scholarly journals Michigan Men’s diabetes project (MenD): protocol for a peer leader diabetes self-management education and support intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaclynn Hawkins ◽  
Katherine Kloss ◽  
Martha Funnell ◽  
Robin Nwankwo ◽  
Claudia Schwenzer ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Black Men ◽  
Critical Role ◽  
Small Sample ◽  
Self Management ◽  
Developmental Phase ◽  
Peer Leaders ◽  
Management Support ◽  
Management Interventions ◽  
Peer Leader

Abstract Background Black men are more likely to be diagnosed with type 2 diabetes (T2D) compared to non-Hispanic White men, and this disparity increases among men over the age of 55. A growing body of literature demonstrates the critical role of gender in the management of health behaviors such as T2D and shows that male gender norms can conflict with healthy behaviors. These studies suggest that tailoring diabetes self-management interventions to address the needs of Black men may be critical to helping them to achieve optimal health outcomes. Further, our own research on Blacks with T2D found gender disparities in participation in diabetes interventions, with males participating at significantly lower rates than females. Peer leaders are trained lay individuals who are used to provide ongoing diabetes self-management support to people with diabetes, particularly in minority communities. However, despite studies showing that diabetes management interventions using peer leaders have been successful, the majority of peer leaders as well as the participants in those studies are women. The limited studies to date suggest that Black men with T2D prefer peer-led, male-to-male T2D programs, however, this research consists primarily of nonrandomized, small sample feasibility studies calling for additional studies to establish the efficacy of these approaches. The proposed study will develop and preliminarily validate the effectiveness of an adapted peer leader diabetes self-management support (PLDSMS) intervention designed to improve diabetes-related lifestyle and self-management behaviors in Black men (over 55) with T2D. Method We propose to tailor an existing intervention by 1) our using male peers and 2) modifying the peer leader training content to focus on material appropriate for men. The proposed study includes a developmental phase (development of the intervention with expert feedback, followed by feasibility testing with Black men) and a validation phase [randomized clinical trial (RCT)]. Discussion If successful, this study will lead to the development and dissemination of an intervention that will address the unique needs of Black men with T2D, helping them to achieve optimal diabetes self-management and health outcomes. Trial registration Registered at ClinicalTrials.gov with an ID NCT04760444 on February 17, 2021

scholarly journals Innovating the treatment of COPD exacerbations: a phone interactive telesystem to increase COPD Action Plan adherence

2019 ◽  
Vol 6 (1) ◽  
pp. e000379 ◽  
Author(s):  
Raquel Farias ◽  
Maria Sedeno ◽  
Danielle Beaucage ◽  
Isabelle Drouin ◽  
Isabelle Ouellet ◽  
...  
Keyword(s):  
Large Scale ◽  
Action Plan ◽  
Real Life ◽  
Healthcare Utilisation ◽  
Administrative Databases ◽  
Self Management ◽  
Chronic Obstructive ◽  
Management Support ◽  
Copd Exacerbations ◽  
Management Interventions

IntroductionSelf-management interventions with Written Action Plans and case management support have been shown to improve outcomes in patients with chronic obstructive pulmonary disease (COPD). Novel telehealth technologies may improve self-management interventions. The objectives of this study were to determine whether the use of an interactive phone telesystem increases Action Plan adherence, improves exacerbation recovery and reduces healthcare use in a real-life practice of a COPD clinic.MethodsInitially, 40 patients were followed by a COPD telesystem for 1 year. Detailed data from patients’ behaviours during exacerbations was recorded. The telesystem use was then extended to 256 patients from a real-life COPD clinic. Healthcare utilisation for the year before and after telesystem enrolment was then assessed through hospital administrative databases.ResultsThirty-three of the 40 patients completed the initial 1-year study. Eighty-one exacerbations were reported in the 1-year follow-up. Action Plan adherence was observed for 72% of the exacerbations and those who were adherent had a significantly faster exacerbation recovery time. The large-scale implementation of the telesystem resulted in a significant decrease in the proportion of patients with ≥1 respiratory-related emergency room (ER) visits (120 before vs 110 after enrolment, p<0.001) and with ≥1 COPD-related hospitalisations (75 before vs 65 after enrolment, p<0.001).DiscussionCOPD Written Action Plan adherence was further enhanced with the use of telehealth technologies in a specialised clinic with experience in COPD self-management. Patients followed by the telesystem recovered faster from exacerbations and had a further decrease in COPD-related ER visits and hospitalisations.Trial registration numberNCT02275078.

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

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.

scholarly journals Evidence generation for the clinical impact of myCOPD in patients with mild, moderate and newly diagnosed COPD: a randomised controlled trial

2020 ◽  
Vol 6 (4) ◽  
pp. 00460-2020
Author(s):  
Michael G. Crooks ◽  
Jack Elkes ◽  
William Storrar ◽  
Kay Roy ◽  
Mal North ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Usual Care ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Self Management ◽  
Open Label ◽  
Management Interventions ◽  
Randomised Controlled ◽  
The Impact

Self-management interventions in COPD aim to improve patients' knowledge, skills and confidence to make correct decisions, thus improving health status and outcomes. myCOPD is a web-based self-management app known to improve inhaler use and exercise capacity in individuals with more severe COPD.We explored the impact of myCOPD in patients with mild–moderate or recently diagnosed COPD through a 12-week, open-label, parallel-group, randomised controlled trial of myCOPD compared with usual care. The co-primary outcomes were between-group differences in mean COPD assessment test (CAT) score at 90 days and critical inhaler errors. Key secondary outcomes were app usage and patient activation measurement (PAM) score.Sixty patients were randomised (29 myCOPD, 31 usual care). Groups were balanced for forced expiratory volume in 1 s (FEV1 % pred) but there was baseline imbalance between groups for exacerbation frequency and CAT score. There was no significant adjusted mean difference in CAT score at study completion, −1.27 (95% CI −4.47–1.92, p=0.44) lower in myCOPD. However, an increase in app use was associated with greater CAT score improvement. The odds of ≥1 critical inhaler error was lower in the myCOPD arm (adjusted OR 0.30 (95% CI 0.09–1.06, p=0.061)). The adjusted odds ratio for being in a higher PAM level at 90 days was 1.65 (95% CI 0.46–5.85) in favour of myCOPD.The small sample size and phenotypic difference between groups limited our ability to demonstrate statistically significant evidence of benefit beyond inhaler technique. However, our findings provide important insights into associations between increased app use and clinically meaningful benefit warranting further study in real world settings.

The Effects of Self-Management Interventions on the Health Outcomes of Individuals With Chronic Kidney Disease After Critical Illness: An Integrative Review

2019 ◽  
Vol 13 (3) ◽  
pp. 126-144
Author(s):  
Claudia Leung Ho Yau ◽  
Janita Chau Pak Chun
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
English Language ◽  
Well Being ◽  
Management Program ◽  
Self Management ◽  
Management Interventions

BackgroundSelf-management is a crucial step towards achieving better physical and mental well-being and a better health-related quality of life for individuals with chronic kidney disease (CKD). Despite the high prevalence of CKD and the significant burdens faced by the individuals with CKD, their caregivers, and healthcare systems, very few studies have explored CKD and its consequences compared to other chronic diseases.ObjectiveTo synthesize and present the best available evidence on the effectiveness of CKD self-management interventions in terms of the biomedical, psychosocial, and behavioral aspects of health outcomes.MethodsThree electronic English-language literature databases were searched from inceptions to March 2018. Two reviewers independently selected articles according to pre-specified criteria, critically appraised and extracted data from relevant research. Narrative summaries were presented because the interventions and study features of the included articles were heterogeneous.ResultsOf the five included articles, three were interventional and two were systematic reviews. Effective self-management interventions have beneficial effects on biomedical outcomes such as blood pressure, psychosocial outcomes such as quality of life and self-efficacy, and behavioral outcomes such as CKD knowledge, self-management techniques, and adherence to self-care regimens and treatments.ConclusionsA self-management program that could provide better education and guidance for individuals with CKD is needed, as this would improve the provision of resources and preparations for foreseeable and avoidable CKD complications. The findings from the included articles demonstrate that limited amount of research has focused on CKD management. Additional randomized controlled trials that compare interventions with usual care are needed to determine the efficacy of CKD self-management programs.

Self-Management Support Needs From the Perspectives of Persons With Severe Mental Illness: A Systematic Review and Thematic Synthesis of Qualitative Research

2019 ◽  
Vol 26 (5) ◽  
pp. 464-482 ◽  
Author(s):  
Titus A. A. Beentjes ◽  
Betsie G. I. van Gaal ◽  
Theo van Achterberg ◽  
Peter J. J. Goossens
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Essential Element ◽  
Self Management ◽  
Support Needs ◽  
Management Support ◽  
Thematic Synthesis ◽  
Management Interventions ◽  
Important Others

BACKGROUND: The development of de-hospitalization policies in mental health has resulted in a growing emphasis on self-management. In the chronic care model, self-management support is an essential element. Because of the episodic nature of severe mental illness (SMI) and its high relapse rates, we assume that the extent of self-management support needs of individuals with an SMI is considerable. However, a clear overview of the nature of the self-management support needs of persons with SMI is missing. AIMS: This study aimed to identify self-management support needs from the perspective of individuals with SMI. METHOD: A systematic review was conducted using the method of thematic synthesis of qualitative studies. After searching the databases MEDLINE, PsycINFO, CINAHL, and EMBASE, we screened the papers for the eligibility criteria: individuals with an SMI, adequately representing the voice of persons with SMI and describing their self-management support needs. Thirty-one papers were included. RESULTS: The main findings showed that participants in the studies described the need for informational support, emotional support, acknowledgment, encouragement, and guidance to make sense of their illness experiences, ease suffering, obtain validation and recognition, execute self-management tasks, and be led through unfamiliar territory. CONCLUSION: The perspectives of persons with SMI can provide a road map for constructing a self-management support intervention for persons with SMI. Important others have an essential role in fulfilling support needs. Independently managing an SMI is difficult. Therefore, it is preferable to let important others participate in self-management interventions and to introduce peer support.

scholarly journals Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Owis Eilayyan ◽  
Aliki Thomas ◽  
Marie-Christine Hallé ◽  
Sara Ahmed ◽  
Anthony C. Tibbles ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Health Outcomes ◽  
Self Care ◽  
Theoretical Domains Framework ◽  
Action Planning ◽  
Lifestyle Changes ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Management Support ◽  
Spine Pain

Abstract Background The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS. Methods In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery. Results Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders. Conclusions Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes.

Self-efficacy in disadvantaged communities: Perspectives of healthcare providers and clients

2021 ◽  
pp. 174239532110497
Author(s):  
Ruth Hardman ◽  
Stephen Begg ◽  
Evelien Spelten
Keyword(s):  
Behaviour Change ◽  
Low Income ◽  
Self Efficacy ◽  
Resource Constraints ◽  
Outcome Expectations ◽  
Self Management ◽  
Management Support ◽  
Health Providers ◽  
Management Interventions

Objective Most chronic disease self-management interventions emphasise the integral role of self-efficacy in achieving behaviour change. We explored the applicability of this model in a low-income setting, from the perspective of both patients and clinicians. Methods Interviews with multimorbid patients and their health providers at two rural community health centres in Victoria, Australia. We used a phenomenological methodology, exploring themes of confidence to manage health, outcome expectations and goals. Results Many assumptions in which the self-efficacy model is grounded did not apply to this population. Past experiences and resource constraints, especially poverty and healthcare access, influenced confidence, expectations and the ability to achieve desired outcomes. Discussion The focus of traditional self-management support on individual behaviour change disadvantages rural low-income patients, who face barriers related to life experience and resource constraints. For this group, self-management support needs to return to its roots, moving away from a narrow conception of behaviour change and reinstating the role of ‘support’ into ‘self-management support’ interventions. Health providers working in rural low-income settings should recognise the limits inherent in self-efficacy focussed interventions and think broadly about engaging with their clients in whatever way supports them to find a life with meaning and purpose.

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