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

BACKGROUND Limited English proficiency (LEP) is an important driver of health disparities. Many successful patient-level interventions to prevent chronic disease progression and complications have used automated telephone self-management support, which relies on patient activation and communication to achieve improved health outcomes. It is not clear whether these interventions are similarly applicable to patients with LEP compared to patients with English proficiency. OBJECTIVE The objectives of this study were as follows: (1) To examine the impact of LEP on patient engagement (primary outcome) with a 12-month language-concordant self-management program that included automated telephone self-management support, designed for patients with chronic kidney disease (CKD). (2) To assess the impact of LEP on change in systolic blood pressure (SBP) and albuminuria (secondary outcomes) resulting from the self-management program. METHODS This was a secondary analysis of the Kidney Awareness Registry and Education (KARE) pilot trial (NCT01530958) which was funded by the National Institutes of Health in August 2011, approved by the University of California Institutional Review Board in October 2011 (No. 11-07399), and executed between 2013 and 2015. Multivariable logistic and linear models were used to examine various facets of patient engagement with the CKD self-management support program by LEP status. Patient engagement was defined by patient’s use of educational materials, completion of a health coaching action plan, and degree of participation with automated telephone self-management support. Changes in SBP and albuminuria at 12 months by LEP status were determined using multivariable linear mixed models. RESULTS Of 137 study participants, 53 (38.7%) reported LEP, of which 45 (85%) were Spanish speaking and 8 (15%) Cantonese speaking. While patients with LEP and English proficiency similarly used the program’s educational materials (85% [17/20] vs 88% [30/34], P=.69) and completed an action plan (81% [22/27] vs 74% [35/47], P=.49), those with LEP engaged more with the automated telephone self-management support component. Average call completion was 66% among patients with LEP compared with 57% among those with English proficiency; patients with LEP requested more health coach telephone calls (P=.08) and had a significantly longer average automated call duration (3.3 [SD 1.4] min vs 2.2 [1.1 min], P<.001), indicating higher patient engagement. Patients with LEP randomized to self-management support had a larger, though nonstatistically significant (P=.74), change in SBP (–4.5 mmHg; 95% CI –9.4 to 0.3) and albuminuria (–72.4 mg/dL; 95% CI –208.9 to 64.1) compared with patients with English proficiency randomized to self-management support (–2.1 mmHg; 95% CI –8.6 to 4.3 and –11.1 mg/dL; 95% CI –166.9 to 144.7). CONCLUSIONS Patients with LEP with CKD were equally or more engaged with a language-concordant, culturally appropriate telehealth intervention compared with their English-speaking counterparts. Augmented telehealth may be useful in mitigating communication barriers among patients with LEP. CLINICALTRIAL ClinicalTrials.gov NCT01530958; https://clinicaltrials.gov/ct2/show/NCT01530958

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OP21 Effectiveness and cost-utility of a group self-management support intervention (COPERS) for people with chronic musculoskeletal pain: a randomised controlled trial

Journal of Epidemiology & Community Health ◽

10.1136/jech-2014-204726.24 ◽

2014 ◽

Vol 68 (Suppl 1) ◽

pp. A13.2-A14 ◽

Cited By ~ 1

Author(s):

S Eldridge ◽

A Spenser ◽

T Pincus ◽

A Rahman ◽

SA Bremner ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Musculoskeletal Pain ◽

Controlled Trial ◽

Cost Utility ◽

Chronic Musculoskeletal Pain ◽

Self Management ◽

Management Support ◽

Support Intervention ◽

Randomised Controlled ◽

Group Self

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A self‐management support program for older Australians with multiple chronic conditions: a randomised controlled trial

The Medical Journal of Australia ◽

10.5694/mja17.00127 ◽

2018 ◽

Vol 208 (2) ◽

pp. 69-74 ◽

Cited By ~ 5

Author(s):

Richard L Reed ◽

Leigh Roeger ◽

Sara Howard ◽

Jodie M Oliver‐Baxter ◽

Malcolm W Battersby ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Chronic Conditions ◽

Controlled Trial ◽

Support Program ◽

Self Management ◽

Multiple Chronic Conditions ◽

Management Support ◽

Randomised Controlled

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Diabetes Text-Message Self-Management Support Program (SMS4BG): A Pilot Study

JMIR mhealth and uhealth ◽

10.2196/mhealth.3988 ◽

2015 ◽

Vol 3 (1) ◽

pp. e32 ◽

Cited By ~ 41

Author(s):

Rosie Dobson ◽

Karen Carter ◽

Richard Cutfield ◽

Ashley Hulme ◽

Richard Hulme ◽

...

Keyword(s):

Pilot Study ◽

Text Message ◽

Support Program ◽

Self Management ◽

Management Support

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The Effect of Dietary and Exercise Self-Management Support Program on Dietary Behavior Exercise Behavior and Clinical Outcomes in Muslim Patients with Poorly Controlled Type 2 DM in a Community Setting in Indonesia

Nurse Media Journal of Nursing ◽

10.14710/nmjn.v5i1.10186 ◽

2015 ◽

Vol 5 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Rian Adi Pamungkas ◽

Tippamas Chinnawong ◽

Charuwan Kritpracha

Keyword(s):

Clinical Outcomes ◽

Dietary Behavior ◽

Exercise Behavior ◽

Support Program ◽

Self Management ◽

Control Group ◽

Management Support ◽

Type 2 Dm ◽

Experimental Group

Purpose: The objective of this study was to examine the effect of dietary and exercise self-management support program on the dietary behavior, exercise behavior, and clinical outcomes of Muslim patients with poorly controlled type 2 DM in Indonesia. Methods: This study was a quasi-experimental, two group, pre-test and post-test design. The experimental group received the dietary and exercise self-management support program and usual care, whereas the control group only received the usual nursing care.Result: 35 subjects in the experimental group and 35 subjects in the control group completed the program, respectively. The findings indicated that there are significantly differences in dietary behavior (p=.00), exercise behavior (p=.00) and clinical outcomes: fasting blood glucose (FBG) (p=.00), cholesterol total level (p=.01) and systolic blood pressure (p=.00) between the experimental group and control group. However, for the BMI status (p=.84) and diastolic blood pressure (BP) (p=.32) were no significant differences between two groups. Conclusion: The dietary and exercise self-management support program was effective for improving the dietary behavior, exercise behavior, FBG, and total cholesterol level for individuals with poorly controlled type 2 diabetes mellitus. Further studies should be replicated using larger groups over a longer time frame.

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Self-management interventions for Type 2 Diabetes: systematic review protocol focusing on patient workload and capacity support

Wellcome Open Research ◽

10.12688/wellcomeopenres.17238.1 ◽

2021 ◽

Vol 6 ◽

pp. 257

Author(s):

Peter Hanlon ◽

Iona Bryson ◽

Holly Morrison ◽

Qasim Rafiq ◽

Kasey Boehmer ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Hospital Admissions ◽

Macrovascular Disease ◽

Self Management ◽

Management Support ◽

Patient Capacity ◽

Management Interventions ◽

The Impact

Introduction: People living with type 2 diabetes undertake a range of tasks to manage their condition, collectively referred to as self-management. Interventions designed to support self-management vary in their content, and efficacy. This systematic review will analyse self-management interventions for type 2 diabetes drawing on theoretical models of patient workload and capacity. Methods and analysis: Five electronic databases (Medline, Embase, CENTRAL, CINAHL and PsycINFO) will be searched from inception to 27th April 2021, supplemented by citation searching and hand-searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include Population: Adults with type 2 diabetes mellitus; Intervention: Randomised controlled trials of self-management support interventions; Comparison: Usual care; Outcomes: HbA1c (primary outcome) health-related quality of life (QOL), medication adherence, self-efficacy, treatment burden, healthcare utilization (e.g. number of appointment, hospital admissions), complications of type 2 diabetes (e.g. nephropathy, retinopathy, neuropathy, macrovascular disease) and mortality; Setting: Community. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool. Interventions will be classified according to the EPOC taxonomy and the PRISMS self-management taxonomy and grouped into similar interventions for analysis. Clinical and methodological heterogeneity will be assessed within subgroups, and random effects meta-analyses performed if appropriate. Otherwise, a narrative synthesis will be performed. Interventions will be graded on their likely impact on patient workload and support for patient capacity. The impact of these theoretical constructs on study outcomes will be explored using meta-regression. Conclusion This review will provide a broad overview of self-management interventions, analysed within the cumulative complexity model theoretical framework. Analyses will explore how the workload associated with self-management, and support for patient capacity, impact on outcomes of self-management interventions. Registration number: PROSPERO CRD42021236980.

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