Influences of Transportation on Health Decision-Making and Self-Management Behaviors among Older Adults with Chronic Conditions

Objective: To determine the association of frailty with out-of-pocket expenses (OOPEs) during the last year of life of Mexican older adults. Methods: Cross-sectional secondary analysis of the Mexican Health and Aging Study (MHAS), a representative population-based cohort study. Health care expenses were estimated, and a probit model was used to estimate the probability that older adults had OOPE. A general linear model was applied to explain OOPE magnitudes. Results: A total of 55.8% of individuals reported having OOPE with a mean of 3,261 USD. Average OOPE for hospitalization during the last year of life was 7,011.9 USD. Older adults taking their own medical decisions during the last year of life expended less than those who did not. Conclusion: No affiliation to health services, frailty, and health decision-making by others increased the probability of OOPE. The magnitude is determined by age, hospitalization, medical visits, affiliation, frailty, and health decision-making by others.

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Timing of onset and self-management of multiple chronic conditions: A qualitative examination taking a lifespan perspective

Chronic Illness ◽

10.1177/1742395318792066 ◽

2018 ◽

Vol 16 (3) ◽

pp. 173-189 ◽

Cited By ~ 2

Author(s):

Allison R Heid ◽

Andrew R Gerber ◽

David S Kim ◽

Stefan Gillen ◽

Seran Schug ◽

...

Keyword(s):

Older Adults ◽

Social Life ◽

Chronic Conditions ◽

Self Management ◽

Multiple Chronic Conditions ◽

Older Individuals ◽

Structured Interviews ◽

Targeted Interventions ◽

Timing Of Onset ◽

Management Behaviors

Objectives Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions. Methods Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions. Results Findings highlight the complex process by which illnesses unfold in the context of individuals’ lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness. Discussion Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person’s history and life experiences must be considered.

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Public Library Training Program for Older Adults Addresses Their Computer and Health Literacy Needs

Evidence Based Library and Information Practice ◽

10.18438/b8cp6b ◽

2012 ◽

Vol 7 (4) ◽

pp. 105

Author(s):

Cari Merkley

Keyword(s):

Older Adults ◽

Decision Making ◽

Health Literacy ◽

Training Program ◽

Public Libraries ◽

Computer Anxiety ◽

Public Library ◽

National Institutes Of Health ◽

Health Decision Making ◽

Health Decision

Objective – To evaluate the efficacy of an e-health literacy educational intervention aimed at older adults. Design – Pre and post intervention questionnaires administered in an experimental study. Setting – Two public library branches in Maryland. Subjects – 218 adults between 60 and 89 years of age. Methods – A convenience sample of older adults was recruited to participate in a four week training program structured around the National Institutes of Health toolkit Helping Older Adults Search for Health Information Online. During the program, classes met at the participating libraries twice a week. Sessions were two hours in length, and employed hands on exercises led by Master of Library Science students. The training included an introduction to the Internet, as well as in depth training in the use of the NIHSeniorHealth and MedlinePlus websites. In the first class, participants were asked to complete a pre-training questionnaire that included questions relating to demographics and previous computer and Internet experience, as well as measures from the Computer Anxiety Scale and two subscales of the Attitudes toward Computers Questionnaire. Participants between September 2008 and June 2009 also completed pre-training computer and web knowledge tests that asked individuals to label the parts of a computer and of a website using a provided list of terms. At the end of the program, participants were asked to complete post-training questionnaires that included the previously employed questions from the Computer Anxiety Scale and Attitudes towards Computer Questionnaire. New questions were added relating to the participants’ satisfaction with the training, its impact on their health decision making, their perceptions of public libraries, and the perceived usability and utility of the two websites highlighted during the training program. Those who completed pre-training knowledge tests were also asked to complete the same exercises at the end of the program. Main Results – Participants showed significant decreases in their levels of computer anxiety, and significant increases in their interest in computers at the end of the program (p>0.01). Computer and web knowledge also increased among those completing the knowledge tests. Most participants (78%) indicated that something they had learned in the program impacted their health decision making, and just over half of respondents (55%) changed how they took medication as a result of the program. Participants were also very satisfied with the program’s delivery and format, with 97% indicating that they had learned a lot from the course. Most (68%) participants said that they wished the class had been longer, and there was full support for similar programming to be offered at public libraries. Participants also reported that they found the NIHSeniorHealth website more useful, but not significantly more usable, than MedlinePlus. Conclusion – The intervention as designed successfully addressed issues of computer and health literacy with older adult participants. By using existing resources, such as public library computer facilities and curricula developed by the National Institutes of Health, the intervention also provides a model that could be easily replicated in other locations without the need for significant financial resources.

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How could health information be improved? Recommended actions from the Victorian Consultation on Health Literacy

Australian Health Review ◽

10.1071/ah16106 ◽

2018 ◽

Vol 42 (2) ◽

pp. 134 ◽

Cited By ~ 2

Author(s):

Sophie J. Hill ◽

Tanya A. Sofra

Keyword(s):

Decision Making ◽

Health Literacy ◽

Health Information ◽

Information Needs ◽

Self Management ◽

Objective Health ◽

Health Decision Making ◽

Health Decision ◽

Information Materials ◽

Improve Health

Objective Health literacy is on the policy agenda. Accessible, high-quality health information is a major component of health literacy. Health information materials include print, electronic or other media-based information enabling people to understand health and make health-related decisions. The aim of the present study was to present the findings and recommended actions as they relate to health information of the Victorian Consultation on Health Literacy. Methods Notes and submissions from the 2014 Victorian Consultation workshops and submissions were analysed thematically and a report prepared with input from an advisory committee. Results Health information needs to improve and recommendations are grouped into two overarching themes. First, the quality of information needs to be increased and this can be done by developing a principle-based framework to inform updating guidance for information production, formulating standards to raise quality and improving the systems for delivering information to people. Second, there needs to be a focus on users of health information. Recommendation actions were for information that promoted active participation in health encounters, resources to encourage critical users of health information and increased availability of information tailored to population diversity. Conclusion A framework to improve health information would underpin the efforts to meet literacy needs in a more consistent way, improving standards and ultimately increasing the participation by consumers and carers in health decision making and self-management. What is known about the topic? Health information is a critical component of the concept of health literacy. Poorer health literacy is associated with poorer health outcomes across a range of measures. Improving access to and the use of quality sources of health information is an important strategy for meeting the health literacy needs of the population. In recent years, health services and governments have taken a critical interest in improving health literacy. What does this paper add? This article presents the findings of the Victorian Consultation on Health Literacy as they relate to needs, priorities and potential actions for improving health information. In the context of the National Statement for Health Literacy, health information should be a priority, given its centrality to the public’s management of its own health and effective, standards-based, patient-centred clinical care. A framework to improve health information would underpin the efforts of government, services and consumer organisations to meet literacy needs in a more consistent way, improving standards and ultimately increasing the participation by consumers and carers in health decision making and self-management. What are the implications for practitioners? The development and provision of health information materials needs to be systematised and supported by infrastructure, requiring leadership, cultural change, standards and skills development.

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Modelling SARS-CoV-2 Disease Progression in Australia and New Zealand: An Agent-Based Approach to Support Public Health Decision-Making

SSRN Electronic Journal ◽

10.2139/ssrn.3712947 ◽

2020 ◽

Author(s):

Jason Thompson ◽

Roderick McClure ◽

Tony Blakely ◽

Nick Wilson ◽

Michael Baker ◽

...

Keyword(s):

Public Health ◽

Decision Making ◽

New Zealand ◽

Disease Progression ◽

Agent Based ◽

Public Health Decision ◽

Health Decision Making ◽

Health Decision

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Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-048350 ◽

2021 ◽

Vol 11 (2) ◽

pp. e048350

Author(s):

Monika Kastner ◽

Julie Makarski ◽

Leigh Hayden ◽

Jemila S Hamid ◽

Jayna Holroyd-Leduc ◽

...

Keyword(s):

Older Adults ◽

Chronic Disease ◽

Randomised Controlled Trial ◽

Disease Management ◽

Chronic Conditions ◽

Controlled Trial ◽

Management Tool ◽

Self Management ◽

Plain Language ◽

Randomised Controlled

IntroductionIn response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called ‘KeepWell’ that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases.Methods and analysisWe will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness–implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability.Ethics and disseminationEthics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting.Trial registration numberNCT04437238.

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The NCCMT’s dynamic model for evidence-informed public health

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.179 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Clark ◽

S Neil-Sztramko ◽

M Dobbins

Keyword(s):

Public Health ◽

Decision Making ◽

Research Evidence ◽

Decision Makers ◽

Local Data ◽

Public Health Decision ◽

Health Decision Making ◽

Political Preferences ◽

Health Decision ◽

Structured Approach

Abstract Issue It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making. Description of the problem As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making. Results The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated. Lessons Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges. Key messages Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.

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