Complexity and Health Coaching: Synergies in Nursing

Health care professionals are increasingly aware that persons are complex and live in relation with other complex human communities and broader systems. Complex beings and systems are living and evolving in nonlinear ways through a process of mutual influence. Traditional standardized approaches in chronic disease management do not address these non-linear linkages and the meaning and changes that impact day-to-day life and caring for self and family. The RN health coach role described in this paper addresses the complexities and ambiguities for persons living with chronic illness in order to provide person-centered care and support that are unique and responsive to the context of persons’ lives. Informed by complexity thinking and relational inquiry, the RN health coach is an emergent innovation of creative action with community and groups that support persons as they shape their health and patterns of living.

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Branded versus generic drug use in chronic disease management in Hong Kong—perspectives of health care professionals and the general public

Hong Kong Medical Journal ◽

10.12809/hkmj177087 ◽

2018 ◽

Author(s):

Vivian WY Lee ◽

◽

Franco WT Cheng ◽

Felix YH Fong ◽

Enoch EN Ng ◽

...

Keyword(s):

Health Care ◽

Hong Kong ◽

Chronic Disease ◽

Drug Use ◽

Disease Management ◽

Generic Drug ◽

Health Care Professionals ◽

General Public ◽

Chronic Disease Management

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Achieving Value-Based Care in Chronic Disease Management: Intervention Study (Preprint)

10.2196/preprints.10368 ◽

2018 ◽

Author(s):

Nilmini Wickramasinghe ◽

Blooma John ◽

Joey George ◽

Doug Vogel

Keyword(s):

Health Care ◽

Chronic Disease ◽

Disease Management ◽

Standard Care ◽

Chronic Disease Management ◽

Monitoring Device ◽

Patient Centered ◽

Centered Care ◽

Diabetes Monitoring ◽

Technology Solution

BACKGROUND The World Health Organization notes that diabetes, a chronic disease, is a silent epidemic, and by 2020 there will be a 54% rise in the total number of individuals diagnosed with this disease. These are alarming figures that have significant repercussions for the quality of life of individuals and their families as well as for the financial stress of health care systems globally. Early detection and proactive management of diabetes is essential. The Diamond solution provides diabetes self-management by enabling patients to send details about their blood sugar readings at specific times to their nominated care coordinator to receive recommendations for diet and exercise and insulin titration. OBJECTIVE The aim of the study was to assess the usability, acceptability, and fidelity of the Diamond diabetes monitoring device for patients with gestational diabetes mellitus (GDM). Specifically assessed were (1) patient compliance, (2) patient satisfaction, (3) level of glycemic control achieved, and (4) health professional satisfaction. METHODS Using a design science research perspective, the Diamond diabetes monitoring device solution was adapted to the Australian health care environment. Once the solution was deemed fit for purpose by the director of the OB/GYN clinical institute and on securing all relevant ethics approvals, a 2-period 2-arm nonblinded crossover clinical trial was conducted for 8 weeks total time with crossover at 4 weeks to establish proof of concept, usability, and fidelity. The patient perspective was assessed by using structured questionnaires at 4 specific stages of the project, while the clinician perspective was captured via semistructured interviews and unstructured questionnaires. RESULTS The 10 patients studied reported preferring standard care with the technology solution to standard care alone. Further, all clinicians involved concurred that the technology solution greatly assisted their ability to provide higher value patient-centered care. They also noted that it was extremely helpful for assisting in systematically monitoring glucose levels and any/all changes and trends. CONCLUSIONS Based on these initial findings, we offer a holistic pervasive approach to enable the achievement of value-based, patient-centered care in chronic disease management. Key lessons include the importance when designing such solutions to focus on the two primary user groups (patients and clinicians).

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Facebook Groups for the Management of Chronic Diseases (Preprint)

10.2196/preprints.7558 ◽

2017 ◽

Author(s):

Stephanie R Partridge ◽

Patrick Gallagher ◽

Becky Freeman ◽

Robyn Gallagher

Keyword(s):

Health Care ◽

Chronic Disease ◽

Disease Management ◽

Health Care Professionals ◽

Chronic Disease Management ◽

Comprehensive Evaluation ◽

Online Communication ◽

Future Research ◽

Content Development ◽

Traditional Research

UNSTRUCTURED The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group “champions”; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations.

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Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Health Care Professionals, Patients, and Family Members: Multisite Single-Arm Feasibility Study

Journal of Medical Internet Research ◽

10.2196/25060 ◽

2021 ◽

Vol 23 (2) ◽

pp. e25060

Author(s):

Tobias Kowatsch ◽

Theresa Schachner ◽

Samira Harperink ◽

Filipe Barata ◽

Ullrich Dittler ◽

...

Keyword(s):

Health Care ◽

Chronic Disease ◽

Disease Management ◽

Family Member ◽

Working Alliance ◽

Health Care Professionals ◽

Chronic Disease Management ◽

Family Members ◽

Conversational Agent ◽

Conversational Agents

Background Successful management of chronic diseases requires a trustful collaboration between health care professionals, patients, and family members. Scalable conversational agents, designed to assist health care professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out to the everyday lives of patients and their family members. However, to date, it remains unclear whether conversational agents, in such a role, would be accepted and whether they can support this multistakeholder collaboration. Objective With asthma in children representing a relevant target of chronic disease management, this study had the following objectives: (1) to describe the design of MAX, a conversational agent–delivered asthma intervention that supports health care professionals targeting child-parent teams in their everyday lives; and (2) to assess the (a) reach of MAX, (b) conversational agent–patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of health care professionals in primary and secondary care settings. Methods MAX was designed to increase cognitive skills (ie, knowledge about asthma) and behavioral skills (ie, inhalation technique) in 10-15-year-olds with asthma, and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) to build a conversational agent–patient working alliance; (2) to offer hybrid (human- and conversational agent–supported) ubiquitous coaching; and (3) to provide an intervention with high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The conversational agent communicates with health care professionals via email, with patients via a mobile chat app, and with a family member via SMS text messaging. A single-arm feasibility study in primary and secondary care settings was performed to assess MAX. Results Results indicated an overall positive evaluation of MAX with respect to its reach (49.5%, 49/99 of recruited and eligible patient-family member teams participated), a strong patient-conversational agent working alliance, and high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the conversational agent as opposed to between patients and health care professionals, thus indicating the scalability of MAX. In addition, it took health care professionals less than 4 minutes to assess the inhalation technique and 3 days to deliver related feedback to the patients. Several suggestions for improvement were made. Conclusions This study provides the first evidence that conversational agents, designed as mediating social actors involving health care professionals, patients, and family members, are not only accepted in such a “team player” role but also show potential to improve health-relevant outcomes in chronic disease management.

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