The Quebec Diabetes Empowerment Group Program: Program Description and Considerations Regarding Feasibility and Acceptability of Implementation in Primary Health Care Settings

Introduction: Diabetes is a highly prevalent chronic disease that frequently coexists with other medical conditions and implies a high burden for patients and the healthcare system. Clinicians currently are challenged to provide effective interventions that are both multidisciplinary and empower patient self-care. The Diabetes Empowerment Group Program (DEGP) was developed with the aims of fostering patient engagement in diabetes self-care through the lens of empowerment and to support the empowerment of patients with diabetes by providing multidisciplinary group-based care. This research's objectives were to: (1) develop a comprehensive description of the DEGP for potential adopters, and (2) explore the factors influencing the feasibility and acceptability of implementing it in other healthcare settings in Montreal.Methods: A qualitative descriptive study was conducted, following a participatory approach. Data were obtained from: (1) semi-structured interviews with 14 patients who participated in the pilot program; (2) from semi-structured group interviews with patient partners, healthcare professionals, and other stakeholders from 4 Montreal family medicine groups, and (3) discussions among the participatory research team during various knowledge translation activities. Inductive content analysis of the data was performed.Results: The DEGP identified seven key elements: medical visit, continuity of care, group-based dynamics, multi-disciplinarity, clinician facilitation, patient-centered agenda, and a theoretical framework of empowerment. The content and organization of the group visits were conceived to address each of these four domains. The empowerment framework comprises four domains of self-care: emotional (attitude), cognitive (knowledge), behavioral (skills), and relational (relatedness). Factors impacting the feasibility and acceptability of implementing the DEGP in other primary care settings were identified.Discussion: The DEGP fits within the discourse around the need for more patient-centered programs for people living with diabetes, following a more comprehensive empowerment model. This research could facilitate the development or adaptation of similar programs in other settings.

Download Full-text

Patient, caregiving partner, and clinician recommendations for improving heart failure care in the Veterans Health Administration

Chronic Illness ◽

10.1177/1742395320966366 ◽

2020 ◽

pp. 174239532096636

Author(s):

Cindie Slightam ◽

Rashmi Risbud ◽

Timothy C Guetterman ◽

Andrea L Nevedal ◽

Karin M Nelson ◽

...

Keyword(s):

Heart Failure ◽

Learning Style ◽

Self Care ◽

Secondary Data ◽

Veterans Health ◽

Health Administration ◽

Structured Interviews ◽

Patient Centered ◽

Heart Failure Care ◽

Centered Care

Objective Heart Failure (HF) care requires substantial care coordination between patients, patients’ informal caregivers, and clinicians, but few studies have examined recommendations from all three perspectives. The objective of this study was to understand and identify shared recommendations to improve HF self-care from the perspective of VA persons with HF, their caregiving partners, and clinicians. Methods Secondary data analysis from a study of semi-structured interviews with 16 couples (persons with HF and their caregiving partners) and 13 clinicians (physicians, nurses, other specialists) from a large Veterans Affairs (VA) hospital. Interviews were double-coded, and analyzed for themes around commonly used or recommended self-care strategies. Results Three themes emerged: (1) Couples and clinicians believe that improvements are still needed to existing HF education, especially the need to be tailored to learning style and culture, (2) Couples and clinicians believe that technology can facilitate better HF self-care, and (3) Couples and clinicians believe that caregiving partners are part of the self-care team, and should be involved in care management to support the person with HF. Discussion Recommendations from couples and clinicians address barriers to HF self-care and encourage patient-centered care.

Download Full-text

Long-Term Effects of One Year of Intensified Podiatric Activities on Foot-Care Knowledge and Self-Care Habits in Patients With Diabetes

The Diabetes Educator ◽

10.1177/014572179802400609 ◽

1998 ◽

Vol 24 (6) ◽

pp. 734-740 ◽

Cited By ~ 29

Author(s):

Helena Hämäläinen ◽

Tapani Rönnemaa ◽

Tuula Toikka ◽

Irmeli Liukkonen

Keyword(s):

Self Care ◽

Knowledge Score ◽

Care Group ◽

Control Group ◽

Prevention Measures ◽

Foot Care ◽

Long Term Effects ◽

Structured Interviews ◽

Individual Counseling ◽

Patients With Diabetes

The purpose of this study was to evaluate the effectiveness of the activities of a podiatrist in the outpatient foot care of patients with diabetes. Patients from southwestern Finland, ages 10 to 80 years, were selected from the national diabetes register. Those without a recent visit to a podiatrist and without any obvious need for foot care (n=530) were randomized into a podiatric care group (individual counseling and primary prevention measures, n=267) and a control group (written instructions only, n=263). Knowledge of foot care and self-care habits were evaluated by means of structured interviews, and a podiatric examination was performed at baseline and 1 and 7 years later. Compared with the baseline scores, the knowledge score was higher at the 7-year follow-up in both the podiatric and control group and similarly in men and women. Self-care score increased in men similarly in both treatment groups. The self-care score for women increased more in the podiatric group during the first year and the difference between the groups remained for up to 7 years. There were no significant differences between the groups in the podiatric findings.

Download Full-text

Small talk as work talk: Enacting the patient-centered approach in nurse-practitioner-patient visits

Communication & Medicine ◽

10.1558/cam.31374 ◽

2018 ◽

Vol 14 (2) ◽

pp. 97-107 ◽

Cited By ~ 2

Author(s):

Staci Defibaugh

Keyword(s):

Nurse Practitioners ◽

Nurse Practitioner ◽

Medical Visit ◽

Patient Centered ◽

Small Talk ◽

Medical Visits ◽

Relational Work ◽

The Us ◽

The Individual ◽

Patient Relationships

Small talk in medical visits has received ample attention; however, small talk that occurs at the close of a medical visit has not been explored. Small talk, with its focus on relational work, is an important aspect of medical care, particularly so considering the current focus in the US on the patient-centered approach and the desire to construct positive provider– patient relationships, which have been shown to contribute to higher patient satisfaction and better health outcomes. Therefore, even small talk that is unrelated to the transactional aspect of the medical visit in fact serves an important function. In this article, I analyze small talk exchanges between nurse practitioners (NPs) and their patients which occur after the transactional work of the visit is completed. I focus on two exchanges which highlight different interactional goals. I argue that these examples illustrate a willingness on the part of all participants to extend the visit solely for the purpose of constructing positive provider–patient relationships. Furthermore, because exchanges occur after the ‘work’ of the visit has been completed, they have the potential to construct positive relationships that extend beyond the individual visit.

Download Full-text

A patient-centered mobile intervention to promote self-management and improve patient outcomes in chronic heart failure: The ManageHF4Life trial (Preprint)

10.2196/preprints.26185 ◽

2020 ◽

Author(s):

Michael P. Dorsch ◽

Karen B. Farris ◽

Brigid E. Rowell ◽

Scott L. Hummel ◽

Todd M. Koelling

Keyword(s):

Heart Failure ◽

Mobile Application ◽

Controlled Trial ◽

Intervention Group ◽

Self Care ◽

Self Management ◽

Control Group ◽

Patient Centered ◽

Self Monitoring ◽

Heart Failure Questionnaire

BACKGROUND Successful management of heart failure (HF) involves guideline based medical therapy as well as self-care behavior. As a result, the management of HF is moving toward a proactive real-time technological model of assisting patients with monitoring and self-management. OBJECTIVE Evaluate the effectiveness of a mobile application intervention that enhances self-monitoring on health-related quality of life, self-management, and reduces HF readmissions. METHODS A single-center randomized controlled trial was performed. Patients greater than 45 years of age and admitted for acute decompensated HF or recently discharged in the past 4 weeks were included. The intervention group used a mobile application (App). The intervention prompted daily self-monitoring and promoted self-management. The control group (No App) received usual care. The primary outcome was the change in Minnesota Living with Heart Failure Questionnaire (MLHFQ) from baseline to 6 and 12 weeks. Secondary outcomes were the Self-Care Heart Failure Index (SCHFI) questionnaire and recurrent HF admissions. RESULTS Eighty-three patients were enrolled and completed all baseline assessments. Baseline characteristics were similar between groups with the exception of HF etiology. The App group had a reduced MLHFQ at 6 weeks (37.5 ± 3.5 vs. 48.2 ± 3.7, P=0.039) but not at 12 weeks (44.2 ± 4 vs. 45.9 ± 4, P=0.778) compared to No App. There was no effect of the App on the SCHFI at 6 or 12 weeks. The time to first HF admission was not statistically different between the App versus No App groups (HR 0.89, 95% CI 0.39-2.02, P=0.781) over 12 weeks. CONCLUSIONS The mobile application intervention improved MLHFQ at 6 weeks, but did not sustain its effects at 12 weeks. No effect was seen on HF self-care. Further research is needed to enhance engagement in the application for a longer period of time and to determine if the application can reduce HF admissions in a larger study. CLINICALTRIAL NCT03149510

Download Full-text

Training, Supervising, and Supporting Students With Emotional–Behavioral Disorders as Cross-Age Tutors

Intervention in School and Clinic ◽

10.1177/10534512211014834 ◽

2021 ◽

pp. 105345122110148

Author(s):

Gavin W. Watts ◽

John W. McKenna

Keyword(s):

Behavioral Disorders ◽

Special Educators ◽

Skills Training ◽

Instructional Delivery ◽

Behavioral Skills ◽

Intervention Models ◽

Effective Interventions ◽

Effective Procedures ◽

Students With Ebd

Students with emotional and behavioral disorders (EBD) are frequently on the receiving end of intervention models (e.g., social skills training) in which targeted skills are modeled and practiced in unnatural arrangements (i.e., teacher-lead). Special educators consistently report a need for effective interventions and instructional arrangements that promote social-behavioral skills of students with EBD in natural learning environments (i.e., with peers). When students with EBD are provided the opportunity to serve in the role of tutor (i.e., on the instructional delivery end of the model), increases in academic and behavioral skills have been found for both tutors and tutees. This article provides an overview of effective procedures and considerations for training, supervising, and supporting students with EBD as cross-age tutors.

Download Full-text

Closing the Loop in Computer Agent/Patient Communication

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641165 ◽

2020 ◽

Vol 64 (1) ◽

pp. 711-715

Keyword(s):

Older Adults ◽

Best Practice ◽

Self Care ◽

Effective Teacher ◽

Care Providers ◽

Conversational Agents ◽

Patient Centered ◽

Face To Face ◽

Communication Techniques ◽

Improve Instruction

While patient-centered communication supports patient self-care, providers rarely have enough time to consistently use patient- centered communication techniques. Technology has potential to support patient-centered communication, but frequently older adults prefer face-to-face communication with providers. Conversational agents (CAs) may support provider communication with older adults by emulating best practices from face-to-face communication. We investigated older adults’ response to a prototype CA communication system that served as a virtual provider and presented medication instructions using teachback, a recommended best practice that involves asking patients questions to ‘close the communication loop’. Older adults were told how to take medications by a CA who used (or did not use) teachback, and then were interviewed. Older adults were open to interacting with the CA and thought it would help support self-care. They thought the CA was a more effective teacher when using teachback and that this interactive strategy helped them remember the instructions. However, teachback did not improve instruction memory.

Download Full-text

The role of economic, educational and social resources in supporting the use of digital health technologies by people with T2D: a qualitative study

BMC Public Health ◽

10.1186/s12889-021-10325-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sophie Turnbull ◽

Patricia J. Lucas ◽

Alastair D. Hay ◽

Christie Cabral

Keyword(s):

Social Networks ◽

Social Status ◽

Digital Health ◽

Self Care ◽

Social Resources ◽

Health Interventions ◽

Structured Interviews ◽

Health Technologies ◽

Digital Skills ◽

Care Support

Abstract Background Type 2 Diabetes (T2D) is a common chronic disease, with socially patterned incidence and severity. Digital self-care interventions have the potential to reduce health disparities, by providing personalised low-cost reusable resources that can increase access to health interventions. However, if under-served groups are unable to access or use digital technologies, Digital Health Technologies (DHTs) might make no difference, or worse, exacerbate health inequity. Study aims To gain insights into how and why people with T2D access and use DHTs and how experiences vary between individuals and social groups. Methods A purposive sample of people with experience of using a DHT to help them self-care for T2D were recruited through diabetes and community groups. Semi-structured interviews were conducted in person and over the phone. Data were analysed thematically. Results A diverse sample of 21 participants were interviewed. Health care practitioners were not viewed as a good source of information about DHTs that could support T2D. Instead participants relied on their digital skills and social networks to learn about what DHTs are available and helpful. The main barriers to accessing and using DHT described by the participants were availability of DHTs from the NHS, cost and technical proficiency. However, some participants described how they were able to draw on social resources such as their social networks and social status to overcome these barriers. Participants were motivated to use DHTs because they provided self-care support, a feeling of control over T2D, and personalised advice or feedback. The selection of technology was also guided by participants’ preferences and what they valued in relation to DHTs and self-care support, and these in turn were influenced by age and gender. Conclusion This research indicates that low levels of digital skills and high cost of digital health interventions can create barriers to the access and use of DHTs to support the self-care of T2D. However, social networks and social status can be leveraged to overcome some of these challenges. If digital interventions are to decrease rather than exacerbate health inequalities, these barriers and facilitators to access and use must be considered when DHTs are developed and implemented.

Download Full-text

Reframing the Medication Experience in Pharmacy Using Seminal Concepts of Patient-Centered Care—Implications for Practice

Pharmacy ◽

10.3390/pharmacy9010009 ◽

2021 ◽

Vol 9 (1) ◽

pp. 9

Author(s):

Brian Isetts ◽

Anthony Olson ◽

Jon Schommer

Keyword(s):

Therapeutic Relationship ◽

Secondary Analysis ◽

Patient Centered Care ◽

National Sample ◽

Patient Specific ◽

Structured Interviews ◽

Patient Centeredness ◽

Patient Centered ◽

Centered Care ◽

Medication Experience

Team-based, Patient-Centered Care is essential to chronic disease prevention and management but there are differing ideas about the concept’s meaning across healthcare populations, settings and professions. This commentary’s objective is to empirically evaluate the theoretical relationships of the [a] Medication Experience, [b] Patient-Centeredness and other relevant component concepts from pharmaceutical care (i.e., [c] Therapeutic Relationship, [d] Patient-specific preferences for achieving goals of therapy and resolving drug therapy problems) so as to provide practice-based insights. This is achieved using a secondary analysis of 213 excerpts generated from in-depth semi-structured interviews with a national sample of pharmacists and patients about Patient-Centeredness in pharmacist practice. The four component concepts (i.e., a–d) related to the objective were examined and interpreted using a novel 3-archetype heuristic (i.e., Partner, Client and Customer) revealing common practice-based themes related to care preferences and expectations in collaborative goal setting, enduring relationships, value co-creation and evolving patient expectations during challenging medical circumstances. Most practice-based insights were generated within the Partner archetype, likely reflecting high congruence with pharmacist and patient responses related to the Medication Experience and Therapeutic Relationship. The practice-based insights may be especially useful for new practitioners and students accelerating their advancement in providing effective and efficient Patient-Centered Care.

Download Full-text