Sleep Disturbance and Self-management in Adults With Subarachnoid Hemorrhage: A Qualitative Study

Subarachnoid hemorrhage (SAH) survivors often experience sleep disturbances. Little is known about sleep-management practices used to improve their sleep. The purpose of this qualitative study was to explore interest in and engagement with self-management practices to promote sleep health in SAH survivors. We conducted a cross-sectional qualitative study using semi-structured interviews with a convenience sample of 30 SAH survivors recruited from a university hospital. We conducted content analysis of interview transcripts. Three themes and 15 subcategories were identified: (1) sleep disturbances (difficulties falling asleep, wake after sleep onset, daytime sleepiness, too much or insufficient sleep, and poor sleep quality); (2) sleep-management practices (exercise, regular sleep schedule, relaxation, keeping busy and staying active, changing beverage intake, taking supplements, taking medications, recharging energy, and barriers to sleep management); and (3) consulting with healthcare providers (discussing sleep problems with healthcare providers). Self-management strategies focusing on health-promoting behaviors may improve SAH survivors’ sleep health.

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1140 Sleep Disturbances, Lifestyle, And Self-Management In Adults With Subarachnoid Hemorrhage

SLEEP ◽

10.1093/sleep/zsaa056.1134 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A434-A434

Author(s):

E Byun ◽

S McCurry ◽

S Kwon ◽

B Kim ◽

H Thompson

Keyword(s):

Subarachnoid Hemorrhage ◽

Sleep Quality ◽

Daytime Sleepiness ◽

Sleep Disturbances ◽

Management Practices ◽

Self Management ◽

Poor Sleep ◽

Nursing Research ◽

Poor Sleep Quality ◽

Sleep Management

Abstract Introduction Subarachnoid hemorrhage (SAH) survivors often suffer sleep disturbances. Self-management strategies focusing on lifestyle changes and health-promoting behaviors may improve sleep in SAH survivors. Few studies have examined sleep in SAH survivors, and little is known about sleep management practices used to improve their sleep. The purposes of this study were to: 1) describe the prevalence of sleep disturbances using subjective and objective sleep measures, and 2) explore interest in and engagement with self-management practices to promote sleep health in SAH survivors. Methods We conducted a cross-sectional study with a convenience sample of 30 SAH survivors recruited from a university hospital. We assessed sleep quality using the Pittsburgh Sleep Quality Index (PSQI), daytime sleepiness using the Epworth Sleepiness Scale (ESS), and objective sleep using wrist actigraphy. We conducted content analysis of semi-structured interviews, with two authors each coding sleep disturbances and self-management practices addressing sleep. Results Seventy-three percent of SAH survivors reported poor sleep quality (PSQI > 5) and 27% had daytime sleepiness (ESS > 10). Actigraphy analysis indicated that 41% of SAH survivors slept less than 7 hours or more than 9 hours. Interview content analyses suggested 3 themes and 15 sub-categories: 1) Sleep disturbances (difficulties in falling asleep, wake after sleep onset, daytime sleepiness, too much or insufficient sleep, and poor sleep quality), 2) Sleep management practices (exercise, regular sleep schedule, relaxation, keeping busy and staying active, changing beverage intake, taking supplements, taking medication, recharging energy, and barriers to sleep management), and 3) Healthcare providers (discussing sleep problems with health care providers). Conclusion Sleep disturbances are highly prevalent and an urgent need exists to focus on improving sleep in SAH survivors. Developing tailored interventions that incorporate self-management and lifestyle change would be a critical next step to improve sleep and promote health in this at-risk population. Support This research was supported by grants from the National Institutes of Health/National Institute of Nursing Research (K23 NR017404), University of Washington Institute of Translational Health Science Translational Research Scholars Program (UL1 TR000423), and University of Washington School of Nursing Research and Intramural Funding Program.

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Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-044777 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044777

Author(s):

Susanne Lundin ◽

Marina Jonsson ◽

Carl-Fredrik Wahlgren ◽

Emma Johansson ◽

Anna Bergstrom ◽

...

Keyword(s):

Young Adults ◽

Atopic Dermatitis ◽

Qualitative Study ◽

Healthcare Providers ◽

Transition Process ◽

Population Based ◽

Self Management ◽

School Age ◽

Perceived Availability ◽

Semistructured Interviews

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

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534 Food Insecurity and Sleep Health by Race/Ethnicity and Age Group in the United States

SLEEP ◽

10.1093/sleep/zsab072.532 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A211-A211

Author(s):

Nyree Riley ◽

Dana Alhasan ◽

W Braxton Jackson ◽

Chandra Jackson

Keyword(s):

Food Security ◽

Food Insecurity ◽

Sleep Duration ◽

Sleep Disturbances ◽

The United States ◽

Poor Sleep ◽

High Food ◽

Short Sleep Duration ◽

Sleep Health ◽

Falling Asleep

Abstract Introduction Food insecurity may influence sleep through poor mental health (e.g., depression) and immune system suppression. Although prior studies have found food insecurity to be associated with poor sleep, few studies have investigated the food security-sleep association among racially/ethnically diverse participants and with multiple sleep dimensions. Methods Using National Health Interview Survey data, we examined overall, age-, sex/gender-, and racial/ethnic-specific associations between food insecurity and sleep health. Food security was categorized as very low, low, marginal, and high. Sleep duration was categorized as very short (<6 hours), short (<7 hours), recommended (7–9 hours), and long (≥9 hours). Sleep disturbances included trouble falling and staying asleep, insomnia symptoms, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographic characteristics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CI) for sleep dimensions by very low, low, and marginal vs. high food security. Results The 177,435 participants’ mean age was 47.2±0.1 years, 52.0% were women, 68.4% were Non-Hispanic (NH)-White. Among individuals reporting very low food security, 75.4% had an annual income of <$35,000 and 60.3% were ≥50 years old. After adjustment, very low vs. high food security was associated with a higher prevalence of very short (PR=2.61 [95%CI: 2.44–2.80]) and short (PR=1.66 [95% CI: 1.60–1.72]) sleep duration. Very low vs. high food security was associated with both trouble falling asleep (PR=2.21 [95% CI: 2.12–2.30]) and trouble staying asleep (PR=1.98 [95% CI: 1.91–2.06]). Very low vs. high food security was associated with higher prevalence of very short sleep duration among Asians (PR=3.64 [95% CI: 2.67–4.97]), Whites (PR=2.73 [95% CI: 2.50–2.99]), Blacks (PR=2.03 [95% CI: 1.80–2.31]), and Hispanic/Latinxs (PR=2.65 [95% CI: 2.30–3.07]). Conclusion Food insecurity was associated with poor sleep in a diverse sample of the US population. Support (if any):

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Promoting Self-Management of Chronic Health Conditions

10.1093/med-psych/9780190606145.001.0001 ◽

2017 ◽

Cited By ~ 1

Keyword(s):

Management Practices ◽

Healthcare Providers ◽

Chronic Health Conditions ◽

Health Conditions ◽

Self Management ◽

Psychological Interventions ◽

Management Support ◽

Chronic Health ◽

Treatment Plans

This book explores the theories and practices that help to facilitate self-management of chronic health conditions (also known as chronic impairments or chronic diseases). It consists of four parts, in addition to an introductory chapter and a chapter on defining self-management, for a total of 22 chapters. This book includes discussions about self-management models, psychological interventions, and collaborative care on both individual and systemic levels for the promotion of self-management. Self-management requires that individuals understand the range of symptoms related to their specific chronic impairment, what those symptoms may indicate, and what actions to take to address those symptoms. Healthcare providers are an integral part of providing self-management support (SMS) to these individuals. Self-management includes the micro-decisions that individuals with chronic health conditions make about their conditions and the macro-decisions (e.g., creating treatment plans) that healthcare providers make in collaboration with individuals with chronic health conditions. This book focuses on exploring a range of self-management practices that can empower individuals with chronic health conditions to be less dependent on healthcare systems and, ultimately, to be more in control of their lives.

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Facilitators and Barriers of Managing Patients with Multiple Chronic Conditions in the Community: A Qualitative Study

10.21203/rs.2.15520/v2 ◽

2019 ◽

Author(s):

Kah Mun Foo ◽

Meena Sundram ◽

Helena Legido-Quigley

Keyword(s):

Qualitative Study ◽

Waiting Time ◽

Chronic Conditions ◽

Resource Constraints ◽

Healthcare Providers ◽

Policy Formulation ◽

Care Quality ◽

Self Management ◽

Multiple Chronic Conditions ◽

Facilitators And Barriers

Abstract Background About one-third of all adults worldwide were diagnosed with multiple chronic conditions (MCCs). Literature had found several challenges of providers and patients coping with managing MCCs in the community, and yet limited research studies that consider their viewpoints in combination. A qualitative study involving healthcare providers and users was thus conducted to examine facilitators and barriers of managing patients with MCCs in the community in Singapore. Methods This involves 26 semi-structured interviews with 10 physicians, 2 caregivers and 14 patients seeking treatment in the polyclinics that provides subsidised primary care services. Topic guides were developed with reference from literature review, Chronic Care Model (CCM) and Framework for patient-centred access to healthcare. Results Despite perceived affordable charges and availability of support system, some patients still encountered financial difficulties in managing care. These include inadequacy of the nation-wide medical savings scheme to cover outpatient treatment and medications. Half of the healthcare users did not know where to seek help. While patients could access comprehensive services in polyclinics, those that did not turn up might not receive timely care. Furthermore, patients reported long consultation waiting time. Physicians were able to propose and drive quality improvement projects to improve care quality. However, there were challenges of delivering safe and quality care with limited consultation duration due to the need to manage waiting time, inadequate communication with specialists to coordinate care, and resource constraints in managing complex patients. Although providers could equip patients with self-management and lifestyle related guidelines, patients’ actions are influenced by multiple factors including work nature, beliefs and environment. Conclusions There were barriers on care access, delivery and self-management as reported. It is crucial to adopt whole-of-society approach involving individuals, community, institutions and policymakers to improve and support MCCs management. This study has also highlighted the importance to consider different viewpoints of healthcare providers and users in policy formulation and community care planning.

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Changes of evening exposure to electronic devices during the COVID-19 lockdown affect the time course of sleep disturbances

SLEEP ◽

10.1093/sleep/zsab080 ◽

2021 ◽

Author(s):

Federico Salfi ◽

Giulia Amicucci ◽

Domenico Corigliano ◽

Aurora D’Atri ◽

Lorenzo Viselli ◽

...

Keyword(s):

Sleep Quality ◽

Sleep Disturbances ◽

Time Course ◽

Electronic Device ◽

Electronic Devices ◽

Sleep Onset Latency ◽

Negative Consequences ◽

Sleep Health ◽

Falling Asleep ◽

Insomnia Symptoms

Abstract Study Objectives During the coronavirus disease 2019 (COVID-19) lockdown, there was a worldwide increase in electronic devices’ daily usage. Prolonged exposure to backlit screens before sleep influences the circadian system leading to negative consequences on sleep health. We investigated the relationship between changes in evening screen exposure and the time course of sleep disturbances during the home confinement period due to COVID-19. Methods 2,123 Italians (mean age ± standard deviation, 33.1 ± 11.6) were tested longitudinally during the third and the seventh week of lockdown. The web-based survey evaluated sleep quality and insomnia symptoms through the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. The second assessment survey inquired about intervening changes in backlit screen exposure in the two hours before falling asleep. Results Participants who increased electronic device usage showed decreased sleep quality, exacerbated insomnia symptoms, reduced sleep duration, prolonged sleep onset latency, and delayed bedtime and rising time. In this subgroup, the prevalence of poor sleepers and individuals reporting moderate/severe insomnia symptoms increased. Conversely, respondents reporting decreased screen exposure exhibited improved sleep quality and insomnia symptoms. In this subgroup, the prevalence of poor sleepers and moderate/severe insomniacs decreased. Respondents preserving screen time habits did not show variations of the sleep parameters. Conclusions Our investigation demonstrated a strong relationship between modifications of evening electronic device usage and time course of sleep disturbances during the lockdown period. Monitoring the potential impact of excessive evening exposure to backlit screens on sleep health is recommendable during the current period of restraining measures due to COVID-19.

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Dietary self-management practices among persons with T2DM: An exploratory qualitative study from western-coast of India

Diabetes & Metabolic Syndrome Clinical Research & Reviews ◽

10.1016/j.dsx.2020.10.033 ◽

2020 ◽

Vol 14 (6) ◽

pp. 2161-2167

Author(s):

Prabhath Matpady ◽

Arun G. Maiya ◽

Pallavi Prakash Saraswat ◽

Shreemathi S. Mayya ◽

Mamatha S. Pai ◽

...

Keyword(s):

Qualitative Study ◽

Management Practices ◽

Self Management ◽

Western Coast

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Involving clinic patients in systematic symptom reporting to improve cancer care: Exploring prevalence of sleep disturbances (SD) and fatigue (FAT).

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.68 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 68-68

Author(s):

Margaret Irwin ◽

Catherine Brown ◽

Ashlee Vennettilli ◽

Lawson Eng ◽

Aein Zarrin ◽

...

Keyword(s):

Cancer Patients ◽

Sleep Disturbances ◽

Healthcare Providers ◽

Severity Index ◽

Symptom Reporting ◽

Care Plan ◽

Systematic Evaluation ◽

Cancer Center ◽

Falling Asleep ◽

Patient Reported

68 Background: SD and FAT occur in 30-50% of cancer patients. Patient-reported outcome measure surveys are avenues through which healthcare providers (HCP) can receive symptom-related clinically relevant information directly from patients, and engage them in their own care plan. By asking patients to report symptoms rapidly through tablet/computer-based technology, HCPs can involve patients in the delivery of care. Methods: In a pilot study evaluating utility of systematic symptom reporting, 336 adult cancer patients across all stages and disease sites who were attending outpatient cancer clinics at Princess Margaret Cancer Centre (PMCC) (Toronto, Canada) completed electronic tablet-administered secure surveys on SD (Insomnia Severity Index) and FAT patterns (FACT-fatigue). These tools measured both symptom severity and interference with function. Results: With a median age of 59 (19-91) years, 55% female, across a broad distribution of cancer sites, 56% of our sample reported moderate to very severe (MTVS) SD over the last 7 days: 31% had MTVS difficulty falling asleep; 43% had MTVS difficulties staying asleep; 36% had MTVS problems waking up too early. While 62% who had MTVS SD were not distressed by their SD, 95% who were distressed by their SD met the criteria of MTVS SD. 78% of patients had any level of FAT over the last 7 days, with 40% reporting MTVS FAT. While 40% who had MTVS FAT were still able to perform their usual activities, 67% of patients who were not able to do their usual activities had MTVS FAT. Conclusions: Across all stages and disease sites of cancer patients at PMCC, the prevalence of SD and FAT was both high. Severity and interference with function by FAT and SD were often distinct and non-overlapping. Involving patients in the systematic evaluation of symptoms, particularly using newer tablet-based technology within the clinic, was feasible. Through the use of patient reported electronic applications, patients could easily and systemically report their symptoms in real-time. FAT management has always been a high priority at our institution. However, based on our results, a cancer center-wide self-management plan is being considered for SD.

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Abstract 311: Facilitators and Barriers to Self-management of Patients with Type 2 Diabetes in Communities in China, a Qualitative Study

Hypertension ◽

10.1161/hyp.60.suppl_1.a311 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Xiang Y Chen ◽

Peng Yue ◽

Yong L Wang ◽

Shu Q Xiao ◽

Xin W Feng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Qualitative Study ◽

Management Practices ◽

Diabetes Management ◽

Financial Burden ◽

Chinese Patients ◽

Self Management ◽

Difficult Time ◽

Facilitators And Barriers

Background: Self-management has become a key strategy for caring chronic patients in community. However, little is known about peoples’ self-management experiences and their perceived cues and barriers to engagement in self-management. Objective: To explore issues patients with type 2 diabetes experienced in their self-management practices,to understand cues and barriers to engagement in self-management. Design: Qualitative study (Semi-structured interviews) Setting: 11 communities in Beijing, China Participants: Type 2 diabetes patients in community, aged >18, no admission in past 90 days. Methods: 40 critical incident interviews were run during Apr to Sep in 2011 using purposive sampling (20 interviews with patients whose HbA1c well-controlled (<6.5%), while 20 badly-controlled (≥8%)).Themes from interviews were identified using content analysis, which revealed cues and barriers to self-modification for diabetes management. Results: Implications for self- management practice included objectively understanding on the severity and complications of diabetes. In addition to family support such as supervision in family and fully-use of family resource, desires/duties to be responsible for whole family life as a breadwinner was emerged as a key cue to engagement in self-control. Barriers to engagement in self-management stemmed from financial burden to monitor blood glucose daily, dissatisfaction of HbA1c level after efforts, and malignant life events. It is worth mentioning that starving experience of difficult time with natural disasters in1960s- 1970s in China was identified also as a key barrier to engagement in diet management. Discussion and Conclusion: There was a strong desire for Chinese patients to comply with Chinese cultural norms; particularly those relating to family value. It was the patients’ power to be involved in self-management that they could devote their healthy life to family duty. Everyone had his/her own history so experiences in past shaped patients’ behaviors now. The findings highlighted the importance of understanding the family value and the personal experiences as facilitators and barriers to self-management of Chinese patients with type 2 diabetes living in community.

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