-01

    Background: Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online

  7. Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial

    NARCIS (Netherlands)

    van Vugt, M.; de Wit, M.; Hendriks, S.H.; Roelofsen, Y.; Bilo, H.J.; Snoek, F.J.

    2013-01-01

    Background: Self-management is recognized as the cornerstone of overall diabetes management. Web-based self-management programs have the potential of supporting type 2 diabetes patients with managing their diabetes and reducing the workload for the care provider, where the addition of online

  8. Towards Self-Managed Executable Petri Nets

    DEFF Research Database (Denmark)

    Hansen, Klaus Marius; Zhang, Weishan; Ingstrup, Mads

    2008-01-01

    An issue in self-managed systems is that different abstractions and programming models are used on different architectural layers, leading to systems that are harder to build and understand. To alleviate this, we introduce a self-management approach which combines high-level Petri nets...... with the capability of distributed communication among nets. Organized in a three-layer goal management, change management, and component control architecture this allows for self-management in distributed systems. We validate the approach through the Flamenco/CPN middleware that allows for self-management of service......-oriented pervasive computing systems through the runtime interpretation of colored Petri nets. The current work focuses on the change management and component control layers....

  9. Effects of a self-management program on antiemetic-induced constipation during chemotherapy among breast cancer patients: a randomized controlled clinical trial.

    Science.gov (United States)

    Hanai, Akiko; Ishiguro, Hiroshi; Sozu, Takashi; Tsuda, Moe; Arai, Hidenori; Mitani, Akira; Tsuboyama, Tadao

    2016-01-01

    Research on patient-reported outcomes indicates that constipation is a common adverse effect of chemotherapy, and the use of 5-hydroxytryptamine (serotonin; 5HT3) receptor antagonists aggravates this condition. As cancer patients take multiple drugs as a part of their clinical management, a non-pharmacological self-management (SM) of constipation would be recommended. We aimed to evaluate the effectiveness of a SM program on antiemetic-induced constipation in cancer patients. Thirty patients with breast cancer, receiving 5HT3 receptor antagonists to prevent emesis during chemotherapy were randomly assigned to the intervention or control group. The SM program consisted of abdominal massage, abdominal muscle stretching, and education on proper defecation position. The intervention group started the program before the first chemotherapy cycle, whereas patients in the wait-list control group received the program on the day before their second chemotherapy cycle. The primary outcome was constipation severity, assessed by the constipation assessment scale (CAS, sum of eight components). The secondary outcome included each CAS component (0-2 points) and mood states. A self-reported assessment of satisfaction with the program was performed. The program produced a statistically and clinically significant alleviation of constipation severity (mean difference in CAS, -3.00; P = 0.02), decrease in the likelihood of a small volume of stool (P = 0.03), and decrease in depression and dejection (P = 0.02). With regards to program satisfaction, 43.6 and 26.4 % patients rated the program as excellent and good, respectively. Our SM program is effective for mitigating the symptoms of antiemetic-induced constipation during chemotherapy.

  10. Effects of a self-management education program on self-efficacy in patients with COPD: a mixed-methods sequential explanatory designed study

    Science.gov (United States)

    Ng, Wai I; Smith, Graeme Drummond

    2017-01-01

    Background Self-management education programs (SMEPs) are potentially effective in the symptomatic management of COPD. Little is presently known about the effectiveness of these programs in Chinese COPD patients. The objective of this study was to evaluate the effectiveness of a specifically designed SMEP on levels of self-efficacy in Chinese patients with COPD. Materials and methods Based on the Medical Research Council framework for evaluating complex interventions, an exploratory phase randomized controlled trial was employed to examine the effects of an SMEP. Self-efficacy was the primary outcome using the COPD Self-efficacy Scale, measured at baseline and 6 months after the program. Qualitative data were sequentially collected from these patients via three focus groups to supplement the quantitative findings. Results The experimental group displayed significant improvement in their general self-efficacy (Z =−2.44, P=0.015) and specifically in confronting 1) physical exertion (Z =−2.57, P=0.01), 2) weather/environment effects (Z =−2.63, PChinese patients with COPD. Further attention should be given to cultural considerations when developing this type of intervention in Chinese populations with COPD and other chronic diseases. PMID:28790816

  11. The ABCs of diabetes: diabetes self-management education program for African Americans affects A1C, lipid-lowering agent prescriptions, and emergency department visits.

    Science.gov (United States)

    Magee, Michelle; Bowling, Andrea; Copeland, James; Fokar, Ali; Pasquale, Patricia; Youssef, Gretchen

    2011-01-01

    The purpose of the study was to examine the feasibility and impact of a concise community-based program on diabetes self-management education (DSME), according to frequency of emergency department visits and knowledge of, prescriptions for, and control of A1C, blood pressure, and low-density lipoprotein (LDL) cholesterol. A free community-based DSME program was placed in a public library. Adults with diabetes (N, 360) consented to participate in this prospective nonrandomized cohort study with preintervention-postintervention design. The small-group interactive DSME (two 2.5-hour classes) focused on improving cardiovascular disease risk factors and facilitating communication with the primary care physician. An increase in knowledge of American Diabetes Association-recommended targets for A1C, blood pressure, and LDL cholesterol from baseline to postintervention was seen among participants. Significant clinical outcomes included reduction in self-reported emergency department visits and reduction in mean A1C. However, despite an increase in prescriptions written for lipid-lowering drugs, blood pressure and LDL cholesterol did not change. Participants who started on insulin were more likely to achieve or maintain A1C location for offering DSME programs.

  12. Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project.

    Science.gov (United States)

    Van den Broucke, S; Van der Zanden, G; Chang, P; Doyle, G; Levin, D; Pelikan, J; Schillinger, D; Schwarz, P; Sørensen, K; Yardley, L; Riemenschneider, H

    2014-12-01

    Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels. © Georg Thieme Verlag KG Stuttgart · New York.

  13. PKU Self-Management Timeline

    Science.gov (United States)

    ... about pku UW PKU Clinic News & Events PKU Self-Management Timeline This timeline is also available as an ... Acrobat file. Click here to download. The PKU Self- Management timeline is included to provide long-term view ...

  14. An internet survey of the characteristics and physical activity of community-dwelling Australian adults with acquired brain injury: Exploring interest in an internet-delivered self-management program focused on physical activity.

    Science.gov (United States)

    Jones, Taryn M; Dean, Catherine M; Dear, Blake F; Hush, Julia M; Titov, Nickolai

    2016-01-01

    Individuals with acquired brain injury (ABI) are more likely to be physically inactive and experience barriers to accessing services to address inactivity. This study was designed to guide the development of an internet-delivered self-management program to increase physical activity after ABI. The aims of this study were to examine the current physical activity status of community-dwelling Australian adults with ABI, the barriers to physical activity they experience and to explore interest an internet-delivered self-management program aimed at increasing physical activity. An online survey of Australian adults with ABI was used to collect information about demographic characteristics; general health; emotional well-being; mobility and physical activity status, and satisfaction; barriers to physical activity; confidence in overcoming barriers, and; interest in an internet self-management program. Data were analyzed descriptively and correlational analyses examined relationships between variables. Data were analyzed from 59 respondents. Over half were not satisfied with their current physical activity status. The most frequently reported barriers were pain/discomfort, fatigue and fear, and confidence to overcome these barriers was very low. Interest in an internet-delivered self-management program was high (74%) and not related to the amount of physical activity, satisfaction with physical activity and mobility status or total number of barriers. Australian adults with ABI are not satisfied with their activity levels and experience barriers in maintaining their physical activity levels. Participants were interested in accessing an internet-delivered self-management program aimed at improving physical activity levels. Therefore such a program warrants development and evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study

    NARCIS (Netherlands)

    Koetsenruijter, J.; Lieshout, J. van; Vassilev, I.; Portillo, M.C.; Serrano, M.; Knutsen, I.; Roukova, P.; Lionis, C.; Todorova, E.; Foss, C.; Rogers, A.; Wensing, M.

    2014-01-01

    BACKGROUND: Long-term conditions pose major challenges for healthcare systems. Optimizing self-management of people with long-term conditions is an important strategy to improve quality of life, health outcomes, patient experiences in healthcare, and the sustainability of healthcare systems. Much

  16. The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation

    OpenAIRE

    Kerr, C.; Murray, E.; Noble, L.; Morris, R.; Bottomley, C.; Stevenson, F.; Patterson, D.; Peacock, R.; Turner, I.; Jackson, K.; Nazareth, I.

    2010-01-01

    Background: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide.Objective: To explore the effectiveness of a web-based intervention in de...

  17. The Potential of Web-based Interventions for Heart Disease Self-Management: A Mixed Methods Investigation

    OpenAIRE

    Kerr, Cicely; Murray, Elizabeth; Noble, Lorraine; Morris, Richard; Bottomley, Christian; Stevenson, Fiona; Patterson, David; Peacock, Richard; Turner, Indra; Jackson, Keith; Nazareth, Irwin

    2010-01-01

    Background: Existing initiatives to support patient self-management of heart disease do not appear to be reaching patients most in need. Providing self-management programs over the Internet (web-based interventions) might help reduce health disparities by reaching a greater number of patients. However, it is unclear whether they can achieve this goal and whether their effectiveness might be limited by the digital divide. Objective: To explore the effectiveness of a web-based intervention in d...

  18. Internet-based support for self-management strategies for people with COPD-protocol for a controlled pragmatic pilot trial of effectiveness and a process evaluation in primary healthcare.

    Science.gov (United States)

    Nyberg, André; Wadell, Karin; Lindgren, Helena; Tistad, Malin

    2017-08-01

    The use of adequate self-management strategies for people with chronic obstructive pulmonary disease (COPD) reduces healthcare use, improves health-related quality of life (HRQoL) and recovery after acute exacerbations. However, not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted. This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention, the COPD-web. METHODS AND ANALYSIS: The overall design is a pragmatic controlled pilot trial with preassessments and postassessments and a parallel process evaluation. Patients with the diagnosis of COPD will be eligible for the study. The intervention group will be recruited when visiting one of the six participating primary care units in Sweden. The control group will be identified from the unit's computerised registers. The intervention, the COPD-web, is an interactive web page with two sections; one directed at people with COPD and one at healthcare professionals. The sections aim to support patients' self-management skills-and to facilitate the provision of support for self-management strategies, respectively. Effectiveness with regard to patients' symptoms, HRQoL, knowledge of and readiness for COPD-related self-management, health literacy, self-efficacy for physical activity and time spent in physical activity and time being sedentary, and further, healthcare professionals' knowledge of and readiness to support COPD-related self-management strategies will be assessed using questionnaires at 3 and 12 months. The process evaluation will include observations and interviews. Ethical approval has been obtained. Findings will be presented at conferences, submitted for publication in peer-reviewed publications and presented to the involved healthcare professionals, patients and to patient organisations

  19. Pipe support program at Pickering

    International Nuclear Information System (INIS)

    Sahazizian, L.A.; Jazic, Z.

    1997-01-01

    This paper describes the pipe support program at Pickering. The program addresses the highest priority in operating nuclear generating stations, safety. We present the need: safety, the process: managed and strategic, and the result: assurance of critical piping integrity. In the past, surveillance programs periodically inspected some systems, equipment, and individual components. This comprehensive program is based on a managed process that assesses risk to identify critical piping systems and supports and to develop a strategy for surveillance and maintenance. The strategy addresses all critical piping supports. Successful implementation of the program has provided assurance of critical piping and support integrity and has contributed to decreasing probability of pipe failure, reducing risk to worker and public safety, improving configuration management, and reducing probability of production losses. (author)

  20. Self-management strategies in chronic obstructive pulmonary disease: a first step toward personalized medicine.

    Science.gov (United States)

    Barrecheguren, Miriam; Bourbeau, Jean

    2018-03-01

    Self-management has gained increased relevance in the management of chronic obstructive pulmonary disease patients. The heterogeneity in self-management interventions has complicated the development of recommendations for clinical practice. In this review, we present the latest findings regarding conceptual definition, effectiveness of self-management interventions and self-management strategies in chronic obstructive pulmonary disease as a first step toward personalized medicine: what, how and to whom? Self-management interventions have shown benefits in improving health-related quality of life and reducing hospital admissions. Favorable outcomes can only be achieved if patients have an ultimate goal, that is their desired achievements in their life. In the continuum of care, the components of the self-management program will vary to adapt to the condition of the patient (disease severity, comorbidities) and to factors such as patient motivation, confidence (self-efficacy), access to health care, family and social support. A combination of education, case management and patient-centric action plan has shown the best chance of success. The individual patient's needs, own preferences and personal goals should inform the design of any intervention with a behavioral component. A continuous loop process has to be implemented to constantly assess what work and does not work, aiming at achieving the desired outcomes for a given patient.

  1. PSF support pilot program

    Science.gov (United States)

    Anderson, Jay

    2013-10-01

    The goal of this program is to observe the center of Omega Cen {which has a nice flat distribution of reasonably-spaced-out stars} in order to construct a PSF model for ACS's three workhorse filters: F435W, F606W, and F814W. These also happen to be the three ACS filters that will be used in the Frontier-Field program. PI-Anderson will use the data to consturct an 9x10 array of fiducial PSFs that describe the static variation of the PSF across the frame for each filter. He will also provide some simple routines that the public can use to insert PSFs into images.The observations will dither the center of the cluster around in a circle with a radius of about 30" such that any single star never falls in the ACS gap more than once. This has the additional benefit that we can use this large dither to validate or improve the distortion solution at the same time we are solving for the PSF. We will get four exposures through each of the ACS filters. The exposure times for the three ACS filters {F435W, F606W, and F814W} were chosen to maximize the number of bright unsaturated stars while simultaneously minimizing the number of saturated stars present. To do this, we made sure that the SGB {which is where the LF rises precipitously} is just below the saturation level. We used archival images from GO-9444 and GO-10775 to ensure that 339s for F435W, 80s in F606W, and 90s in F814W is perfect for this.In addition to the ACS exposures, we also take parallels with WFC3/IR. These exposures will sample a field that is 6' off center. The core radius is 2.5', so this outer field should have a density that is 5x lower than at the center, meaning the typical star is maybe 2.5x farther away. This should compensate for the larger WFC3/IR pixels and will allow us to construct PSFs that are appropriate. We take a total of 32 WFC3/IR exposures, each with an exposure time of 103s, and divide these 32 exposures among the four FF WFC3/IR exposures: F105W, F125W, F140W, and F160W. We will use

  2. Diabetes self-management education in South Auckland, New Zealand, 2007-2008.

    Science.gov (United States)

    Silva, Martha; Clinton, Janet; Appleton, Sarah; Flanagan, Pat

    2011-03-01

    Self-management education programs seek to help patients realize that they are their own principal caregivers and that health care professionals are consultants who support them in this role. The aim of this study was to evaluate a diabetes self-management education program implemented as part of a district-wide approach in South Auckland, New Zealand, which has some of the highest prevalence rates for diabetes and is one of the most ethnically diverse and deprived regions of New Zealand. Self-management attitudes and behaviors were monitored with the use of questionnaires before and after program implementation. Clinical outcomes such as hemoglobin A1c, body mass index, and blood pressure were also tracked before the program began and 3 months after the program ended. Participant focus groups and facilitator interviews were conducted to explore perceptions of the program. Participants showed improvement in attitudes toward their own ability to manage their diabetes; in diet, physical activity, and foot care; and in hemoglobin A1c levels 3 months after the end of participation. Participants also reduced their sense of isolation when dealing with their diabetes. However, catering to the needs of a multiethnic community is extremely resource-intensive because of the need to provide adequate language and cultural interpretation. Self-management education can work in multiethnic, high-needs communities in New Zealand. Programs must ensure they enable the appropriate mechanisms and have appropriate resources to support the community's needs.

  3. The Impact of a Diabetes Self-Management Education Program Provided through a Telemedicine Link to Rural California Health Care Clinics

    Directory of Open Access Journals (Sweden)

    Jim Nuovo

    2013-01-01

    Full Text Available Background This project investigated the impact of a DM self-management education program provided through a telemedicine link at nine rural health clinics in Northern California. Methods Two hundred thirty nine patients were provided with a single 2-hour class on DM delivered through a live televideo connection. Patients provided pre-intervention information on: demographics and overall health, self-care behaviors, and knowledge about DM. All participants completed a post-education survey on knowledge and self-care behaviors. Results There was a significant decrease in the number of patients who felt overwhelmed with their DM; pre-intervention 18.8%; post-intervention 5.4% ( P < 0.0001. Patients increased the number of days they exercised; pre-intervention 3.4 days; post-intervention 3.9 days ( P = 0.02. Patients increased the number of days they checked their feet; pre-intervention 4.2 days; post-intervention 5.6 days ( P < 0.01. Knowledge about DM improved over the study period ( P < 0.01. Conclusions A single 2-hour class on DM administered through a telemedicine link to patients in rural health clinics resulted in feeling less overwhelmed, more knowledgeable about DM, and demonstrated an increase in self-care behavior; ie, exercise and foot care.

  4. Keys to successful diabetes self-management for uninsured patients: social support, observational learning, and turning points: a safety net providers' strategic alliance study.

    Science.gov (United States)

    Madden, Melissa Hanahan; Tomsik, Philip; Terchek, Joshua; Navracruz, Lisa; Reichsman, Ann; Clark, Terri Clemons; Cella, Peggi; Weirich, Stephen A; Munson, Michelle R; Werner, James J

    2011-03-01

    To examine how medically uninsured patients who receive health care at federally qualified health centers and free clinics are able to successfully self-manage diabetes compared to patients who are less successful. Two distinct groups of patients with diabetes for 6 months or longer were enrolled: (1) successful, defined as those with glycated hemoglobin (HbA1c) of 7% or less or a recent improvement of at least 2% (n=17); and (2) unsuccessful, defined as patients with HbAlc of at least 9% (n=9) and without recent improvement. Patients were interviewed about enabling factors, motivators, resources, and barriers to diabetes self-management. Data from interviews, chart reviews, and clinician surveys were analyzed using qualitative methods and statistical techniques. African Americans comprised 57.7% of the sample and whites 38.5% (N=26). No significant differences were detected between successful and unsuccessful groups in age, race, education, or employment status. Clinicians rated unsuccessful patients as having more severe diabetes and significantly lower levels of control than successful patients. Compared to unsuccessful patients, successful patients more often reported having friends or family with diabetes, more frequently sought information about the disease, used evidence-based self-management strategies, held more accurate perceptions of their own diabetes control, and experienced "turning point" events that motivated increased efforts in disease management. Patients who successfully managed diabetes learned from diabetic family members and interpreted disease-related events as motivational turning points. It may be beneficial to incorporate social learning and motivational enhancement into diabetes interventions to increase patients' motivation for improved levels of self-management.

  5. A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.

    Science.gov (United States)

    Yu, Catherine H; Parsons, Janet A; Mamdani, Muhammad; Lebovic, Gerald; Hall, Susan; Newton, David; Shah, Baiju R; Bhattacharyya, Onil; Laupacis, Andreas; Straus, Sharon E

    2014-12-14

    Management of diabetes mellitus is complex and involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. The objective of this study was to determine the effect of a web-based patient self-management intervention on psychological (self-efficacy, quality of life, self-care) and clinical (blood pressure, cholesterol, glycemic control, weight) outcomes. For this cohort study we used repeated-measures modelling and qualitative individual interviews. We invited patients with type 2 diabetes to use a self-management website and asked them to complete questionnaires assessing self-efficacy (primary outcome) every three weeks for nine months before and nine months after they received access to the website. We collected clinical outcomes at three-month intervals over the same period. We conducted in-depth interviews at study conclusion to explore acceptability, strengths and weaknesses, and mediators of use of the website. We analyzed the data using a qualitative descriptive approach and inductive thematic analysis. Eighty-one participants (mean age 57.2 years, standard deviation 12) were included in the analysis. The self-efficacy score did not improve significantly more than expected after nine months (absolute change 0.12; 95% confidence interval -0.028, 0.263; p = 0.11), nor did clinical outcomes. Website usage was limited (average 0.7 logins/month). Analysis of the interviews (n = 21) revealed four themes: 1) mediators of website use; 2) patterns of website use, including role of the blog in driving site traffic; 3) feedback on website; and 4) potential mechanisms for website effect. A self-management website for patients with type 2 diabetes did not improve self-efficacy. Website use was limited

  6. Comparing effects in regular practice of e-communication and Web-based self-management support among breast cancer patients: preliminary results from a randomized controlled trial.

    Science.gov (United States)

    Børøsund, Elin; Cvancarova, Milada; Moore, Shirley M; Ekstedt, Mirjam; Ruland, Cornelia M

    2014-12-18

    While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care. Our aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months' follow-up data in a 12-month trial. We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time. Patients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e

  7. Site Support Program Plan Infrastructure Program

    International Nuclear Information System (INIS)

    1995-01-01

    The Fiscal Year 1996 Infrastructure Program Site Support Program Plan addresses the mission objectives, workscope, work breakdown structures (WBS), management approach, and resource requirements for the Infrastructure Program. Attached to the plan are appendices that provide more detailed information associated with scope definition. The Hanford Site's infrastructure has served the Site for nearly 50 years during defense materials production. Now with the challenges of the new environmental cleanup mission, Hanford's infrastructure must meet current and future mission needs in a constrained budget environment, while complying with more stringent environmental, safety, and health regulations. The infrastructure requires upgrading, streamlining, and enhancement in order to successfully support the site mission of cleaning up the Site, research and development, and economic transition

  8. Site Support Program Plan Infrastructure Program

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-09-26

    The Fiscal Year 1996 Infrastructure Program Site Support Program Plan addresses the mission objectives, workscope, work breakdown structures (WBS), management approach, and resource requirements for the Infrastructure Program. Attached to the plan are appendices that provide more detailed information associated with scope definition. The Hanford Site`s infrastructure has served the Site for nearly 50 years during defense materials production. Now with the challenges of the new environmental cleanup mission, Hanford`s infrastructure must meet current and future mission needs in a constrained budget environment, while complying with more stringent environmental, safety, and health regulations. The infrastructure requires upgrading, streamlining, and enhancement in order to successfully support the site mission of cleaning up the Site, research and development, and economic transition.

  9. A pilot evaluation of Arthritis Self-Management Program by lay leaders in patients with chronic inflammatory arthritis in Hong Kong.

    Science.gov (United States)

    Leung, Ying-Ying; Kwan, Jackie; Chan, Patsy; Poon, Peter K K; Leung, Christine; Tam, Lai-Shan; Li, Edmund K; Kwok, Anna

    2016-04-01

    The objectives of this paper are to evaluate the efficacy of a community-based lay-led Arthritis Self-Management Program (ASMP) among patients with chronic inflammatory arthritis and evaluate the effectiveness of "shared care collaboration" between hospital and community. We trained 17 lay leaders and recruited patients with chronic inflammatory arthritis via a new shared-care model between hospital rheumatology centers and community organizations. Participants were allocated to interventional group or a wait list control group. Evaluations were completed before, after (6 weeks), and 3 months after ASMP. We performed analysis of covariance with adjustment with age, sex, marital status, education, employment, duration of illness, and disability at baseline. A total of 65 participants and 32 controls completed the study. The mean (SD) age and duration of illness were 52.0 (11.4) and 5.6 (7.3) years, 90.7 % were female, 80.4 % had rheumatoid arthritis; 25.8, 53.6, and 12.4 % referrals were from hospitals, community organizations, and patient self-help groups, respectively. The interventional group had significantly less pain (p = 0.049 at 6 weeks), used more cognitive coping methods (p = 0.008 at 6 weeks, p = 0.041 at 3 months) and practiced more aerobic exercise (p = 0.049 at 6 weeks, p = 0.008 at 3 months) after adjustment of covariance. The interventional group had a trend of improvement in self-efficacy, fatigue, self-rated health, and health distress. A community-based lay-led ASMP showed positive beneficial effects on participants with chronic inflammatory arthritis. Shared-care collaboration between hospitals, community organizations, and patient self-help groups was demonstrated.

  10. Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: a scoping review.

    Science.gov (United States)

    Tung, James Y; Stead, Brent; Mann, William; Ba'Pham; Popovic, Milos R

    2015-01-01

    Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.

  11. Keys to Successful Diabetes Self-Management for Uninsured Patients: Social Support, Observational Learning, and Turning Points A Safety Net Providers’ Strategic Alliance Study

    Science.gov (United States)

    Hanahan, Melissa A.; Werner, James J.; Tomsik, Phillip; Weirich, Stephen A.; Reichsman, Ann; Navracruz, Lisa; Clemons-Clark, Terri; Cella, Peggi; Terchek, Joshua; Munson, Michelle R.

    2015-01-01

    Objective To determine how medically uninsured patients with limited material resources successfully manage diabetes. Methods Clinicians at 5 safety net practices enrolled uninsured adult patients (N=26) with prior diagnosis of diabetes for 6 months or longer. Patients were interviewed about enabling factors, motivations, resources, and barriers. Chart reviews and clinician surveys supplemented interview data. Interview, survey, and chart review data were analyzed and findings were summarized. Results Two distinct groups of patients were investigated: 1) “successful,” defined as those with an HbA1c of ≤7% or a recent improvement of at least 2% (n=17); and 2) “unsuccessful,” defined as patients with HbA1c of ≥9% (n=9) without recent improvement. In comparison to unsuccessful patients, successful patients more often reported having friends or family with diabetes, sought information about the disease, used evidence-based self-management strategies, held an accurate perception of their own disease control, and experienced “turning point” events that motivated increased efforts in disease management. Conclusions Uninsured safety net patients who successfully managed diabetes learned from friends and family with diabetes and leveraged disease-related events into motivational turning points. It may be beneficial for clinicians to incorporate social learning and motivational enhancement into diabetes interventions to increase patients’ motivation for improved levels of self-management. PMID:21671529

  12. Self-management through shame

    DEFF Research Database (Denmark)

    Staunæs, Dorthe; Bjerg, Helle

    2011-01-01

    of management of self-management in two ways. Firstly, by thinking management of self-management trough concepts from what has become known as the affective turn. Secondly, by illustrating the precise mechanisms of management of self-management in every day life and thereby pointing to how management of self...... to recognition, but is also linked to the production of shame or at least potential shame. This argument is developed theoretically from Brian Massumi's theory on affectivity and intensity combined with Silvan Tomkins's theory of shame as the most self-reflexive affect of all affects. In order to exemplify......  Critical studies on management of self-management and governmentality have primarily been occupied with the production of identities, subject positions and the reflexive elements of self-management. The aim of this article is to challenge and contribute to the field of critical studies...

  13. Wellness and illness self-management skills in community corrections.

    Science.gov (United States)

    Kelly, Patricia J; Ramaswamy, Megha; Chen, Hsiang-Feng; Denny, Donald

    2015-02-01

    Community corrections provide a readjustment venue for re-entry between incarceration and home for inmates in the US corrections system. Our goal was to determine how self-management skills, an important predictor of re-entry success, varied by demographic and risk factors. In this cross-sectional study, we analyzed responses of 675 clients from 57 community corrections programs run by the regional division of the Federal Bureau of Prisons. A self-administered survey collected data on self-management skills, demographics, and risk factors; significant associations were applied in four regression models: the overall self-management score and three self-management subscales: coping skills, goals, and drug use. Over one-quarter (27.2%/146) of participants had a mental health history. White race, no mental health history and high school education were associated with better overall self-management scores; mental health history and drug use in the past year were associated with lower coping scores; female gender and high school education were associated with better self-management goals; female gender was associated with better self-management drug use scores. Self-management programs may need to be individualized for different groups of clients. Lower scores for those with less education suggest an area for targeted, nurse-led interventions.

  14. Challenges of a pharmacist-directed peer support program among adolescents with diabetes.

    Science.gov (United States)

    Sims, Lisa M; Haines, Seena L

    2011-01-01

    To describe the development and challenges of a pharmacist-directed peer support program among adolescents with diabetes. The program was designed as adjunctive therapy for adolescents receiving care at the Diabetes Education and Research Center (DERC). DERC is an interdisciplinary facility at which the clinical pharmacist provides direct, diabetes-related patient care services. Through collaboration with DERC, pharmacists developed and facilitated each component of the program. The U. S. Diabetes Conversation Map program was used for the educational component of the program. This is an innovative, American Diabetes Association-approved tool for providing group education on diabetes self-management. As trained facilitators of the conversation maps, the investigators educated group leaders on how to be facilitators for their peers. Glycosylated hemoglobin (A1C), diabetes self-management skills, and diabetes-related quality of life were measured at baseline and following program completion. Qualitative outcomes were measured via validated questionnaires in adolescents with type 1 diabetes. The investigators facilitated the gathering of all quantitative and qualitative data. Several participants did not meet all inclusion criteria; therefore, data from only six participants were assessed. A1C increased among participants, affirming the challenge of metabolic control during adolescence. Despite this, qualitative analysis of questionnaires revealed improvements in adherence to lifestyle modifications and health perception after program completion. Evidence illustrates beneficial effects of peer-facilitated support on the physical and psychological challenges of diabetes self-management; however, challenges existed when implementing this program among adolescents. Suggestions to overcome these challenges include same-sex support groups, use of an appealing setting for participants, incorporation into camps or after-school programs, and extended program length

  15. Informal care and the self-management partnership: implications for Australian health policy and practice.

    Science.gov (United States)

    Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

    2010-11-01

    The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

  16. Managing Epilepsy Well: Emerging e-Tools for epilepsy self-management.

    Science.gov (United States)

    Shegog, Ross; Bamps, Yvan A; Patel, Archna; Kakacek, Jody; Escoffery, Cam; Johnson, Erica K; Ilozumba, Ukwuoma O

    2013-10-01

    The Managing Epilepsy Well (MEW) Network was established in 2007 by the Centers for Disease Control and Prevention Epilepsy Program to expand epilepsy self-management research. The network has employed collaborative research strategies to develop, test, and disseminate evidence-based, community-based, and e-Health interventions (e-Tools) for epilepsy self-management for people with epilepsy, caregivers, and health-care providers. Since its inception, MEW Network collaborators have conducted formative studies (n=7) investigating the potential of e-Health to support epilepsy self-management and intervention studies evaluating e-Tools (n=5). The MEW e-Tools (the MEW website, WebEase, UPLIFT, MINDSET, and PEARLS online training) and affiliated e-Tools (Texting 4 Control) are designed to complement self-management practices in each phase of the epilepsy care continuum. These tools exemplify a concerted research agenda, shared methodological principles and models for epilepsy self-management, and a communal knowledge base for implementing e-Health to improve quality of life for people with epilepsy. © 2013.

  17. Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Matthew Lee Smith

    2018-04-01

    Full Text Available Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72] relative to CDSMP (‘Usual Care’ [n = 109] to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%, non-Hispanic white (62%, and obese (73%. On average, participants were age 48 (range: 23–72 and self-reported 3.25 chronic conditions (range: 1–16. The most commonly reported conditions were high cholesterol (45%, high blood pressure (45%, anxiety/emotional/mental health condition (26%, and diabetes (25%. Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018, fatigue (uΔ = −2.88, p = 0.002, sedentary behavior (uΔ = −4.49, p = 0.018, soda/sugar beverage consumption (uΔ = −0.78, p = 0.028, and fast food intake (uΔ = −0.76, p = 0.009 from baseline to follow-up. Significant improvements in patient–provider communication (uΔ = 0.46, p = 0.031 and mental work limitations (uΔ = −8.89, p = 0.010 were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05. The translation of Usual Care (content and format has potential to improve health among employees with chronic conditions and increase uptake in workplace

  18. Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial.

    Science.gov (United States)

    Smith, Matthew Lee; Wilson, Mark G; Robertson, Melissa M; Padilla, Heather M; Zuercher, Heather; Vandenberg, Robert; Corso, Phaedra; Lorig, Kate; Laurent, Diana D; DeJoy, David M

    2018-04-25

    Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [ n = 72]) relative to CDSMP (‘Usual Care’ [ n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23⁻72) and self-reported 3.25 chronic conditions (range: 1⁻16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient⁻provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations ( p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace

  19. Self-management in patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Pathak SN

    2014-07-01

    Full Text Available Swetha Narahari Pathak,1 Pauline L Scott,1 Cameron West,1 Steven R Feldman,1–3 1Center for Dermatology Research, Departments of Dermatology, 2Center for Dermatology Research, Departments of Pathology, 3Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA Abstract: Psoriasis is a chronic inflammatory disorder effecting the skin and joints. Additionally, multiple comorbidities exist, including cardiovascular, metabolic, and psychiatric. The chronic nature of psoriasis is often frustrating for both patients and physicians alike. Many options for treatment exist, though successful disease management rests largely on patients through the application of topical corticosteroids, Vitamin D analogs, and calcineurin inhibitors, amongst others and the administration of systemic medications such as biologics and methotrexate. Phototherapy is another option that also requires active participation from the patient. Many barriers to effective self-management of psoriasis exist. Successful treatment requires the establishment of a strong doctor-patient relationship and patient empowerment in order to maximize adherence to a treatment regimen and improve outcomes. Improving patient adherence to treatment is necessary in effective self-management. Many tools exist to educate and empower patients, including online sources such as the National Psoriasis Foundation and online support group, Talk Psoriasis, amongst others. Effective self management is critical in decreasing the physical burden of psoriasis and mitigating its multiple physical, psychological, and social comorbidities, which include obesity, cardiovascular disease, alcohol dependence, depression, anxiety, and social anxiety. Keywords: psoriasis, adherence, self management, compliance

  20. Extending Self-Management Strategies: The Use of a Classwide Approach

    Science.gov (United States)

    Hoff, Kathryn E.; Ervin, Ruth A.

    2013-01-01

    Notwithstanding the wealth of research that documents the effectiveness of self-management programs in the classroom, few investigations have explored classwide use of self-management procedures as a universal intervention. To extend existing research in this area, we examined the effectiveness of a classwide self-management intervention for…

  1. Development of patient-centric linguistically tailored psychoeducational messages to support nutrition and medication self-management in type 2 diabetes: a feasibility study

    Directory of Open Access Journals (Sweden)

    Ellis RJB

    2014-10-01

    Full Text Available Rebecca J Bartlett Ellis,1 Ulla Connor,2 James Marshall21Indiana University School of Nursing, 2Indiana University School of Liberal Arts, International Center for Intercultural Communication, Indiana University, Indianapolis, IN, USA Purpose: This study evaluated the feasibility of developing linguistically tailored educational messages designed to match the linguistic styles of patients segmented into types with the Descriptor™, and to determine patient preferences for tailored or standard messages based on their segments. Patients and methods: Twenty patients with type 2 diabetes (T2DM were recruited from a diabetes health clinic. Participants were segmented using the Descriptor™, a language-based questionnaire, to identify patient types based on their control orientation (internal/external, agency (high/low, and affect (positive/negative, which are well studied constructs related to T2DM self-management. Two of the seven self-care behaviors described by the American Association of Diabetes Educators (healthy eating and taking medication were used to develop standard messages and then linguistically tailored using features of the six different construct segment types of the Descriptor™. A subset of seven participants each provided feedback on their preference for standard or linguistically tailored messages; 12 comparisons between standard and tailored messages were made. Results: Overall, the tailored messages were preferred to the standard messages. When the messages were matched to specific construct segment types, the tailored messages were preferred over the standard messages, although this was not statistically significant. Conclusion: Linguistically tailoring messages based on construct segments is feasible. Furthermore, tailored messages were more often preferred over standard messages. This study provides some preliminary evidence for tailoring messages based on the linguistic features of control orientation, agency, and affect

  2. Lay Health Trainers Supporting Self-Management amongst Those with Low Heath Literacy and Diabetes: Lessons from a Mixed Methods Pilot, Feasibility Study.

    Science.gov (United States)

    Bartlam, Bernadette; Rathod, Trishna; Rowlands, Gillian; Protheroe, Joanne

    2016-01-01

    This article reports a mixed methods process evaluation of a pilot feasibility randomised controlled trial comparing a Lay Health Trainer (LHT) intervention and usual care for those with poorly controlled Type 2 Diabetes Melitus (T2DM). Set in a deprived area in the UK, this research explores patient and health care practitioner (HCP) views on whether a structured interview between a patient and a Lay Health Trainer (LHT), for the purpose of developing a tailored self-management plan for patients, is acceptable and likely to change health behaviours. In doing so, it considers the implications for a future, randomised controlled trial (RCT). Participants were patients, LHTs delivering the intervention, service managers, and practice nurses recruiting patients to the study. Patients were purposively sampled on their responses to a baseline survey, and semistructured interviews were conducted within an exploratory thematic analysis framework. Findings indicate that the intervention is acceptable to patients and HCPs. However, LHTs found it challenging to work with older patients with long-term and/or complex conditions. In order to address this, given an ageing population and concomitant increases in those with such health needs, LHT training should develop skills working with these populations. The design of any future RCT intervention should take account of this.

  3. Chronic condition self-management: expectations of responsibility.

    Science.gov (United States)

    Lawn, Sharon; McMillan, John; Pulvirenti, Mariastella

    2011-08-01

    While self-management may be beneficial for many patients it assumes and encourages a particular conception of responsibility and self-management that may not fit with all patients' experience of their chronic conditions and their management. It therefore warrants further examination. We examine the concept of self-management and responsibility from a range of standpoints, focusing on the Australian context. Attempts to meet people's needs run the risk of imposing specific conceptions of how people should live their lives. While self-management appears to be consistent with placing patients' needs, values and priorities at the heart of healthcare, ill-defined assumptions about responsibility may confound these goals. Reflection on social determinants of health, the context in which patients seek self-management support from health services, and how their needs and preferences are listened to by health professionals, is critical for the collaborative self-management partnership between them to be effectively realized. Providing services without reflecting on the meaning of self-management for the person with chronic conditions creates unintended assumptions about responsibility, engagement and care provision which may serve to alienate and further stigmatise some patients. Often, these are the very patients with complex needs who need such service support the most. Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Personal discovery in diabetes self-management: Discovering cause and effect using self-monitoring data.

    Science.gov (United States)

    Mamykina, Lena; Heitkemper, Elizabeth M; Smaldone, Arlene M; Kukafka, Rita; Cole-Lewis, Heather J; Davidson, Patricia G; Mynatt, Elizabeth D; Cassells, Andrea; Tobin, Jonathan N; Hripcsak, George

    2017-12-01

    To outline new design directions for informatics solutions that facilitate personal discovery with self-monitoring data. We investigate this question in the context of chronic disease self-management with the focus on type 2 diabetes. We conducted an observational qualitative study of discovery with personal data among adults attending a diabetes self-management education (DSME) program that utilized a discovery-based curriculum. The study included observations of class sessions, and interviews and focus groups with the educator and attendees of the program (n = 14). The main discovery in diabetes self-management evolved around discovering patterns of association between characteristics of individuals' activities and changes in their blood glucose levels that the participants referred to as "cause and effect". This discovery empowered individuals to actively engage in self-management and provided a desired flexibility in selection of personalized self-management strategies. We show that discovery of cause and effect involves four essential phases: (1) feature selection, (2) hypothesis generation, (3) feature evaluation, and (4) goal specification. Further, we identify opportunities to support discovery at each stage with informatics and data visualization solutions by providing assistance with: (1) active manipulation of collected data (e.g., grouping, filtering and side-by-side inspection), (2) hypotheses formulation (e.g., using natural language statements or constructing visual queries), (3) inference evaluation (e.g., through aggregation and visual comparison, and statistical analysis of associations), and (4) translation of discoveries into actionable goals (e.g., tailored selection from computable knowledge sources of effective diabetes self-management behaviors). The study suggests that discovery of cause and effect in diabetes can be a powerful approach to helping individuals to improve their self-management strategies, and that self-monitoring data can

  5. LASL's FY 1978 supporting research program

    International Nuclear Information System (INIS)

    Hammel, E.F.; Merlan, S.J.; Freiwald, D.A.

    1978-09-01

    This report gives a brief overview of Los Alamos Scientific Laboratory's supporting research program, including philosophy, management and program analysis, funding, and a brief description of the kinds of work currently supported. 10 figures

  6. A theoretical framework for a virtual diabetes self-management community intervention.

    Science.gov (United States)

    Vorderstrasse, Allison; Shaw, Ryan J; Blascovich, Jim; Johnson, Constance M

    2014-10-01

    Due to its high prevalence, chronic nature, potential complications, and self-management challenges for patients, diabetes presents significant health education and support issues. We developed and pilot-tested a virtual community for adults with type 2 diabetes to promote self-management education and provide social support. Although digital-based programs such as virtual environments can address significant barriers to reaching patients (i.e., child care, transportation, location), they must be strongly grounded in a theoretical basis to be well-developed and effective. In this article, we discuss how we synthesized behavioral and virtual environment theoretical frameworks to guide the development of SLIDES (Second Life Impacts Diabetes Education and Support). © The Author(s) 2014.

  7. Theory-driven group-based complex intervention to support self-management of osteoarthritis and low back pain in primary care physiotherapy: protocol for a cluster randomised controlled feasibility trial (SOLAS).

    Science.gov (United States)

    Hurley, Deirdre A; Hall, Amanda M; Currie-Murphy, Laura; Pincus, Tamar; Kamper, Steve; Maher, Chris; McDonough, Suzanne M; Lonsdale, Chris; Walsh, Nicola E; Guerin, Suzanne; Segurado, Ricardo; Matthews, James

    2016-01-21

    International clinical guidelines consistently endorse the promotion of self-management (SM), including physical activity for patients with chronic low back pain (CLBP) and osteoarthritis (OA). Patients frequently receive individual treatment and advice to self-manage from physiotherapists in primary care, but the successful implementation of a clinical and cost-effective group SM programme is a key priority for health service managers in Ireland to maximise long-term outcomes and efficient use of limited and costly resources. This protocol describes an assessor-blinded cluster randomised controlled feasibility trial of a group-based education and exercise intervention underpinned by self-determination theory designed to support an increase in SM behaviour in patients with CLBP and OA in primary care physiotherapy. The primary care clinic will be the unit of randomisation (cluster), with each clinic randomised to 1 of 2 groups providing the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention or usual individual physiotherapy. Patients are followed up at 6 weeks, 2 and 6 months. The primary outcomes are the (1) acceptability and demand of the intervention to patients and physiotherapists, (2) feasibility and optimal study design/procedures and sample size for a definitive trial. Secondary outcomes include exploratory analyses of: point estimates, 95% CIs, change scores and effect sizes in physical function, pain and disability outcomes; process of change in target SM behaviours and selected mediators; and the cost of the intervention to inform a definitive trial. This feasibility trial protocol was approved by the UCD Human Research Ethics-Sciences Committee (LS-13-54 Currie-Hurley) and research access has been granted by the Health Services Executive Primary Care Research Committee in January 2014. The study findings will be disseminated to the research, clinical and health service communities through publication in

  8. [Establishing self-management for chronic spinal cord injury patients: a qualitative investigation].

    Science.gov (United States)

    Okochi, Ayako; Tadaka, Etsuko

    2015-01-01

    "confidently modifying the established self-management methods". They employed self-monitoring, preventative measures for secondary difficulties, and stress management techniques. However, they also avoided medication through self-determination and they prioritized their established lifestyle over medically ideal behavior. Subjects learned sustainable self-management methods through trial and error, although in each period of adaptation, they sometimes failed to acknowledge the necessity of health maintenance and medical care, and they coped with their health care needs in their own way. Future research is essential to develop self-management programs that include the patient's own perspectives, to teach health maintenance methods that enable patients to balance social participation and self-management, and to establish cooperative networks among professionals who support the patient's home care.

  9. Lay and health care professional understandings of self-management: A systematic review and narrative synthesis

    Directory of Open Access Journals (Sweden)

    Euan Sadler

    2014-08-01

    Full Text Available Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions. Methods: Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts. Results: In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional–patient relationship (self-management as a tool to promote compliance; different expectations of responsibility; quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice. Conclusion: Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions.

  10. Improving hypertension self-management with community health coaches.

    Science.gov (United States)

    Dye, Cheryl J; Williams, Joel E; Evatt, Janet Hoffman

    2015-03-01

    Approximately two thirds of those older than 60 years have a hypertension diagnosis. The aim of our program, Health Coaches for Hypertension Control, is to improve hypertension self-management among rural residents older than 60 years through education and support offered by trained community volunteers called Health Coaches. Participants received baseline and follow-up health risk appraisals with blood work, educational materials, and items such as blood pressure monitors and pedometers. Data were collected at baseline, 8 weeks, and 16 weeks on 146 participants who demonstrated statistically significant increases in hypertension-related knowledge from baseline to 8 weeks that persisted at 16 weeks, as well as significant improvements in stage of readiness to change behaviors and in actual behaviors. Furthermore, clinically significant decreases in all outcome measures were observed, with statistically significant changes in systolic blood pressure (-5.781 mmHg; p = .001), weight (-2.475 lb; p definition of controlled hypertension at baseline, the proportion of participants meeting this definition at 16 weeks postintervention increased to 51.0%. This article describes a university-community-hospital system model that effectively promotes hypertension self-management in a rural Appalachian community. © 2014 Society for Public Health Education.

  11. Self-reported diabetes self-management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with Type 1 diabetes.

    Science.gov (United States)

    Mohn, J; Graue, M; Assmus, J; Zoffmann, V; B Thordarson, H; Peyrot, M; Rokne, B

    2015-11-01

    To investigate the associations of self-perceived competence in diabetes management and autonomy support from healthcare providers with diabetes distress in adults with Type 1 diabetes mellitus that is not optimally controlled [HbA(1c) ≥ 64 mmol/mol (8.0%)]. This cross-sectional study comprised blood sampling and three self-report questionnaires, the Problem Areas in Diabetes scale, the Perceived Competence in Diabetes Scale and a measure of autonomy support by healthcare providers, the Health Care Climate Questionnaire. We fitted blockwise linear regression models to assess the associations between Problem Areas in Diabetes score and the variables of interest (autonomy support and perceived diabetes competence), controlling for clinical and sociodemographic variables. Of the study sample [n = 178; mean age 36.7 (±10.7) years], 31.5% had long-term complications and 43.2% reported elevated (≥40) Problem Areas in Diabetes scores. A significant negative association was found between autonomy support and Problem Areas in Diabetes score (B = -3.61, P = 0.001), indicating that lower autonomy support was associated with greater diabetes distress. When perceived competence was controlled, it mediated the association of autonomy support with diabetes distress, reducing it to non-significance. There was a significant negative association between perceived competence and Problem Areas in Diabetes score (B = -8.89, P perceived competence was associated with greater perceived distress. There was an indirect (fully mediated) relationship between autonomy support and diabetes distress; autonomy support was associated with increased perceived competence, which, in turn, was associated with reduced distress. Healthcare providers' communication styles enhancing perceived competence through autonomy support may contribute to effective treatment for people with Type 1 diabetes and suboptimum glycaemic control. © 2015 The Authors. Diabetic Medicine Published by John Wiley & Sons

  12. Integrating Self-Management and Exercise for People Living with Arthritis

    Science.gov (United States)

    Mendelson, A. D.; McCullough, C.; Chan, A.

    2011-01-01

    The Program for Arthritis Control through Education and Exercise, PACE-Ex[TM}, is an arthritis self-management program incorporating principles and practice of self-management, goal setting and warm water exercise. The purpose of this program review is to examine the impact of PACE-Ex on participants' self-efficacy for condition management,…

  13. Self-management in patients with COPD: theoretical context, content, outcomes, and integration into clinical care.

    Science.gov (United States)

    Kaptein, Ad A; Fischer, Maarten J; Scharloo, Margreet

    2014-01-01

    In this narrative review, we put self-management in the context of a 50-year history of research about how patients with COPD respond to their illness. We review a definition of self-management, and emphasize that self-management should be combined with disease management and the chronic care model in order to be effective. Reviewing the empirical status of self-management in COPD, we conclude that self-management is part and parcel of modern, patient-oriented biopsychosocial care. In pulmonary rehabilitation programs, self-management is instrumental in improving patients' functional status and quality of life. We conclude by emphasizing how studying the way persons with COPD make sense of their illness helps in refining self-management, and thereby patient-reported outcomes in COPD.

  14. Pharmacist-Led Self-management Interventions to Improve Diabetes Outcomes. A Systematic Literature Review and Meta-Analysis

    NARCIS (Netherlands)

    van Eikenhorst, Linda; Taxis, Katja; van Dijk, Liset; de Gier, Han

    2017-01-01

    Background: Treatment of diabetes requires a strict treatment scheme which demands patient self-management. Pharmacists are in a good position to provide self-management support. This review examines whether pharmacist-led interventions to support self-management in diabetes patients improve

  15. Pharmacist-led self-management interventions to improve diabetes outcomes. A systematic literature review and meta-analysis.

    NARCIS (Netherlands)

    Eikenhorst, L. van; Dijk, L. van; Taxis, K; Gier, H. de

    2017-01-01

    Background Treatment of diabetes requires a strict treatment scheme which demands patient self-management. Pharmacists are in a good position to provide self-management support. This review examines whether pharmacist-led interventions to support self-management in diabetes patients improve clinical

  16. Self-reported diabetes self-management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with Type 1 diabetes

    DEFF Research Database (Denmark)

    Mohn, J; Graue, M; Assmus, J

    2015-01-01

    comprised blood sampling and three self-report questionnaires, the Problem Areas in Diabetes scale, the Perceived Competence in Diabetes Scale and a measure of autonomy support by healthcare providers, the Health Care Climate Questionnaire. We fitted blockwise linear regression models to assess......AIM: To investigate the associations of self-perceived competence in diabetes management and autonomy support from healthcare providers with diabetes distress in adults with Type 1 diabetes mellitus that is not optimally controlled [HbA(1c) ≥ 64 mmol/mol (8.0%)]. METHODS: This cross-sectional study...... the associations between Problem Areas in Diabetes score and the variables of interest (autonomy support and perceived diabetes competence), controlling for clinical and sociodemographic variables. RESULTS: Of the study sample [n = 178; mean age 36.7 (±10.7) years], 31.5% had long-term complications and 43...

  17. A Qualitative Exploration of Motivation to Self-Manage and Styles of Self-Management amongst People Living with Type 2 Diabetes.

    Science.gov (United States)

    Newton, Paul; Asimakopoulou, Koula; Scambler, Sasha

    2015-01-01

    The study examined the motives that people living with type 2 diabetes (T2D) had for self-managing their condition and ways they used to assess the success of their self-management efforts. Using semistructured interviews (N = 25), focus groups (3 × N = 12 participants), and open-ended questionnaires (N = 6), people living with and self-managing T2D were recruited from a community-based T2D participation group. Most participants were older (aged 60+) and lived in a socioeconomically deprived area in the United Kingdom. Data were analysed thematically using framework analysis. Patients' motives for self-management included (i) concern about the anticipative effects of T2D; (ii) wishing to "stay well"; (iii) maintaining independence; (iv) reducing the need for healthcare professionals; and (v) improving quality of life. Six self-management styles were found and pertained to self-managing: (i) through routinisation; (ii) as a burden; (iii) as maintenance; (iv) through delegation; (v) through comanagement; and (vi) through autonomy. Motivators for self-management shaped the criteria people used to judge the success of their self-management practices and influenced their self-management style. The findings show that styles of T2D self-management are mediated and moderated by sociocontextual issues. Healthcare professionals should take these into account when supporting people living with T2D.

  18. A Qualitative Exploration of Motivation to Self-Manage and Styles of Self-Management amongst People Living with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Paul Newton

    2015-01-01

    Full Text Available The study examined the motives that people living with type 2 diabetes (T2D had for self-managing their condition and ways they used to assess the success of their self-management efforts. Using semistructured interviews (N=25, focus groups (3 ×  N=12 participants, and open-ended questionnaires (N=6, people living with and self-managing T2D were recruited from a community-based T2D participation group. Most participants were older (aged 60+ and lived in a socioeconomically deprived area in the United Kingdom. Data were analysed thematically using framework analysis. Patients’ motives for self-management included (i concern about the anticipative effects of T2D; (ii wishing to “stay well”; (iii maintaining independence; (iv reducing the need for healthcare professionals; and (v improving quality of life. Six self-management styles were found and pertained to self-managing: (i through routinisation; (ii as a burden; (iii as maintenance; (iv through delegation; (v through comanagement; and (vi through autonomy. Motivators for self-management shaped the criteria people used to judge the success of their self-management practices and influenced their self-management style. The findings show that styles of T2D self-management are mediated and moderated by sociocontextual issues. Healthcare professionals should take these into account when supporting people living with T2D.

  19. Clinicians’ beliefs and attitudes toward patient self-management in the Netherlands: translation and testing of the American Clinician Support for Patient Activation Measure (CS-PAM).

    NARCIS (Netherlands)

    Rademakers, J.; Jansen, D.; Hoek, L. van der; Heijmans, M.

    2015-01-01

    Background: The aim of this study was to test the Dutch version of the Clinician Support for Patient Activation Measure (CS-PAM), to explore the beliefs of Dutch clinicians about patients’ selfmanagement, and to establish whether there are differences in this respect between general practitioners

  20. Employment specialist competencies for supported employment programs

    NARCIS (Netherlands)

    Corbière, M.; Brouwers, E.P.M.; Lanctôt, N.; van Weeghel, J.

    2014-01-01

    Purpose Supported employment (SE) programs are evidence-based programs offered to people with severe mental illness to facilitate obtaining and keeping competitive work. However, significant variations in individuals’ vocational success may be partly explained by differences in their employment

  1. Self-management and creativity

    Science.gov (United States)

    Medvedev, B. A.; Skaptsov, A. A.; Polikarpov, M. A.

    2008-06-01

    How to improve physicist's creativity? How one can make himself an instrument for creativity? What is the role of the humanities in initiation of intuitive moments in thinking? The problems are discussed in terms of such modern conception as Self-management, in context of the dialogue between nature and human being by Prigogine, "Farther reaches of human nature" by Maslow, and mathematical approach for modeling of mental structure elements.

  2. A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil.

    Science.gov (United States)

    do Valle Nascimento, Thais Moura Ribeiro; Resnicow, Ken; Nery, Marcia; Brentani, Alexandra; Kaselitz, Elizabeth; Agrawal, Pooja; Mand, Simanjit; Heisler, Michele

    2017-01-13

    Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil. Nineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients' reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients' reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs' fidelity to and experiences with the intervention. Patients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/-19) to 68 (+/-21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (-16.1 mg/dL, p = .005) and triglyceride levels (-38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many

  3. Use of Online Self-Management Diaries in Asthma and COPD : A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors.

    NARCIS (Netherlands)

    Dr. A.L. van Staa; J.C.C.M. in 't Veen; Dr. J. Dwarswaard; B. Mennema; S.A. Adams; V. van Kruijssen

    2015-01-01

    BACKGROUND: Online self-management diaries are used to support patients' self-management skills and facilitate associated behavioral changes. Although web-based diaries are well-known as a potential self-management tool, reasons that patients use (or do not use) self-management diaries, as well as

  4. An evaluation of the cost-effectiveness of booklet-based self-management of dizziness in primary care, with and without expert telephone support

    Directory of Open Access Journals (Sweden)

    King Debbie

    2009-12-01

    Full Text Available Abstract Background Dizziness is a very common symptom that often leads to reduced quality of life, anxiety and emotional distress, loss of fitness, lack of confidence in balance, unsteadiness and an increased risk of falling. Most dizzy patients are managed in primary care by reassurance and medication to suppress symptoms. Trials have shown that chronic dizziness can be treated effectively in primary care using a self-help booklet to teach patients vestibular rehabilitation exercises that promote neurological adaptation and skill and confidence in balance. However, brief support from a trained nurse was provided in these trials, and this model of managing dizzy patients has not been taken up due to a lack of skills and resources in primary care. The aim of this trial is to evaluate two new alternative models of delivery that may be more feasible and cost-effective. Methods/Design In a single blind two-centre pragmatic controlled trial, we will randomise 330 patients from 30 practices to a self-help booklet with telephone support from a vestibular therapist, b self-help booklet alone, c routine medical care. Symptoms, disability, handicap and quality of life will be assessed by validated questionnaires administered by post at baseline, immediately post-treatment (3 months, and at one year follow-up. The study is powered to test our primary hypothesis, that the self-help booklet with telephone support will be more effective than routine care. We will also explore the effectiveness of the booklet without any support, and calculate the costs of treatment in each arm. Discussion If our trial indicates that patients can cost-effectively manage their dizziness in primary care, then it can be easily rolled out to relieve the symptoms of the many patients in primary care who currently have chronic, untreated, disabling dizziness. Treatment in primary care may reduce the development of psychological and physical sequelae that cause handicap and require

  5. An employee assistance program for caregiver support.

    Science.gov (United States)

    Mains, Douglas A; Fairchild, Thomas J; René, Antonio A

    2006-01-01

    The Comprehensive Caregiver Choices Program provided support for employee caregivers of elderly people for employees at a hospital in Fort Worth, Texas. Key informant interviews and focus groups provided direction for program development and implementation. A full-time MSW and professionals with expertise in gerontology/geriatrics provided education and care coordination services to caregivers. Approximately 4% of the hospital's workforce participated in the program. Attendees evaluated educational sessions and follow-up interviews were conducted with program participants. Caregiver support programs must continue to seek innovative and creative marketing and service delivery methods to reach out and assist working caregivers in need of support.

  6. Tailoring Self-Management in Chronic Care

    NARCIS (Netherlands)

    Touwen, ID

    2016-01-01

    Self-management is nowadays seen as an important element in chronic care and therefore, self-management is increasingly embedded in chronic care guidelines; however, implementation in clinical practice is a slow and difficult process. Evidence, from research on self-management interventions, shows

  7. Content and characteristics of goals created during a self-management intervention for people with epilepsy.

    Science.gov (United States)

    Walker, Elizabeth Reisinger; Wexler, Bethany; Dilorio, Colleen; Escoffery, Cam; McCarty, Frances; Yeager, Katherine A

    2009-12-01

    Goals are presented in the chronic illness literature as effective strategies to help people adopt self-management behaviors; however, not much is known about the types and characteristics of individuals' goals. The purpose of this study was to examine goal setting among people with epilepsy who participated in the WebEase program. WebEase is an Internet-based, theory-driven, self-management program with modules on medication adherence, stress management, and sleep habits. Participants had the opportunity to create and evaluate goals over the course of 6 weeks, with 2 weeks for each module. The goals were analyzed using three dimensions: content, specificity, and proximity. Most participants in the sample wrote goals for each week of the program. Several main content areas emerged within the modules. Goal quality, measured by specificity and proximity, did not differ according to readiness for behavior change. Readiness to change did not differ between those who wrote a goal and those who did not. The diversity of goal content and quality indicates that individuals should be supported in goal development and encouraged to set their own self-management goals, regardless of their readiness for behavior change.

  8. The South Australia Health Chronic Disease Self-Management Internet Trial

    Science.gov (United States)

    Lorig, Kate; Ritter, Philip L.; Plant, Kathryn; Laurent, Diana D.; Kelly, Pauline; Rowe, Sally

    2013-01-01

    Objectives: To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method: Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures,…

  9. Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes

    NARCIS (Netherlands)

    Huygens, M.W.J.; Vermeulen, J.; Swinkels, I.C.S.; Friele, R.D.; Schayck, O.C.P. van; Witte, L.P. de

    2016-01-01

    Background: Self-management is considered as an essential component of chronic care by primary care professionals. eHealth is expected to play an important role in supporting patients in their self-management. For effective implementation of eHealth it is important to investigate patients’

  10. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.

    Science.gov (United States)

    Bratzke, Lisa C; Muehrer, Rebecca J; Kehl, Karen A; Lee, Kyoung Suk; Ward, Earlise C; Kwekkeboom, Kristine L

    2015-03-01

    The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers

  11. A New Zealand pilot randomized controlled trial of a web-based interactive self-management programme (MSInvigor8) with and without email support for the treatment of multiple sclerosis fatigue.

    Science.gov (United States)

    van Kessel, Kirsten; Wouldes, Trecia; Moss-Morris, Rona

    2016-05-01

    To pilot and compare the efficacy of an internet-based cognitive behavioural therapy self-management programme with (MSInvigor8-Plus) and without (MSInvigor8-Only) the use of email support in reducing fatigue severity and impact (primary outcomes), and depressed and anxious mood (secondary outcomes). Randomized controlled trial using an independent randomization system built into the website and intention-to-treat analysis. Participants were recruited through the local Multiple Sclerosis Society and hospital neurological services in New Zealand. A total of 39 people (aged 31-63 years), experiencing multiple sclerosis fatigue, able to walk with and without walking aids, were randomized to MSInvigor8-Only (n = 20) or to MSInvigor8-Plus (n = 19). MSInvigor8 is an eight-session programme based on cognitive behaviour therapy principles including psycho-education, self-monitoring, and changing unhelpful activity and thought patterns. Outcome measures included fatigue severity (Chalder Fatigue Scale) and impact (Modified Fatigue Impact Scale), and anxiety and depression (Hospital Anxiety and Depression Scale). Assessments were performed at baseline and at 10 weeks. The MSInvigor8-Plus condition resulted in significantly greater reductions in fatigue severity (F [1,36] = 9.09, p multiple sclerosis in New Zealand. © The Author(s) 2015.

  12. The short-term effects of a body awareness program : better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms

    NARCIS (Netherlands)

    Landsman-Dijkstra, Jeanet J. A.; van Wijck, R; Groothoff, JW; Rispens, P

    A three-day residential Body Awareness Program (BAP) was developed to teach people with Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The short-term effects of the program for people with

  13. The short-term effects of a body awareness program : better self-management of health problems for individuals with chronic a-specific psychosomatic symptoms

    NARCIS (Netherlands)

    Landsman-Dijkstra, Jeanet J. A.; van Wijck, R; Groothoff, JW; Rispens, P

    2004-01-01

    A three-day residential Body Awareness Program (BAP) was developed to teach people with Chronic A-specific Psychosomatic Symptoms (CAPS) to react adequately to disturbances of the balance between a daily workload and the capacity to deal with it. The short-term effects of the program for people with

  14. Supporting Self-management of Chronic Pain

    Science.gov (United States)

    2018-04-04

    Chronic Pain Syndrome; Chronic Pain; Chronic Pain Due to Injury; Chronic Pain Due to Trauma; Chronic Pain Due to Malignancy (Finding); Chronic Pain Post-Procedural; Chronic Pain Hip; Chronic Pain, Widespread

  15. Activating Patients for Sustained Chronic Disease Self-Management: Thinking Beyond Clinical Outcomes.

    Science.gov (United States)

    Dye, Cheryl J; Williams, Joel E; Evatt, Janet H

    2016-04-01

    This article describes the impact of an 8-week community program implemented by trained volunteers on the hypertension self-management of 185 patients who were batch randomized to intervention or wait-list control groups. Compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, η2 = .036, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P < .0005, η(2) = .094. Enduring lifestyle changes necessary for chronic disease self-management require that psychosocial determinants of health behavior are instilled, which is typically beyond standard medical practice. We recommend peer-led, community-based programs as a complement to clinical care and support the increasing health system interest in promoting population health beyond clinical walls. © The Author(s) 2016.

  16. Mindfulness and motivational interviewing: two candidate methods for promoting self-management.

    Science.gov (United States)

    Benzo, Roberto P

    2013-08-01

    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

  17. Managing epilepsy well: self-management needs assessment.

    Science.gov (United States)

    Fraser, Robert T; Johnson, Erica K; Miller, John W; Temkin, Nancy; Barber, Jason; Caylor, Lisa; Ciechanowski, Paul; Chaytor, Naomi

    2011-02-01

    Epilepsy self-management interventions have been investigated with respect to health care needs, medical adherence, depression, anxiety, employment, and sleep problems. Studies have been limited in terms of representative samples and inconsistent or restricted findings. The direct needs assessment of patients with epilepsy as a basis for program design has not been well used as an approach to improving program participation and outcomes. This study investigated the perceived medical and psychosocial problems of adults with epilepsy, as well as their preferences for self-management program design and delivery format. Results indicated a more psychosocially challenged subgroup of individuals with significant depressive and cognitive complaints. A self-management program that involves face-to-face individual or group meetings led by an epilepsy professional and trained peer leader for 60 minutes weekly was preferred. Six to eight sessions focused on diverse education sessions (e.g., managing disability and medical care, socializing on a budget, and leading a healthy lifestyle) and emotional coping strategies delivered on weeknights or Saturday afternoons were most highly endorsed. Emotional self-management and cognitive compensatory strategies require special emphasis given the challenges of a large subgroup. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Use of Medicare's Diabetes Self-Management Training Benefit

    Science.gov (United States)

    Strawbridge, Larisa M.; Lloyd, Jennifer T.; Meadow, Ann; Riley, Gerald F.; Howell, Benjamin L.

    2015-01-01

    Medicare began reimbursing for outpatient diabetes self-management training (DSMT) in 2000; however, little is known about program utilization. Individuals diagnosed with diabetes in 2010 were identified from a 20% random selection of the Medicare fee-for-service population (N = 110,064). Medicare administrative and claims files were used to…

  19. Approaches to self-management in chronic illness.

    Science.gov (United States)

    Novak, Marta; Costantini, Lucia; Schneider, Sabrina; Beanlands, Heather

    2013-01-01

    Management of a chronic medical condition is a complex process and requires coordinated action between healthcare providers and patients. This process is further complicated by the fact that an increasing number of patients suffer from multiple chronic conditions. Self-management involves active participation of the patients in the everyday care of the symptoms of their illness(es) and medical treatments, as well as maintaining general health and prevention of progression of medical conditions. Managing the psychosocial consequences of illness is also an important component of self-management. Data have demonstrated that enhancing self-management improves quality of life, coping, symptom management, disability, and reduces healthcare expenditures and service utilization. To foster self-management, potential barriers to implementation as well as facilitators and supports for this approach must be acknowledged. In this article, we review various aspects of self-management in chronic illness, focusing on chronic kidney disease. Better understanding of these concepts will facilitate patient-provider collaboration, improve patient care with increased patient and staff satisfaction, and may ultimately result in better clinical outcomes and enhanced quality of life for both the patients and their families. © 2013 Wiley Periodicals, Inc.

  20. Evaluation of WebEase: An Epilepsy Self-Management Web Site

    Science.gov (United States)

    DiIorio, Colleen; Escoffery, Cam; McCarty, Frances; Yeager, Katherine A.; Henry, Thomas R.; Koganti, Archana; Reisinger, Elizabeth L.; Wexler, Bethany

    2009-01-01

    People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of…

  1. The Benefits of Teaching Self-Management Skills to Students of Psychology

    Science.gov (United States)

    Kazemi, Ellie; Rice, Brian; Rylander, Alyssa; Morgan, Shannon F.

    2011-01-01

    The various student gains and reported satisfaction with self-management projects have been well documented. However, we found that few psychology programs explicitly teach these skills. In this paper we demonstrate how self-management projects can meet nine out of the ten undergraduate student learning goals outlined by the APA Task Force (2002).…

  2. Defense Contract Management Command Support to System Acquisition Program Managers

    National Research Council Canada - National Science Library

    1999-01-01

    .... This report discusses the planning of contract administration office support to system acquisition program managers through the program integration process and the customer support outreach program...

  3. A self-management approach using self-initiated action plans for symptoms with ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD) and comorbidities: the COPE-III study protocol.

    Science.gov (United States)

    Lenferink, Anke; Frith, Peter; van der Valk, Paul; Buckman, Julie; Sladek, Ruth; Cafarella, Paul; van der Palen, Job; Effing, Tanja

    2013-09-01

    Chronic Obstructive Pulmonary Disease (COPD) frequently coexists with other diseases. Whereas COPD action plans are currently part of usual care, they are less suitable and potentially unsafe for use in the presence of comorbidities. This study evaluates whether an innovative treatment approach directed towards COPD and frequently existing comorbidities can reduce COPD exacerbation days. We hypothesise that this approach, which combines self-initiated action plans and nurse support, will accelerate proper treatment actions and lead to better control of deteriorating symptoms. In this multicenter randomised controlled trial we aim to include 300 patients with COPD (GOLD II-IV), and with at least one comorbidity (cardiovascular disease, diabetes, anxiety and/or depression). Patients will be recruited from hospitals in the Netherlands (n = 150) and Australia (n = 150) and will be assigned to an intervention or control group. All patients will learn to complete daily symptom diaries for 12-months. Intervention group patients will participate in self-management training sessions to learn the use of individualised action plans for COPD and comorbidities, linked to the diary. The primary outcome is the number of COPD exacerbation days. Secondary outcomes include hospitalisations, quality of life, self-efficacy, adherence, patient's satisfaction and confidence, health care use and cost data. Intention-to-treat analyses (random effect negative binomial regression and random effect mixed models) and cost-effectiveness analyses will be performed. Prudence should be employed before extrapolating the use of COPD specific action plans in patients with comorbidities. This study evaluates the efficacy of tailored action plans for both COPD and common comorbidities. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Cluster randomized controlled trial of a peer support program for people with diabetes: study protocol for the Australasian peers for progress study

    Directory of Open Access Journals (Sweden)

    Riddell Michaela A

    2012-10-01

    measures are collected on all participants at baseline, 6 and 12 months. The primary outcome is change in cardiovascular disease risk using the UKPDS risk equation. Secondary outcomes include biomedical, quality of life, psychosocial functioning, and other lifestyle measures. An economic evaluation will determine whether the program is cost effective. Discussion This manuscript presents the protocol for a cluster randomized controlled trial of group-based peer support for people with type 2 diabetes in a community setting. Results from this trial will contribute evidence about the effectiveness of peer support in achieving effective self-management of diabetes. Trial registration number Australian New Zealand Clinical Trials Registry (ANZCTR; ACTRN12609000469213

  5. Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter.

    Science.gov (United States)

    Rees, Sally; Williams, Anne

    There has been a reported rise in the number of people with chronic illness (also referred to as long-term disease) in the Western world. One hundred million people in the United States have at least one chronic condition and in the United Kingdom (UK) as many as 17.5 million adults may be living with chronic disease. New models of care have been developed which recognise the complexities of managing care where there is overlap between the wider community, the health care system and provider organisations, for example, the Chronic Care Model and the Expert Patient Programme. These new models herald a shift away from the idea of chronically ill patients as passive recipients of care towards active engagement, in partnership with health professionals, in managing their own care.Partnership, ideally, involves collaborative care and self-management education. This may support self-care alongside medical, preventative and health maintenance interventions. In this context the nature of the patient-practitioner consultation in promoting self-care takes on a new importance. The overall objective of the review was to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Specifically the review sought to determine: What is the effectiveness of the patient-practitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how 'effectiveness' is defined in this context by patients and different practitioners? The review focussed on self-caring adults aged nineteen years and older living in the community, with a physical chronic illness, and not currently being treated as an in-patient. For

  6. An Electronic Asthma Self-Management Intervention for Young African American Adults.

    Science.gov (United States)

    Speck, Aimee L; Hess, Michael; Baptist, Alan P

    2016-01-01

    Health disparities are seen in many chronic conditions including asthma. Young African American adults represent a population at high risk for poor asthma outcomes due to both their minority status and the difficult transition from adolescence to adulthood. Recruitment and retention has been challenging in this demographic stratum, and traditional asthma education is often not feasible. The objective of this study was to develop and assess the feasibility of an electronic asthma self-management program for young African American adults. A total of 44 African American adults (age 18-30 years) with uncontrolled persistent asthma were enrolled in an asthma self-management program. The 6-week Breathe Michigan program (predicated on the social cognitive theory) was tailored specifically to the concerns and preferences of young African American adults. The entire program was completed electronically, without any specialized human support. At 2 weeks and 3 months after program completion, participants were contacted for follow-up. A total of 89% of enrolled subjects completed the 6-week intervention, and 77% were available for evaluation at 3 months. All subjects completing the 2-week postprogram survey reported that the program was helpful, and 97% would recommend it to others. Asthma control as measured by the Asthma Control Test improved from 16.1 to 19.3 (P young African American adults. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  7. Self-management and transitions in women with advanced breast cancer.

    Science.gov (United States)

    Schulman-Green, Dena; Bradley, Elizabeth H; Knobf, M Tish; Prigerson, Holly; DiGiovanna, Michael P; McCorkle, Ruth

    2011-10-01

    Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions-shifts from one life phase or status to another, for example, from cure- to noncure-oriented care-because they can be disruptive and stressful. Little is known about individuals' experiences with self-management, especially during transitions. Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Participants' mean age was 52 years (range 37-91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens' health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Self-management preferences can vary. Providers should explore and revisit patients' preferences and ability to self-manage over time, particularly during transitions. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  8. Teaching Self-Management: The Design and Implementation of Self-Management Tutorials

    Science.gov (United States)

    Gerhardt, Megan

    2007-01-01

    Learning the skills of self-management is an essential task for students in the 21st century. A total of 223 undergraduate students participated in 4 self-management tutorials that presented the components of understanding and mastering self-management skills including (a) self-assessment, (b) goal setting, (c) time management, and (d)…

  9. Daily self-management and work engagement

    NARCIS (Netherlands)

    Breevaart, K.; Bakker, A.B.; Demerouti, E.

    2014-01-01

    The present study adopts a bottom-up approach to work engagement by examining how self-management is related to employees' work engagement on a daily basis. Specifically, we hypothesized that on days that employees use more self-management strategies, they report higher resources at work and in

  10. Successful implementation of self-managing teams

    NARCIS (Netherlands)

    Weerheim, Wilke; Van Rossum, Lisa; Ten Have, Wouter Dirk

    2018-01-01

    Purpose: Following health-care organisations, many mental health-care organisations nowadays consider starting to work with self-managing teams as their organisation structure. Although the concept could be effective, the way of implementing self-managing teams in an organisation is crucial to

  11. Successful implementation of self-managing teams

    NARCIS (Netherlands)

    Weerheim, W. (Wilke); Van Rossum, L. (Lisa); Ten Have, W.D. (Wouter Dirk)

    2018-01-01

    textabstractPurpose: Following health-care organisations, many mental health-care organisations nowadays consider starting to work with self-managing teams as their organisation structure. Although the concept could be effective, the way of implementing self-managing teams in an organisation is

  12. Self-management of vascular risk factors

    NARCIS (Netherlands)

    Sol-de Rijk, B.G.M.

    2009-01-01

    Summary The aim of this thesis was to provide insight into the potential of a self-management approach in treatment of vascular risk factors and to develop a self-management intervention. Furthermore to examine if this intervention, based on self-efficacy promoting theory, is effective in reducing

  13. Self-management education for cystic fibrosis.

    LENUS (Irish Health Repository)

    Savage, Eileen

    2011-01-01

    Self-management education may help patients with cystic fibrosis and their families to choose, monitor and adjust treatment requirements for their illness, and also to manage the effects of illness on their lives. Although self-management education interventions have been developed for cystic fibrosis, no previous systematic review of the evidence of effectiveness of these interventions has been conducted.

  14. Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes.

    Science.gov (United States)

    Huygens, Martine W J; Vermeulen, Joan; Swinkels, Ilse C S; Friele, Roland D; van Schayck, Onno C P; de Witte, Luc P

    2016-07-08

    Self-management is considered as an essential component of chronic care by primary care professionals. eHealth is expected to play an important role in supporting patients in their self-management. For effective implementation of eHealth it is important to investigate patients' expectations and needs regarding self-management and eHealth. The objectives of this study are to investigate expectations and needs of people with a chronic condition regarding self-management and eHealth for self-management purposes, their willingness to use eHealth, and possible differences between patient groups regarding these topics. Five focus groups with people with diabetes (n = 14), COPD (n = 9), and a cardiovascular condition (n = 7) were conducted in this qualitative research. Separate focus groups were organized based on patients' chronic condition. The following themes were discussed: 1) the impact of the chronic disease on patients' daily life; 2) their opinions and needs regarding self-management; and 3) their expectations and needs regarding, and willingness to use, eHealth for self-management purposes. A conventional content analysis approach was used for coding. Patient groups seem to differ in expectations and needs regarding self-management and eHealth for self-management purposes. People with diabetes reported most needs and benefits regarding self-management and were most willing to use eHealth, followed by the COPD group. People with a cardiovascular condition mentioned having fewer needs for self-management support, because their disease had little impact on their life. In all patient groups it was reported that the patient, not the care professional, should choose whether or not to use eHealth. Moreover, participants reported that eHealth should not replace, but complement personal care. Many participants reported expecting feelings of anxiety by doing measurement themselves and uncertainty about follow-up of deviant data of measurements. In addition

  15. A pragmatic randomized control trial and realist evaluation on the implementation and effectiveness of an internet application to support self-management among individuals seeking specialized mental health care: a study protocol

    Directory of Open Access Journals (Sweden)

    Jennifer M. Hensel

    2016-10-01

    Full Text Available Abstract Background Mental illness is a substantial and rising contributor to the global burden of disease. Access to and utilization of mental health care, however, is limited by structural barriers such as specialist availability, time, out-of-pocket costs, and attitudinal barriers including stigma. Innovative solutions like virtual care are rapidly entering the health care domain. The advancement and adoption of virtual care for mental health, however, often occurs in the absence of rigorous evaluation and adequate planning for sustainability and spread. Methods A pragmatic randomized controlled trial with a nested comparative effectiveness arm, and concurrent realist process evaluation to examine acceptability, effectiveness, and cost-effectiveness of the Big White Wall (BWW online platform for mental health self-management and peer support among individuals aged 16 and older who are accessing mental health services in Ontario, Canada. Participants will be randomized to 3 months of BWW or treatment as usual. At the end of the 3 months, participants in the intervention group will have the opportunity to opt-in to an intervention extension arm. Those who opt-in will be randomized to receive an additional 3 months of BWW or no additional intervention. The primary outcome is recovery at 3 months as measured by the Recovery Assessment Scale-revised (RAS-r. Secondary outcomes include symptoms of depression and anxiety measured with the Personal Health Questionnaire-9 item (PHQ-9 and the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7 respectively, quality of life measured with the EQ-5D-5L, and community integration assessed with the Community Integration Questionnaire. Cost-effectiveness evaluations will account for the cost of the intervention and direct health care costs. Qualitative interviews with participants and stakeholders will be conducted throughout. Discussion Understanding the impact of virtual strategies, such as BWW, on

  16. Ostomy telehealth for cancer survivors: Design of the Ostomy Self-management Training (OSMT) randomized trial.

    Science.gov (United States)

    Sun, Virginia; Ercolano, Elizabeth; McCorkle, Ruth; Grant, Marcia; Wendel, Christopher S; Tallman, Nancy J; Passero, Frank; Raza, Sabreen; Cidav, Zuleyha; Holcomb, Michael; Weinstein, Ronald S; Hornbrook, Mark C; Krouse, Robert S

    2018-01-01

    An ostomy adversely affects health-related quality of life (HRQOL) in a diverse population of cancer survivors and their caregivers. Hit-or-miss ostomy care, nurse counseling, and community referral have been the primary modes of self-management education and support in the peri-operative setting. Few evidence-based, systematic ostomy self-management programs are available to ensure optimal post-operative care. This paper describes the study design of a telehealth-based Ostomy Self-management Training (OSMT) program for cancer survivors and their caregivers. The study is a three-year, randomized trial that tests the effectiveness of the OSMT program on survivor activation, self-efficacy, and HRQOL. The intervention integrates goal setting and problem-solving approaches to enhance survivor activation and self-efficacy to carry out ostomy care. The curriculum is delivered via four group sessions administered by trained ostomy certified nurses (WOCNs) and peer ostomates. An additional session is offered to caregivers to address their needs in relation to ostomy care. Telehealth approaches through videoconferencing are used to enhance program delivery to participants in three different geographic areas across two time zones. Participants join sessions via real-time videoconferencing from their homes. The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Cluster randomized controlled trial of a peer support program for people with diabetes

    DEFF Research Database (Denmark)

    Riddell, Michaela A; Renwick, Carla; Wolfe, Rory

    2012-01-01

    ABSTRACT: BACKGROUND: Well managed diabetes requires active self-management in order to ensure optimal glycaemic control and appropriate use of available clinical services and other supports. Peer supporters can assist people with their daily diabetes self-management activities, provide emotional...... and social support, assist and encourage clinical care and be available when needed. METHODS: A national database of Australians diagnosed with type 2 diabetes is being used to invite people in pre-determined locations to participate in community-based peer support groups. Peer supporters are self......-identified from these communities. All consenting participants receive diabetes self-management education and education manual prior to randomization by community to a peer support intervention or usual care. This multi-faceted intervention comprises four interconnected components for delivering support...

  18. Factors influencing exacerbation-related self-management in patients with COPD: a qualitative study.

    Science.gov (United States)

    Korpershoek, Yjg; Vervoort, Scjm; Nijssen, Lit; Trappenburg, Jca; Schuurmans, M J

    2016-01-01

    In patients with COPD, self-management skills are important to reduce the impact of exacerbations. However, both detection and adequate response to exacerbations appear to be difficult for some patients. Little is known about the underlying process of exacerbation-related self-management. Therefore, the objective of this study was to identify and explain the underlying process of exacerbation-related self-management behavior. A qualitative study using semi-structured in-depth interviews was performed according to the grounded theory approach, following a cyclic process in which data collection and data analysis alternated. Fifteen patients (male n=8; age range 59-88 years) with mild to very severe COPD were recruited from primary and secondary care settings in the Netherlands, in 2015. Several patterns in exacerbation-related self-management behavior were identified, and a conceptual model describing factors influencing exacerbation-related self-management was developed. Acceptance, knowledge, experiences with exacerbations, perceived severity of symptoms and social support were important factors influencing exacerbation-related self-management. Specific factors influencing recognition of exacerbations were heterogeneity of exacerbations and habituation to symptoms. Feelings of fear, perceived influence on exacerbation course, patient beliefs, ambivalence toward treatment, trust in health care providers and self-empowerment were identified as specific factors influencing self-management actions. This study provided insight into factors influencing exacerbation-related self-management behavior in COPD patients. The conceptual model can be used as a framework for health care professionals providing self-management support. In the development of future self-management interventions, factors influencing the process of exacerbation-related self-management should be taken into account.

  19. Chronically ill patients' self-management abilities to maintain overall well-being: What is needed to take the next step in the primary care setting?

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2015-01-01

    textabstractBackground: Although widespread problems in patient-professional interaction and insufficient support of patients' self-management abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to

  20. Chronically ill patients' self-management abilities to maintain overall well-being: what is needed to take the next step in the primary care setting?

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2015-01-01

    markdownabstractAbstract Background: Although widespread problems in patient–professional interaction and insufficient support of patients’self-management abilities have been recognized, research investigating the relationships among care quality, productiveinteraction, and self-management

  1. Table mountain observatory support to other programs

    International Nuclear Information System (INIS)

    Harris, A.W.

    1988-01-01

    The Table Mountain Observatory (TMO) facilities include well equipped 24 inch and 16 inch telescopes with a 40 inch telescope (owned by Pomona College) due for completion during FY 89. This proposal is to provide operational support (equipment maintenance, setup, and observing assistnce) at TMO to other programs. The program currently most heavily supported by this grant is the asteroid photometry program directed by A. W. Harris. During 1987, about 20 asteroids were observed, including a near-earth asteroid, 1951 Midas. The photometric observations are used to derive rotation periods, estimate shapes and pole orientations, and to define the phase relations of asteroids. The E class asteroid 64 Angelina was observed, and showed the same opposition spike observed of 44 Jysa, last year. Comet observations are made with the narrow band camera system of David Rees, University College London. Observational support and training was provided to students and faculty from Claremont Colleges for variable star observing programs. Researchers propose to continue the asteroid program, with emphasis on measuring phase relations of low and high albedo asteroids at very low phase angles, and supporting collaborative studies of asteroid shapes

  2. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.

    Science.gov (United States)

    Teljeur, C; Moran, P S; Walshe, S; Smith, S M; Cianci, F; Murphy, L; Harrington, P; Ryan, M

    2017-08-01

    To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA 1c levels in people with diabetes. Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes. © 2016 Diabetes UK.

  3. Technology and diabetes self-management: An integrative review

    OpenAIRE

    Hunt, Caralise W

    2015-01-01

    Technology can be used to supplement healthcare provider diabetes care by providing both educational and motivational support. Education can be provided using technology allowing patients to learn new practices and routines related to diabetes management. Technology can support daily diabetes self-management activities including blood glucose monitoring, exercising, healthy eating, taking medication, monitoring for complications, and problem-solving. This article describes an integrative revi...

  4. Patient experience in a coordinated care model featuring diabetes self-management education integrated into the patient-centered medical home.

    Science.gov (United States)

    Janiszewski, Debra; O'Brian, Catherine A; Lipman, Ruth D

    2015-08-01

    The purpose of this study is to gain insight about patient experience of diabetes self-management education in a patient-centered medical home. Six focus groups consisting of 37 people with diabetes, diverse in race and ethnicity, were conducted at 3 sites. Participants described their experience in the program and their challenges in diabetes self-management; they also suggested services to meet their diabetes care needs. The most common theme was ongoing concerns about care and support. There was much discussion about the value of the support provided by health navigators integrated in the diabetes health care team. Frequent concerns expressed by participants centered on personal challenges in engaging in healthy lifestyle behaviors. Ongoing programmatic support of self-management goals was widely valued. Individuals who received health care in a patient-centered medical home and could participate in diabetes self-management education with integrated support valued both activities. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. © 2015 The Author(s).

  5. Organizational Structures that Support Internal Program Evaluation

    Science.gov (United States)

    Lambur, Michael T.

    2008-01-01

    This chapter explores how the structure of large complex organizations such as Cooperative Extension affects their ability to support internal evaluation of their programs and activities. Following a literature review of organizational structure and its relation to internal evaluation capacity, the chapter presents the results of interviews with…

  6. Dimensions of osteoarthritis self-management.

    Science.gov (United States)

    Prior, Kirsty N; Bond, Malcolm J

    2004-06-01

    Our aims were to determine whether a taxonomy of self-management strategies for osteoarthritis could be identified, and whether the resultant dimensions of such a taxonomy demonstrate predictable relationships with health status indices. Participants (n = 117) from community-based self-help groups and a general rheumatology outpatient clinic completed a self-management inventory consisting of 11 items, answered for both the past 7 days and a day on which symptoms were worse than usual. Duration of symptoms, level of pain, perceived functional ability and self-rated health were recorded as indicators of health status. Three essentially identical factors were obtained for both past 7 days and worse day items. Resultant scales were labeled passive, complementary and active, respectively. Correlations with health status measures provided modest evidence for the construct validity of these self-management scales. Compared with a simple aggregate score based on the total number of strategies used, the scales provided a clearer understanding of the relationship between self-management and health. The study provided a useful extension to existing research, addressing a number of shortcomings identified by previous researchers. The identified self-management dimensions offered a greater insight into the self-management choices of patients. Suggestions for further improvements to the measurement of self-management are outlined.

  7. Picture Good Health: A Church-Based Self-Management Intervention Among Latino Adults with Diabetes.

    Science.gov (United States)

    Baig, Arshiya A; Benitez, Amanda; Locklin, Cara A; Gao, Yue; Lee, Sang Mee; Quinn, Michael T; Solomon, Marla C; Sánchez-Johnsen, Lisa; Burnet, Deborah L; Chin, Marshall H

    2015-10-01

    Churches may provide a familiar and accessible setting for chronic disease self-management education and social support for Latinos with diabetes. We assessed the impact of a multi-faceted church-based diabetes self-management intervention on diabetes outcomes among Latino adults. This was a community-based, randomized controlled, pilot study. One-hundred adults with self-reported diabetes from a Midwestern, urban, low-income Mexican-American neighborhood were included in the study. Intervention participants were enrolled in a church-based diabetes self-management program that included eight weekly group classes led by trained lay leaders. Enhanced usual care participants attended one 90-minute lecture on diabetes self-management at a local church. The primary outcome was change in glycosylated hemoglobin (A1C). Secondary outcomes included changes in low-density lipoproteins (LDL), blood pressure, weight, and diabetes self-care practices. Participants' mean age was 54 ± 12 years, 81 % were female, 98 % were Latino, and 51 % were uninsured. At 3 months, study participants in both arms decreased their A1C from baseline (-0.32 %, 95 % confidence interval [CI]: -0.62, -0.02 %). The difference in change in A1C, LDL, blood pressure and weight from baseline to 3-month and 6-month follow-up was not statistically significant between the intervention and enhanced usual care groups. Intervention participants reported fewer days of consuming high fat foods in the previous week (-1.34, 95 % CI: -2.22, -0.46) and more days of participating in exercise (1.58, 95 % CI: 0.24, 2.92) compared to enhanced usual care from baseline to 6 months. A pilot church-based diabetes self-management intervention did not reduce A1C, but resulted in decreased high fat food consumption and increased participation in exercise among low-income Latino adults with diabetes. Future church-based interventions may need to strengthen linkages to the healthcare system and provide continued support to

  8. TAP 3, Training Program Support Manual

    International Nuclear Information System (INIS)

    1991-07-01

    Training programs at DOE facilities should provide well-trained, qualified personnel to safely and efficiently operate the facilities in accordance with DOE requirements. A need has been identified for guidance regarding analysis, design, development, implementation, and evaluation of consistent and reliable performance-based training programs. Accreditation of training programs at Category A reactors and high-hazard and selected moderate-hazard nonreactor nuclear facilities will assure consistent, appropriate, and cost-effective training of personnel responsible for the operation, maintenance, and technical support of these facilities. Training programs that are designed and based on systematically determined job requirements, instead of subjective estimation of trainee needs, yield training activities that are consistent and develop or improve knowledge, skills, and abilities that can be directly related to the work setting. Because the training is job-related, the content of these programs more efficiently and effectively meets the needs of the employee. Besides a better trained work force, a greater level of operational reactor safety can be realized. This manual is intended to provide an overview of the accreditation process and a brief description of the elements necessary to construct and maintain training programs that are based on the requirements of the job. Two companion manuals provide additional information to assist contractors in their efforts to accredit training programs

  9. Motivation and Self-Management Behavior of the Individuals With Chronic Low Back Pain.

    Science.gov (United States)

    Jung, Mi Jung; Jeong, Younhee

    2016-01-01

    Self-management behavior is an important component for successful pain management in individuals with chronic low back pain. Motivation has been considered as an effective way to change behavior. Because there are other physical, social, and psychological factors affecting individuals with pain, it is necessary to identify the main effect of motivation on self-management behavior without the influence of those factors. The purpose of this study was to investigate the effect of motivation on self-management in controlling pain, depression, and social support. We used a nonexperimental, cross-sectional, descriptive design with mediation analysis and included 120 participants' data in the final analysis. We also used hierarchical multiple regression to test the effect of motivation, and multiple regression analysis and Sobel test were used to examine the mediating effect. Motivation itself accounted for 23.4% of the variance in self-management, F(1, 118) = 35.003, p motivation was also a significant factor for self-management. In the mediation analysis, motivation completely mediated the relationship between education and self-management, z = 2.292, p = .021. Motivation is an important part of self-management, and self-management education is not effective without motivation. The results of our study suggest that nurses incorporate motivation in nursing intervention, rather than only giving information.

  10. Patient self-management and pharmacist-led patient self-management in Hong Kong: A focus group study from different healthcare professionals' perspectives

    Directory of Open Access Journals (Sweden)

    Wong Eliza LY

    2011-05-01

    Full Text Available Abstract Background Patient self-management is a key approach to manage non-communicable diseases. A pharmacist-led approach in patient self-management means collaborative care between pharmacists and patients. However, the development of both patient self-management and role of pharmacists is limited in Hong Kong. The objectives of this study are to understand the perspectives of physicians, pharmacists, traditional Chinese medicine (TCM practitioners, and dispensers on self-management of patients with chronic conditions, in addition to exploring the possibilities of developing pharmacist-led patient self-management in Hong Kong. Methods Participants were invited through the University as well as professional networks. Fifty-one participants comprised of physicians, pharmacists, TCM practitioners and dispensers participated in homogenous focus group discussions. Perspectives in patient self-management and pharmacist-led patient self-management were discussed. The discussions were audio recorded, transcribed and analysed accordingly. Results The majority of the participants were in support of patients with stable chronic diseases engaging in self-management. Medication compliance, monitoring of disease parameters and complications, lifestyle modification and identifying situations to seek help from health professionals were generally agreed to be covered in patient self-management. All pharmacists believed that they had extended roles in addition to drug management but the other three professionals believed that pharmacists were drug experts only and could only play an assisting role. Physicians, TCM practitioners, and dispensers were concerned that pharmacist-led patient self-management could be hindered, due to unfamiliarity with the pharmacy profession, the perception of insufficient training in disease management, and lack of trust of patients. Conclusions An effective chronic disease management model should involve patients in stable

  11. Self-Management Support Program for Patients With Cardiovascular Diseases: User-Centered Development of the Tailored, Web-Based Program Vascular View

    NARCIS (Netherlands)

    Puijk-Hekman, S.; Gaal, B. van; Bredie, S.J.H.; Nijhuis-Van der Sanden, M.W.G.; Dulmen, A.M. van

    2017-01-01

    BACKGROUND: In addition to medical intervention and counseling, patients with cardiovascular disease (CVD) need to manage their disease and its consequences by themselves in daily life. OBJECTIVE: The aim of this paper is to describe the development of "Vascular View," a comprehensive,

  12. Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda.

    Science.gov (United States)

    Russell, Steve; Martin, Faith; Zalwango, Flavia; Namukwaya, Stella; Nalugya, Ruth; Muhumuza, Richard; Katongole, Joseph; Seeley, Janet

    2016-01-01

    The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management which ART

  13. Finding Meaning: HIV Self-Management and Wellbeing among People Taking Antiretroviral Therapy in Uganda.

    Directory of Open Access Journals (Sweden)

    Steve Russell

    Full Text Available The health of people living with HIV (PLWH and the sustained success of antiretroviral therapy (ART programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's self-management of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resource-limited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': they saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other non-medical aspects of wellbeing for self-management

  14. Large coil program support structure conceptual design

    International Nuclear Information System (INIS)

    Litherland, P.S.

    1977-01-01

    The purpose of the Large Coil Program (LCP) is to perform tests on both pool boiling and force cooled superconducting toroidal field coils. The tests will attempt to approximate conditions anticipated in an ignition tokamak. The test requirements resulted in a coil support design which accommodates up to six (6) test coils and is mounted to a structure capable of resisting coil interactions. The steps leading to the present LCP coil support structure design, details on selected structural components, and the basic assembly sequence are discussed

  15. AIF programs supporting industry self-improvement

    International Nuclear Information System (INIS)

    Szalay, R.A.; Bivens, A.C.

    1985-01-01

    The Atomic Industrial Forum (AIF) report ''Nuclear Power in America's Future'' identifies those actions that must be taken by both government and industry if the nuclear power option is to be preserved. This includes initiatives that: 1) reduce construction costs and lead times; 2) establish a national energy policy that reflects the role of electricity and the nuclear power component; 3) provide better financial arrangements; 4) reform licensing and regulation; 5) enhance the light water reactor design; 6) inform the public on the benefits and contributions of nuclear power; and 7) complete the fuel cycle. In attempting to solve nuclear power's problems, the AIF has programs that support and push these needed actions. Much of the initiative must be taken by industry to enhance the nuclear power option. This paper discusses some AIF initiatives and programs that support industry self-improvement

  16. Self-management in daily life with psoriasis

    DEFF Research Database (Denmark)

    Rasmussen, Gitte Susanne; Maindal, Helle Terkildsen; Lomborg, Kirsten

    2012-01-01

    The aim of this integrative review is to identify and discuss patient needs for education to support self-management in daily life with psoriasis. As psoriasis increasingly gains recognition as a serious chronic autoimmune skin disease with long-term impairment on the life course, and not mainly...... a cosmetic problem, nurses are highly challenged to develop efficient education to support patient self-management. The paper includes five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and synthesis, and (5) presentation, based on theoretic scaffolding...... around the concept "need." Nineteen of 164 original papers within nursing, medicine and psychology, and reflecting patient perspective were included. To capture the patients' cultural understanding of the implications of the disease and care, we developed an interlevel model indicating that self...

  17. Space Life-Support Engineering Program

    Science.gov (United States)

    Seagrave, Richard C. (Principal Investigator)

    1995-01-01

    This report covers the seventeen months of work performed under an extended one year NASA University Grant awarded to Iowa State University to perform research on topics relating to the development of closed-loop long-term life support systems with the initial principal focus on space water management. In the first phase of the program, investigators from chemistry and chemical engineering with demonstrated expertise in systems analysis, thermodynamics, analytical chemistry and instrumentation, performed research and development in two major related areas; the development of low-cost, accurate, and durable sensors for trace chemical and biological species, and the development of unsteady-state simulation packages for use in the development and optimization of control systems for life support systems. In the second year of the program, emphasis was redirected towards concentrating on the development of dynamic simulation techniques and software and on performing a thermodynamic systems analysis, centered on availability or energy analysis, in an effort to begin optimizing the systems needed for water purification. The third year of the program, the subject of this report, was devoted to the analysis of the water balance for the interaction between humans and the life support system during space flight and exercise, to analysis of the cardiopulmonary systems of humans during space flight, and to analysis of entropy production during operation of the air recovery system during space flight.

  18. [Influence of Uncertainty and Uncertainty Appraisal on Self-management in Hemodialysis Patients].

    Science.gov (United States)

    Jang, Hyung Suk; Lee, Chang Suk; Yang, Young Hee

    2015-04-01

    This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.

  19. Complexity of care and strategies of self-management in patients with colorectal cancer

    Directory of Open Access Journals (Sweden)

    Ose D

    2017-04-01

    Full Text Available Dominik Ose,1,2 Eva C Winkler,3 Sarah Berger,1 Ines Baudendistel,1 Martina Kamradt,1 Felicitas Eckrich,1 Joachim Szecsenyi1 1Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany; 2Department of Population Health, Health System Innovation and Research, University of Utah, Salt Lake City, UT, USA; 3Program for Ethics and Patient-oriented Care in Oncology, National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany Purpose: Given the inherent complexity of cancer care, in which personal, social, and clinical aspects accumulate and interact over time, self-management support need to become more comprehensive. This study has the following two aims: 1 to analyze and describe the complexity of individual patient situations and 2 to analyze and describe already established self-management strategies of patients to handle this complexity.Methods: A qualitative study was conducted. Ten focus groups were performed collecting perspectives of the following three user groups: patients with colorectal cancer (n=12 and representatives from support groups (n=2, physicians (n=17, and other health care professionals (HCPs; n=16. Data were analyzed using qualitative content analysis.Results: The results showed that cancer patients are struggling with the complexity of their individual situations characterized by the 1 “complexity of disease”, 2 “complexity of care”, and 3 “complexity of treatment-related data”. To deal with these multifaceted situations, patients have established several individual strategies. These strategies are “proactive demanding” (eg, to get support and guidance or a meaningful dialog with the doctor, “proactive behavior” (eg, preparation of visits, and “proactive data management” (eg, in terms of merging treatment-related data and to disseminate these to their health care providers.Conclusion: Patients with colorectal cancer

  20. The impact of social context on self-management in women living with HIV.

    Science.gov (United States)

    Webel, Allison R; Cuca, Yvette; Okonsky, Jennifer G; Asher, Alice K; Kaihura, Alphoncina; Salata, Robert A

    2013-06-01

    HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicted all domains of HIV self-management including daily health practices (F = 5.40, adjusted R(2) = 0.27, p traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women's social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. British-Pakistani women's perspectives of diabetes self-management: the role of identity.

    Science.gov (United States)

    Majeed-Ariss, Rabiya; Jackson, Cath; Knapp, Peter; Cheater, Francine M

    2015-09-01

    To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management. Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention. An explorative qualitative study. Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically. Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social support enabled women to accept changes within themselves and Supporting family is a barrier to self-management demonstrated how family roles were an aspect of women's identities that was resilient to change. The over-arching theme Role re-alignment enables successful self-management encapsulated how self-management was a continuous process where achievements needed to be sustained. Inter-generational differences were also noted: first generation women talked about challenges associated with ageing and co-morbidities; second generation women talked about familial and work roles competing with self-management. The complex nature of British-Pakistani women's self-identification requires consideration when planning and delivering healthcare. Culturally competent practice should recognise how generational status influences self-identity and diabetes self-management in ethnically diverse women. Health professionals should remain mindful of effective self-management occurring alongside, and being

  2. WebEase: Development of a Web-Based Epilepsy Self-Management Intervention

    OpenAIRE

    DiIorio, Colleen; Escoffery, Cam; Yeager, Katherine A.; Koganti, Archana; Reisinger, Elizabeth; Koganti, Archana; McCarty, Frances; Henry, Thomas R.; Robinson, Elise; Kobau, Rosemarie; Price, Patricia

    2008-01-01

    People with epilepsy must adopt many self-management behaviors, especially regarding medication adherence, stress management, and sleep quality. In response to the need for theory-based self-management programs that people with epilepsy can easily access, the WebEase Web site was created and tested for feasibility, acceptability, and usability. This article discusses the theoretical background and developmental phases of WebEase and lessons learned throughout the development process. The WebE...

  3. Municipal recycling support program. Guide to applicants

    Energy Technology Data Exchange (ETDEWEB)

    1989-01-01

    The Municipal Recycling Support Program stems from the Ontario Ministry of the Environment's policies and programs begun in 1980 aimed at encouraging the development of source separation projects in Ontario. To qualify for financial assistance, municipalities must play a central role in the implementation and ongoing development of recycling; applications will be supported only if there is adequate and reasonable commitment from markets for recovered materials; recycling systems must operate within the framework of a complete waste management system in which cost effectiveness is an important factor; multi-material projects are encouraged as much as possible; and the Ministry will share the costs of projects with the municipalities. The Ministry provides grants for up to 5 years per project to cover the net operating cost of a project up to a specified maximum percentage of eligible gross operating expenses. This manual provides guidelines for applying for such funding, including definitions of eligibility for operating and capital costs, the use of household bins, and guidelines for promotion and advertising, education, demonstration, and feasibility studies.

  4. Patient-centered activity monitoring in the self-management of chronic health conditions.

    Science.gov (United States)

    Chiauzzi, Emil; Rodarte, Carlos; DasMahapatra, Pronabesh

    2015-04-09

    As activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits. Monitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement. Activity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients' daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment 'prescription', behavior

  5. Self-management and skills acquisition in boys with haemophilia.

    Science.gov (United States)

    Khair, Kate; Meerabeau, Liz; Gibson, Faith

    2015-10-01

    There is an increasing prevalence of children/young people with long-term conditions (LTC) in the UK due to improvements in health-care management and delivery. These children are often involved, from an early age, in their own care and management; yet, there are little data to support how or when they develop the necessary skills and knowledge to become competent at this care. This study aimed to understand self-management of haemophilia, from a child's perspective, in the 21st century in the UK where intensive prophylactic therapy is given from early childhood. A qualitative study using grounded theory to evaluate life-experiences of children and young people with haemophilia. Thirty boys aged 4-16 with severe haemophilia treated at a single paediatric haemophilia care centre were interviewed at home or in a focus group. Multimethod qualitative research including age-appropriate research tools (draw and write, photo-elicitation and interviews) to facilitate data collection from children. Boys develop self-management skills over time. They learn from health-care professionals, their parents and other family members with haemophilia. Self-management skills (bleed recognition, self-infusion, self and medicines management, pain and risk management and conceptualizing preventative therapy) are developed through experiential learning and individualized education, and not through formalized expert patient programmes. The boys in this study have benefited from early prophylactic factor replacement therapy. They develop skills in haemophilia and self-management at a relatively young age and are experts in their own haemophilia care. © 2013 John Wiley & Sons Ltd.

  6. Family support programs and adolescent mental health: review of evidence

    Directory of Open Access Journals (Sweden)

    Kuhn ES

    2014-07-01

    Full Text Available Emily S Kuhn, Robert D Laird Department of Psychology, University of New Orleans, New Orleans, LA, USA Abstract: Family support programs aim to improve parent wellbeing and parenting as well as adolescent mental and behavioral health by addressing the needs of parents of adolescents experiencing or at risk for mental health problems. Family support programs can be part of the treatment for adolescents diagnosed with mental or behavioral health problems, or family support programs can be delivered as prevention programs designed to prevent the onset or escalation of mental or behavioral health problems. This review discusses the rationale for family support programs and describes the range of services provided by family support programs. The primary focus of the review is on evaluating the effectiveness of family support programs as treatments or prevention efforts delivered by clinicians or peers. Two main themes emerged from the review. First, family support programs that included more forms of support evidenced higher levels of effectiveness than family support programs that provided fewer forms of support. Discussion of this theme focuses on individual differences in client needs and program adaptions that may facilitate meeting diverse needs. Second, family support prevention programs appear to be most effective when serving individuals more in need of mental and behavioral health services. Discussion of this theme focuses on the intensity versus breadth of the services provided in prevention programs. More rigorous evaluations of family support programs are needed, especially for peer-delivered family support treatments. Keywords: intervention, parent, mental and behavioral health

  7. Internet-based self-management plus education compared with usual care in asthma: a randomized trial

    NARCIS (Netherlands)

    van der Meer, Victor; Bakker, Moira J.; van den Hout, Wilbert B.; Rabe, Klaus F.; Sterk, Peter J.; Kievit, Job; Assendelft, Willem J. J.; Sont, Jacob K.; Assendelft, W. J. J.; Thiadens, H. A.; Bakker, M. J.; van den Hout, W. B.; Kievit, J.; van der Meer, V.; Sont, J. K.; Kaptein, A. A.; Rikkers-Mutsaerts, E. R. V. M.; Rabe, K. F.; Bel, E. H. D.; Detmar, S. B.; Otten, W.; van Stel, H. F.; Roldaan, A. C.; de Jongste, J. C.; Toussaint, P. J.

    2009-01-01

    BACKGROUND: The Internet may support patient self-management of chronic conditions, such as asthma. OBJECTIVE: To evaluate the effectiveness of Internet-based asthma self-management. DESIGN: Randomized, controlled trial. SETTING: 37 general practices and 1 academic outpatient department in the

  8. Making and maintaining lifestyle changes after participating in group based type 2 diabetes self-management educations: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Marit B Rise

    Full Text Available BACKGROUND: Disease management is crucial in type 2 diabetes. Diabetes self-management education aims to provide the knowledge necessary to make and maintain lifestyle changes. However, few studies have investigated the processes after such courses. The aim of this study was to investigate how participants make and maintain lifestyle changes after participating in group-based type 2 diabetes self-management education. METHODS: Data was collected through qualitative semi-structured interviews with 23 patients who attended educational group programs in Central Norway. The participants were asked how they had used the advice given and what they had changed after the course. RESULTS: Knowledge was essential for making lifestyle changes following education. Three factors affected whether lifestyle changes were implemented: obtaining new knowledge, taking responsibility, and receiving confirmation of an already healthy lifestyle. Four factors motivated individuals to maintain changes: support from others, experiencing an effect, fear of complications, and the formation of new habits. CONCLUSION: Knowledge was used to make and maintain changes in diet, medication and physical activity. Knowledge also acted as confirmation of an already adequate lifestyle. Knowledge led to no changes if diabetes appeared "not that scary" or if changes appeared too time consuming. Those involved in diabetes education need to be aware of the challenges in convincing asymptomatic patients about the benefits of adherence to self-management behaviour.

  9. Important, misunderstood, and challenging: a qualitative study of nurses' and allied health professionals' perceptions of implementing self-management for patients with COPD.

    Science.gov (United States)

    Young, Hannah M L; Apps, Lindsay D; Harrison, Samantha L; Johnson-Warrington, Vicki L; Hudson, Nicky; Singh, Sally J

    2015-01-01

    In light of the growing burden of COPD, there is increasing focus on the role of self-management for this population. Currently, self-management varies widely. Little is known either about nurses' and allied health professionals' (AHPs') understanding and provision of self-management in clinical practice. This study explores nurses' and AHPs' understanding and implementation of supported COPD self-management within routine clinical practice. Nurses and AHPs participated in face-to-face semistructured interviews to explore their understanding and provision of COPD self-management, as well as their perceptions of the challenges to providing such care. Purposive sampling was used to select participants from a range of professions working within primary, community, and secondary care settings. Three researchers independently analyzed each transcript using a thematic approach. A total of 14 participants were interviewed. Nurses and AHPs viewed self-management as an important aspect of COPD care, but often misunderstood what it involved, leading to variation in practice. A number of challenges to supporting self-management were identified, which related to lack of time, lack of insight regarding training needs, and assumptions regarding patients' perceived self-management abilities. Nurses and AHPs delivering self-management require clear guidance, training in the use of effective self-management skills, and education that challenges their preconceptions regarding patients. The design of health care services also needs to consider the practical barriers to COPD self-management support for the implementation of such interventions to be successful.

  10. Creating Affordable Housing through self-management:

    DEFF Research Database (Denmark)

    Jensen, Jesper Ole; Stensgaard, Anne Gro

    The paper presents a case on self-management in the Danish social housing sector as a way of providing affordable housing. It is based on an evaluation of a Danish concept for affordable housing, Social Housing Plus (“AlmenBolig+”). The concept was introduced in 2007, and so far app 1.400 housing...

  11. Learning to learn: self-managed learning

    Directory of Open Access Journals (Sweden)

    Jesús Miranda Izquierdo

    2006-09-01

    Full Text Available Thi is article analyzes the potentialities and weaknesses that non directive Pedagogy presents, an example of the so called self managed pedagogy, whose postulates are good to analyze for the contributions that this position can make to the search of new ways of learning.

  12. Beyond Quality Circles: Self-Managing Teams.

    Science.gov (United States)

    Sims, Henry P., Jr.; Dean, James W., Jr.

    1985-01-01

    This article reviews the quality circle concept, shows why its characteristics appeal to American executives, and examines some of its limitations. It looks at self-managing teams and discusses the reasons that adoptions have been relatively few. It then shows what organizational conditions are necessary for quality circles to evolve into teams.…

  13. Quality and Usability of Arthritic Pain Self-Management Apps for Older Adults: A Systematic Review.

    Science.gov (United States)

    Bhattarai, Priyanka; Newton-John, T R O; Phillips, Jane L

    2018-03-01

    To appraise the quality and usability of currently available pain applications that could be used by community-dwelling older adults to self-manage their arthritic pain. A systematic review. Searches were conducted in App Store and Google Play to identify pain self-management apps relevant to arthritic pain management. English language pain management apps providing pain assessment and documentation function and pain management education were considered for inclusion. A quality evaluation audit tool based on the Stanford Arthritis Self-Management Program was developed a priori to evaluate app content quality. The usability of included apps was assessed using an established usability evaluation tool. Out of the 373 apps that were identified, four met the inclusion criteria. The included apps all included a pain assessment and documentation function and instructions on medication use, communication with health professionals, cognitive behavioral therapy-based pain management, and physical exercise. Management of mood, depression, anxiety, and sleep were featured in most apps (N = 3). Three-quarters (N = 3) of the apps fell below the acceptable moderate usability score (≥3), while one app obtained a moderate score (3.2). Few of the currently available pain apps offer a comprehensive pain self-management approach incorporating evidence-based strategies in accordance with the Stanford Arthritis Self-Management Program. The moderate-level usability across the included apps indicates a need to consider the usability needs of the older population in future pain self-management app development endeavors.

  14. Limiting exercise options: depending on a proxy may inhibit exercise self-management.

    Science.gov (United States)

    Shields, Christopher A; Brawley, Lawrence R

    2007-07-01

    We examined the influence of proxy-assistance on exercisers' social cognitions and behavior. Fifty-six fitness class participants reported preference for proxy-assistance and reacted to exercising in different contexts. A 2 (proxy-led vs self-managed exercise context) by 2 (preferred assistance) MANOVA revealed significant assistance by context interactions for self-regulatory efficacy (SRE) and difficulty. Regarding self-managed exercise, high-assistance individuals expressed lower SRE and higher difficulty. Chi-square analysis revealed that significantly fewer high-assistance participants chose self-managed exercise. A one-way MANOVA on preferred assistance indicated that high-assistance participants were less confident, satisfied and perceived their self-managed exercise as more difficult. Results support Bandura's theorizing that use of a proxy can limit SRE of those preferring the proxy's control of their behavior.

  15. [The Utilization of Health-Related Applications in Chronic Disease Self-Management].

    Science.gov (United States)

    Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

    2017-08-01

    The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

  16. An educational intervention to promote self-management and professional socialization in graduate nurse anesthesia students

    Science.gov (United States)

    Maloy, Debra A.

    Traditionally, nurse anesthesia educators have utilized prior academic achievement to predict student success. However, research has indicated that prior academic achievement offers an inadequate assessment of student success in graduate healthcare programs with extensive clinical residencies. The educational literature has identified many non-cognitive factors, such as self-efficacy and locus of control, that may provide a more holistic prediction model of student success. An experimental study with pretest-posttest design and stratified random assignment was conducted to evaluate the effectiveness of an educational intervention to promote self-management, professional socialization, and academic achievement among first semester graduate nurse anesthesia students. Participants (N = 66) were demographically similar to the national graduate nurse anesthesia student body, though Hispanics and younger students were a little over-represented in the sample (56% female, 75.8% White, 15.2% Hispanic, 6% Other, 59% ≤ 30-years-old, 67% ≤ 3 years of ICU). The results showed that most graduate anesthesia students had strong self-management and professional socialization characteristics on admission. The results did not support the effectiveness of this educational intervention. Thus, ceiling effect may have accounted in part for statistically non-significant results regarding self-efficacy (p = .190, o2 = .03), locus of control (p = .137, o2 = .04), professional socialization (p = .819, o2 = .001), and academic achievement (p = .689, o2 = .003). Future researchers may need to expand the scope of the intervention, use a more powerful and sensitive instrument, and utilize a larger sample.

  17. ACHP | Federal Programs that Can Support Heritage Tourism

    Science.gov (United States)

    Search skip specific nav links Home arrow Heritage Tourism arrow Federal Programs that Can Support Heritage Tourism Federal Programs that Can Support Heritage Tourism The following is a sampling of federal programs that can help promote and support local or regional heritage tourism initiatives. Historic

  18. Living well: an intervention to improve self-management of medical illness for individuals with serious mental illness.

    Science.gov (United States)

    Goldberg, Richard W; Dickerson, Faith; Lucksted, Alicia; Brown, Clayton H; Weber, Elyssa; Tenhula, Wendy N; Kreyenbuhl, Julie; Dixon, Lisa B

    2013-01-01

    Individuals with serious mental illness have elevated rates of comorbid chronic general medical conditions and may benefit from interventions designed to support illness self-management. This study examined the effectiveness of a modified version of the Chronic Disease Self-Management Program called Living Well for individuals with serious mental illness. A total of 63 mental health consumers with serious mental illness and at least one concurrent chronic general medical condition were randomly assigned to receive the 13-session peer-cofacilitated Living Well intervention or usual care. Participants were evaluated on attitudinal, behavioral, and functional outcomes at baseline, at the end of the intervention, and at a two-month follow-up. Living Well participants showed significant postintervention improvements across a range of attitudinal (self-efficacy and patient activation), behavioral (illness self-management techniques), and functional (physical and emotional well-being and general health functioning) outcomes. Although attenuation of effect was observed for most outcomes at two months postintervention, evidence was found of continued improvement in general self-management behaviors (use of action planning, brainstorming, and problem-solving). Continued advantage was found for the Living Well group in other areas, such as health-related locus of control and reports of healthy eating and physical activity. Receipt of Living Well was associated with a notable decrease in use of the emergency room for medical care, although the between-group difference was not statistically significant. Living Well shows promise in helping mental health consumers more effectively manage chronic general medical conditions and experience improved functioning and well-being.

  19. Self-management in young adults with bipolar disorder: Strategies and challenges.

    Science.gov (United States)

    Nicholas, Jennifer; Boydell, Katherine; Christensen, Helen

    2017-02-01

    Early adoption of effective self-management strategies for bipolar disorder (BD) results in better clinical outcomes and increased quality of life. Therefore, facilitation of these strategies in young adults who are early in their illness course is vital. However, an understanding of self-management practices and needs of young adults with BD is lacking. This study explores young adult's perspectives of disorder self-management practices and challenges. Young adults with BD completed an online survey about disorder management strategies and challenges. Self-management was investigated through self-report and ratings of literature-derived strategies. Results were analysed using descriptive statistics and qualitative thematic analysis. Eighty-nine participants aged 18-30 (M=24.4; SD=3.9) completed the survey. Adherence to treatment, disorder psychoeducation, and sleep-management were the strategies rated most helpful. Six participant-reported self-management strategies were identified (1) Maintaining a healthy lifestyle; (2) Treatment attendance and adherence; (3) Participation in meaningful activities; (4) Engagement with social support; (5) Meditation and relaxation practices; and (6) Symptom monitoring. The most common self-management challenges experienced by young adults concerned the nature of the disorder, interpersonal relationships, and stigma. Participants likely represent a sub-set of young adults engaged with healthcare and therefore may not be representative of the population. Strategies reported vital by those successfully managing their disorder are not adequately utilised by young adults with BD. Both differences in strategy use and perceived self-management challenges represent important areas of clinical support and intervention. This increased understanding will help facilitate