scholarly journals Implementation and Outcomes of Lay Health Worker–Led Self-Management Interventions for Long-Term Conditions and Prevention: A Systematic Review

2019 ◽  
Vol 46 (6) ◽  
pp. 1045-1072 ◽  
Author(s):  
Mari Punna ◽  
Tarja Kettunen ◽  
Anne-Marie Bagnall ◽  
Kirsti Kasila
Keyword(s):  
Physical Activity ◽  
Cardiovascular Diseases ◽  
Behavior Change ◽  
Health Worker ◽  
Self Management ◽  
Long Term Conditions ◽  
Lay Health Worker ◽  
Management Interventions ◽  
Nutrition Behavior

The aim of this study was to systematically review lay health worker (LHW)–led self-management interventions for adults with long-term conditions to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO, and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes ( n = 29), cardiovascular diseases ( n = 8), and those at risk of cardiovascular diseases ( n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of 1 day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and noneffective interventions. The review found that LHW-led interventions have potential in promoting self-management in long-term condition. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.

scholarly journals Living Well With a Long-Term Condition

2016 ◽  
Vol 27 (4) ◽  
pp. 547-558 ◽  
Author(s):  
Nicola Stenberg ◽  
Penny J. Furness
Keyword(s):  
Social Connectedness ◽  
Holistic Approach ◽  
Self Management ◽  
Theoretical Understanding ◽  
Long Term Conditions ◽  
Term Condition ◽  
Living Well ◽  
The North ◽  
Management Interventions

The outcomes of self-management interventions are commonly assessed using quantitative measurement tools, and few studies ask people with long-term conditions to explain, in their own words, what aspects of the intervention they valued. In this Grounded Theory study, a Health Trainers service in the north of England was evaluated based on interviews with eight service-users. Open, focused, and theoretical coding led to the development of a preliminary model explaining participants’ experiences and perceived impact of the service. The model reflects the findings that living well with a long-term condition encompassed social connectedness, changed identities, acceptance, and self-care. Health trainers performed four related roles that were perceived to contribute to these outcomes: conceptualizer, connector, coach, and champion. The evaluation contributes a grounded theoretical understanding of a personalized self-management intervention that emphasizes the benefits of a holistic approach to enable cognitive, behavioral, emotional, and social adjustments.

scholarly journals Physical Inactivity, Self-Management, and Living Well With COPD

2017 ◽  
Vol 11 (4) ◽  
pp. 303-306
Author(s):  
David B. Coultas
Keyword(s):  
Physical Activity ◽  
Behavior Change ◽  
Physical Inactivity ◽  
Self Management ◽  
Chronic Obstructive ◽  
Short Term ◽  
Optimal Method ◽  
Obstructive Pulmonary Disease ◽  
Specific Patient

Physical inactivity is an underrecognized and undertreated lifestyle behavior among patients with chronic obstructive pulmonary disease and is independently associated with a number of adverse health-related outcomes. Pulmonary rehabilitation with exercise training provides an efficacious intervention with short-term improvements, but it is an infrequently used modality and does not consistently result in longer term increases in physical activity. Similarly, pedometer self-monitoring with coaching has demonstrated short-term increases in physical activity. However, further research is needed to determine the optimal method to support long-term behavior change that will have the greatest benefit. While available evidence suggests that reversing physical inactivity is an essential component of self-management to optimize health, it is only one component of a complex set of interventions needed to support patients in adapting to their chronic condition. In the future, this support will ideally start with identification of specific patient phenotypes, which describes their adaptation to the condition based on patients’ knowledge, skills, confidence, symptoms, and impairments. This information will then be used to tailor education and behavior change strategies over the long term to promote sustainable physical activity and other healthy lifestyles.

scholarly journals A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

2015 ◽  
Vol 3 (34) ◽  
pp. 1-302 ◽  
Author(s):  
Paul Galdas ◽  
Zoe Darwin ◽  
Jennifer Fell ◽  
Lisa Kidd ◽  
Peter Bower ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Meta Analysis ◽  
Self Management ◽  
Management Support ◽  
Quality Appraisal ◽  
Long Term Conditions ◽  
Quantitative Review ◽  
Qualitative Review

BackgroundSelf-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs).ObjectivesTo assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs.MethodsA quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis.Data sourcesIn the quantitative review, 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 gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013.Review methodsIn the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis.ResultsForty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men.ConclusionsHealth professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.Study registrationThis study is registered as PROSPERO CRD42013005394.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals SELF-MANAGEMENT IN PERSONS WITH LIMB LOSS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Daniel J Lee ◽  
Theresa Repole ◽  
Emily Taussig ◽  
Stephanie Edwards ◽  
Jamie Misegades ◽  
...  
Keyword(s):  
Systematic Review ◽  
Limb Loss ◽  
Self Management ◽  
Residual Limb ◽  
Secondary Complications ◽  
Long Term Conditions ◽  
Prosthetic Socket ◽  
Management Interventions ◽  
Skin Breakdown

BACKGROUND: Self-management is an integral component of managing long-term conditions and diseases. For a person with limb loss, this self-management process involves caring for the residual limb, the prosthesis, and the prosthetic socket-residual limb interface. Failure to properly self-manage can result in unwanted secondary complications such as skin breakdown, falls, or non-use of the prosthesis. However, there is little evidence on what self-management interventions are effective at preventing secondary complications. To understand the impact of self-management after the loss of a limb, it is necessary to determine what the current evidence base supports. OBJECTIVE(S): The purpose of this study is to examine the available literature on self-management interventions and/or outcomes for persons with limb loss and describe how it may impact residual limb health or prosthesis use. METHODOLOGY: A systematic review of multiple databases was carried out using a variety of search terms associated with self-management. The results were reviewed and selected based on the inclusion criteria: self-management interventions or direct outcomes related to self-management, which includes the skin integrity of the residual limb, problem-solving the fit of the prosthesis, and education in the prevention of secondary complications associated with prosthesis use. The Cincinnati Childrens’ LEGEND (Let Evidence Guide Every New Decision) appraisal forms were used to analyze the articles and assign grades. FINDINGS: Out of the 40 articles identified for possible inclusion in this study, 33 were excluded resulting in seven articles being selected for this review. Three out of the seven articles focused on silicone liner management while the other four articles focused on skin issues. CONCLUSION: Self-management for a person with limb loss is a key component of preventing complications associated with loss of limb and prosthesis use. There is a lack of high-quality experimental studies exploring the most appropriate intervention for teaching self-management when compared to other conditions, specifically diabetes. Further research in the area of self-management is necessary to understand how to best prevent unwanted secondary complications. Layman's Abstract Self-management is an integral component of managing long-term conditions and diseases. Self-management for a person with limb loss involves performing proper hygiene of the residual limb, caring for the prosthesis, and problem-solving the fit between the prosthetic socket and the residual limb. If a person with limb loss fails to correctly self-manage, they may be exposing themselves to the risk of skin breakdown or injury. Other medical diagnoses like diabetes emphasize self-management in the care of persons with the condition and have established a large body of knowledge surrounding this element of lifestyle adaption. However, in the case of limb loss, there is very little evidence to support how self-management is taught or performed. Therefore, the purpose of this study was to explore the body of literature surrounding self-management in persons with limb loss. The results indicate that there is very little evidence supporting self-management related interventions and that further research is required in this area. With the addition of further research, clinical practice can be improved and self-management interventions can become standardized across the spectrum of care, much like in diabetes care. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/35098/27909 How To Cite: Lee DJ, Repole T, Taussig E, Edwards S, Misegades J, Guerra J, Lisle A. Self-management in persons with limb loss: A systematic review. Canadian Prosthetics & Orthotics Journal. 2021;Volume 4, Issue 1, No.5. https://doi.org/10.33137/cpoj.v4i1.35098 Corresponding Author: Daniel J. Lee, PT, PhD, DPT, GCS, COMTTouro College, Department of Physical Therapy, Bayshore, NY USA.Email:[email protected] ORCID: https://orcid.org/0000-0003-1805-2936  

scholarly journals Self-Management Interventions in Patients with Long-Term Conditions: A Structured Review of Approaches to Reporting Inclusion, Assessment, and Outcomes in Multimorbidity

2014 ◽  
Vol 4 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Cassandra Kenning ◽  
Peter A. Coventry ◽  
Peter Bower
Keyword(s):  
Rapid Development ◽  
Healthcare Delivery ◽  
Self Management ◽  
Chronic Obstructive ◽  
Long Term Conditions ◽  
Management Interventions ◽  
Cochrane Reviews ◽  
Secondary Analyses ◽  
The Impact

Background Multimorbidity has many potential implications for healthcare delivery, but a particularly important impact concerns the validity of trial evidence underpinning clinical guidelines for individual conditions. Objective To review how authors of published trials of self-management interventions reported inclusion criteria, sample descriptions, and consideration of the impact of multimorbidity on trial outcomes. Methods We restricted our analysis to a small number of exemplar long-term conditions: type 2 diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. We focussed our search on published Cochrane reviews. Data were extracted from the trials on inclusion/exclusion, sample description, and impact on outcomes. Results Eleven reviews consisting of 164 unique trials were identified. Sixty percent of trials reported excluding patients with forms of multimorbidity. Reasons for exclusion were poorly described or defined. Reporting of multimorbidity within the trials was poor, with only 35% of trials reporting on multimorbidity in their patient samples. Secondary analyses, exploring the impact of multimorbidity, were very rare. Conclusions The importance of multimorbidity in trials is only going to become more important over time, but trials often exclude patients with multimorbidity, and reporting of multimorbidity in trials including such patients is generally poor. This limits judgements about the external validity of the results for clinical populations. A consistent approach to the conduct and reporting of secondary analyses of the effects of multimorbidity on outcomes, using current best-practice guidance, could lead to a rapid development of the evidence base.

scholarly journals Health Behavior Change Processes Among Adults With Serious Mental Illness Engaged in Illness Self-Management

2021 ◽  
pp. 104973232199204
Author(s):  
Anjana Muralidharan ◽  
Amanda Peeples ◽  
Alicia Lucksted
Keyword(s):  
Mental Illness ◽  
Health Behavior ◽  
Behavior Change ◽  
Serious Mental Illness ◽  
Cognitive Theory ◽  
Self Regulation ◽  
Health Behavior Change ◽  
Self Management ◽  
Living Well ◽  
Management Interventions

Self-management interventions promote illness management among adults with chronic health conditions. Little is known regarding the processes by which these interventions have their effects. The present study examined how Living Well, an effective self-management intervention for adults with serious mental illness, led to health behavior change in a randomized controlled trial. A convenience subset ( N = 15) of participants completed qualitative interviews regarding the feasibility/acceptability of Living Well. An inductive secondary qualitative analysis, using a combination of interpretive phenomenological and social constructivist approaches, was conducted to examine processes of change. Results indicate that Living Well provided information and knowledge, opportunities for learning from others and real-world practice, and an interpersonally supportive environment. These active ingredients led to enhanced self-awareness, confidence, sense of control, and behavior and health status changes among participants. These findings are considered in the context of prominent behavior change theories such as social cognitive theory and self-regulation.

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