scholarly journals Development and Implementation of Couple-Based Collaborative Management Model of Type 2 Diabetes Mellitus for Community-Dwelling Chinese Older Adults: A Pilot Randomized Trial

2021 ◽  
Vol 9 ◽  
Author(s):  
Yuyang Liu ◽  
Xiaocun Xiao ◽  
Chaonan Peng ◽  
Tianyi Zhao ◽  
Yanjuan Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Behavior Change ◽  
Healthcare Workers ◽  
Community Dwelling ◽  
Management Model ◽  
Collaborative Management ◽  
Older Couples ◽  
Community Healthcare ◽  
Older Chinese ◽  
Community Healthcare Workers

Background: To mobilize family's positive involvement in improving and sustaining self-management activities of older adults with diabetes, we developed a couple-based collaborative management model (CCMM) for community-dwelling older Chinese.Methods: The model was developed stepwise through applying theoretical models, interviewing older couples and community healthcare workers, as well as incorporating expert reviews. A 3-month pilot study was conducted to test the model's feasibility and its treatment effects by linear regression on 18 pairs of older couples aged 60 years+, who were equally divided into a couple-based intervention arm and a patient-only control arm.Results: The developed CCMM covered four theory-driven intervention modules: dyadic assessment, dyadic education, dyadic behavior-change training, and dyadic monitoring. Each module was delivered by community healthcare workers and targeted at older couples as the management units. Based on interviews with older couples and healthcare workers, 4 weekly education and training group sessions and 2-month weekly behavior change booster calls were designed to address older adults' main management barriers. These modules and session contents were evaluated as essential and relevant by the expert panel. Furthermore, the CCMM showed good feasibility and acceptability in the pilot, with non-significant yet more positive changes in physiological outcomes of diabetic participants and couples' well-being and exercise levels of these in the intervention arm than their controlled counterparts.Conclusion: We systematically developed a couple-based collaborative management model of diabetes, which was well-received by healthcare practitioners and highly feasible among older Chinese couples living in the community. The model's treatment effects need to be verified in fully powered randomized controlled trials.Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=42964, identifier: ChiCTR1900027137.

scholarly journals Increasing Older Adult Involvement in Geriatric Assessment: A Mixed-Methods Process Evaluation

2021 ◽  
pp. 089826432199332
Author(s):  
Wanda Rietkerk ◽  
Jannet de Jonge-de Haan ◽  
Joris P. J. Slaets ◽  
Sytse U. Zuidema ◽  
Debby L. Gerritsen
Keyword(s):  
Older Adults ◽  
Behavior Change ◽  
Older Adult ◽  
Goal Setting ◽  
Geriatric Assessment ◽  
Well Being ◽  
Community Dwelling ◽  
Implementation Processes ◽  
Adult Involvement ◽  
Community Dwelling Older Adults

Objectives: Goal setting and motivational interviewing (MI) may increase well-being by promoting healthy behavior. Since we failed to show improved well-being in a proactive assessment service for community-dwelling older adults applying these techniques, we studied whether implementation processes could explain this. Methods: Goals set during the comprehensive geriatric assessment were evaluated on their potential for behavior change. MI and goal setting adherence wasassessed by reviewing audiotaped interactions and interviewing care professionals. Results: Among the 280 goals set with 230 frail older adults (mean age 77 ± 6.9 years, 59% women), more than 90% had a low potential for behavior change. Quality thresholds for MI were reached in only one of the 11 interactions. Application was hindered by the context and the limited proficiency of care professionals. Discussion: Implementation was suboptimal for goal setting and MI. This decreased the potential for improved well-being in the participating older adults.

scholarly journals Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

2021 ◽  
Vol 12 ◽  
pp. 204201882110546
Author(s):  
Patrick Ngassa Piotie ◽  
Paola Wood ◽  
Elizabeth M. Webb ◽  
Johannes F.M. Hugo ◽  
Paul Rheeder
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Healthcare Workers ◽  
Digital Health ◽  
Complex Interventions ◽  
Community Healthcare ◽  
Community Healthcare Workers ◽  
Project Intervention

Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

scholarly journals COVID-19 AND ATTITUDES OF GROUND-LEVEL PUBLIC HEALTH STAFF IN SRI LANKA

2021 ◽  
Vol 9 (5) ◽  
pp. 864-869
Author(s):  
Pavithra Harshani Warnakulasooriya ◽  
◽  
S. Mahendra Arnold ◽  
Keyword(s):  
Sri Lanka ◽  
Health Services ◽  
Healthcare Workers ◽  
Demographic Factors ◽  
Chi Square ◽  
Community Healthcare ◽  
Positive Attitudes ◽  
Regional Director ◽  
Chi Square Test ◽  
Community Healthcare Workers

Introduction: Health care workers (HCW) face considerable mental and physical stress caring for patients with Covid-19. Their attitudes towards COVID-19 are important both in the prevention as well treatment of the disease. Aims: To assess the attitudes toward coronavirus disease-2019 (COVID-19) among community healthcare workers at Regional Director of Health Services area Galle district, Sri Lanka. Settings and Design: A cross-sectional study was carried out between August 2020 and January 2021 at the Regional Director of Health Services area Galle district, Sri Lanka. Methods and Material: All community healthcare workers who were directly involved in COVID-19 in Galle district, Sri Lanka were recruited for the study, and the data was collected through a self-administered questionnaire. Descriptive analysis was done to describe the demographic factors and attitudes Chi-square test was used to assess the relationship between the level of attitude and demographic factors. Statistical analysis used: Chi-square test. Results: Of the community health workers 71%(n=84) had a positive attitude indicating a good attitude regarding the COVID-19 prevention strategies. Nearly 91%(n=107) of the population agreed to vaccination against COVID-19. There was no statistically significant association between attitude on COVID-19 with sex, age, marital status, educational level, service period, and category of occupation. Conclusions: A majority of healthcare workers had positive attitudes toward COVID-19. Additional awareness and continuous knowledge updates are required for healthcare workers to sustain positive attitudes during the pandemic.

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