Active Role In Self-management Research Articles

P50 Exploring unmet needs and attitudes to skin self-examination in melanoma survivors: EUNASS study

Abstract A melanoma diagnosis can have significant emotional and psychosocial impact, yet little guidance exists on how best to support individuals following initial diagnosis. This multicentre UK study aimed to evaluate the baseline needs of melanoma survivors and assess attitudes towards practising skin self-examination (SSE) to inform the development of intervention(s) that best support patients with melanoma beyond diagnosis. A prospective multicentre questionnaire study was conducted across four UK sites, including adults diagnosed with American Joint Cancer Committee (AJCC version 8) stage I–III primary cutaneous melanoma. Participants were invited within 3–12 months of their initial diagnosis to self-complete an electronic questionnaire (using Qualtrics software) evaluating unmet needs, which included the Functional Assessment of Cancer Therapy—Melanoma (FACT-M), Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), Melanoma specific unmet needs (SF-36), Sun Protection Behaviour Scale (SPBS), Skin Self-Examination (SSE) benefits and barriers scale, and European Quality of Life 5 Dimensions (EQ-5D). STATA 17 was used for the data analysis. Overall, 252 participants were recruited and 55 excluded for failure to provide any responses. The sample was predominantly male (56.3%) and White (100%), with high educational qualifications (52.1%) and not in paid/self-employment (53.2%). Sites of primary melanoma included the trunk (n = 61; 31.0%), head/neck (n = 45; 22.8%), arm (n = 44; 22.3%), leg (n = 33; 16.8%), hands/feet (n = 10; 5.1%) and genitals (n < 5; < 2.5%). SSE barrier and benefit scales had median scores of 29 [interquartile range (IQR) 27–32] and 27 (IQR 22–32), respectively, indicating positive attitudes towards SSE; however, several barriers exist, including identifying abnormal moles and associated anxiety. The majority of participants (56.4%) were identified as having at least one unmet care need, most commonly with regard to information on recurrence risk (37.1%) and SSE (33.0%). The FACT-M, FACT-M trial outcome index and FACT-G (general) had median scores of 26 (IQR 12–38; n = 180), 16 (IQR 6–22, n = 183) and 21 (IQR 8–29; n = 180), respectively. Participants had a median EQ-5D score of 0.92 [IQR 0.86–1.0; full health = 1.0 (n = 189)] and 59.9% were identified as having less than full health. This multicentre UK study indicates that melanoma survivors experience low quality of life within the first year of their diagnosis. Routine collection of melanoma-specific patient-reported outcome measures could improve the patient experience by stratifying patients to receive appropriate supportive care. Focused educational tools guiding sun protection habits and SSE are needed to reduce the risk of further melanomas. Future qualitative data will support an evidence base to develop supportive tools, enabling patients to take an active role in self-management.

DS09 (P50) Exploring Unmet Needs and Attitudes to Skin ­Self-examination in melanoma survivors: EUNASS study

Abstract A melanoma diagnosis can have significant emotional and psychosocial impact, yet little guidance exists on how best to support individuals following initial diagnosis. This multicentre UK study aimed to evaluate the baseline needs of melanoma survivors and assess attitudes towards practising skin self-examination (SSE) to inform the development of intervention(s) that best support patients with melanoma beyond diagnosis. A prospective multicentre questionnaire study was conducted across four UK sites, including adults diagnosed with American Joint Cancer Committee (AJCC version 8) stage I–III primary cutaneous melanoma. Participants were invited within 3–12 months of their initial diagnosis to self-complete an electronic questionnaire (using Qualtrics software) evaluating unmet needs, which included the Functional Assessment of Cancer Therapy—Melanoma (FACT-M), Fear of Cancer Recurrence Inventory—Short Form (FCRI-SF), Melanoma-specific unmet needs (SF-36), Sun Protection Behaviour Scale (SPBS), Skin Self-Examination (SSE) benefits and barriers scale and European Quality of Life 5 Dimensions (EQ-5D). STATA 17 was used for the data analysis. Overall, 252 participants were recruited and 55 excluded for failure to provide any responses. The sample was predominantly male (56.3%) and White (100%), with high educational qualifications (52.1%) and not in paid/self-employment (53.2%). Sites of primary melanoma included the trunk (n = 61; 31.0%), head/neck (n = 45; 22.8%), arm (n = 44; 22.3%), leg (n = 33; 16.8%), hands/feet (n = 10; 5.1%) and genitals (n < 5; < 2.5%). Skin self-examination barriers and benefits scales had median scores of 29 [interquartile range (IQR) 27–32] and 27 (IQR 22–32), respectively, indicating positive attitudes towards SSE; however, several barriers exist, including identifying abnormal moles and associated anxiety. The majority of participants (56.4%) identified as having at least one unmet care need, most commonly with regard to information on recurrence risk (37.1%) and SSE (33.0%). The FACT-M, FACT-M trial outcome index and FACT-G (general) had median scores of 26 (IQR 12–38; n = 180), 16 (IQR 6–22, n = 183) and 21 (IQR 8–29; n = 180), respectively. Participants had a median EQ-5D score of 0.92 [IQR 0.86–1.0; full health = 1.0 (n = 189)], and 59.9% were identified as having less than full health. This multicentre UK study indicates that melanoma survivors experience low quality of life within the first year of their diagnosis. Routine collection of melanoma-specific patient-reported outcome measures could improve the patient experience by stratifying patients to receive appropriate supportive care. Focused educational tools guiding sun protection habits and SSE are needed to reduce the risk of further melanomas. Future qualitative data will support an evidence base to develop supportive tools, enabling patients to take an active role in self-management.

Perceptions of Finns with chronic diseases about factors affecting their eHealth literacy: A qualitative interview study.

This study aims to describe the factors related to the individual, the system and their interaction, which can affect eHealth literacy from the perspective of people living with one or multiple chronic diseases. As digital solutions are increasingly used in healthcare, perspectives of patients with chronic diseases must be considered. The study design was a qualitative, descriptive interview study, gathering the insights of people living in Finland with chronic disease. The individual semi-structured interviews (n = 17) were conducted via telephone. The eHealth Literacy Framework was used in the data analysis, with a deductive-inductive approach. The range of skills included in the eHealth Literacy Framework was widely applied by participants who described themselves as adept at using eHealth environments to manage health-related needs. The participants evaluated online information and took an active role in self-management of their chronic disease. Most importantly, even participants possessing many of the skills in the eHealth Literacy Framework experienced difficulties in using eHealth environments, and the accessibility of eHealth environments was highlighted. eHealth environments could be useful for health promotion and self-management for people with chronic diseases, but only presuming the environments are adapted to their level of eHealth literacy skills.

User testing of a Scottish Intercollegiate Guideline Network public guideline for the parents of children with autism

BackgroundThe Scottish Intercollegiate Guidelines Network (SIGN) is the leading national clinical guideline producer in Scotland. Improved design and dissemination of guidelines produced for the public can empower people to take an active role in self-management and shared decision-making. The public version of the guideline examined covered getting assessed and diagnosed with autism, and approaches that can help. The aim of this study was to test a public version of a guideline for the parents of children and young people with autism, implement improvements, and identify what works in making it usable and accessible.MethodsWe recruited mothers from across Scotland. User testing involved formal ‘think aloud’ semi-structured interviews that guided users through the booklet. Interviews took place individually and were recorded and transcribed. Key findings were identified and themed using the honeycomb user experience model.ResultsFourteen user-testing interviews were conducted. Facilitators for usability and desirability of the guideline included the chunking of text, consistent use of colour and boxes to highlight important information. Simple language, written in a tone of partnership, helped to engage mothers. Value arose from the guidelines ability to explain the process of diagnosis and make mothers feel empowered in their relationships with healthcare professionals. There was a lack of consensus on the usefulness of rating the strength of evidence and recommendations.ConclusionThere was a marked similarity between what was important to the mothers and what has been found to be important to other groups. The involvement of service users and carers in the guidelines development was key to its credibility. One size does not fit all in presenting evidence-based recommendations to the public and it is a challenge to provide sufficient information while avoiding information overload. Recommendations and evidence levels are suitable for use in public versions, but these should be kept as simple as possible.

Peer Support for People Living With HIV: A Scoping Review.

Peer support for people living with HIV has gained increasing traction and is considered a way to take an active role in self-management. The existing research examining peer support interventions has reported promising evidence of the benefits of peer support. The purpose of our scoping review was to describe research on peer support for people living with HIV. We included 53 studies and sorted them into analytic categories and conducted descriptive analyses. The studies that were published between November/December 2000 and May 2021, had a range of study designs and heterogeneous priority groups, and included 20,657 participants from 16 countries. We identified 43 evaluations of the effect of peer support and 10 evaluations of implementation, process, feasibility, cost of peer support. We also categorized peer support by key functions, finding that the most common key functions were linkage to clinical care and community resources and assistance in daily management, with only one study directly related to chronic care. There is growing research interest in peer support for people living with HIV, particularly in high-income countries and related to the evaluation of effects. The revealed gaps of prioritized functions of peer support have implications for further research. Further focus on interventions addressing secondary prevention related to noncommunicable diseases as part of a care package is recommended to meet people's needs and preferences and increase self-management related to a chronic lifelong condition.

The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis.

The practice of involving people living with HIV in the development and provision of healthcare has gained increasing traction. Peer-support for people living with HIV is assistance and encouragement by an individual considered equal, in taking an active role in self-management of their chronic health condition. The objective of this systematic review was to assess the effects of peer-support for people living with HIV. We conducted a systematic review in accordance with international guidelines. Following systematic searches of eight databases until May 2020, two reviewers performed independent screening of studies according to preset inclusion criteria. We conducted risk of bias assessments and meta-analyses of the available evidence in randomised controlled trials (RCTs). The certainty of the evidence for each primary outcome was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system. After screening 219 full texts we included 20 RCTs comprising 7605 participants at baseline from nine different countries. The studies generally had low risk of bias. Main outcomes with high certainty of evidence showed modest, but superior retention in care (Risk Ratio [RR] 1.07; Confidence Interval [CI] 95% 1.02-1.12 at 12 months follow-up), antiretroviral therapy (ART) adherence (RR 1.06; CI 95% 1.01-1.10 at 3 months follow-up), and viral suppression (Odds Ratio up to 6.24; CI 95% 1.28-30.5 at 6 months follow-up) for peer-support participants. The results showed that the current state of evidence for most other main outcomes (ART initiation, CD4 cell count, quality of life, mental health) was promising, but too uncertain for firm conclusions. Overall, peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It is a feasible and effective approach for linking and retaining people living with HIV to HIV care, which can help shoulder existing services. CRD42020173433.

Patients’ Journey Toward Engagement in Self-Management of Diabetic Foot Ulcer in Adults With Types 1 and 2 Diabetes: A Constructivist Grounded Theory Study

ObjectivesOur aim in this study was to develop the first theory that could explain the processes of engagement in self-management for adults with diabetic foot ulcer (DFU). MethodsA constructivist grounded theory, informed by Charmaz, and symbolic interactionism were used to guide the study design. ResultsThe findings from 30 study participants with active DFU draw attention to the complexity that exists for individuals seeking to balance life and manage their diabetes and DFU. The categories/phases and set of associated concepts comprise the theory known as The Journey Toward Engagement in Self-Management. This theory consists of 5 phases: 1) perception of illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about self-management and 5) engaging in self-management. The theory’s phases describe the processes of engagement in self-management from participants’ unique experience of living and managing DFU. ConclusionsThe results show the pathways taken by participants to learn about self-management practices and how engagement in day-to-day management of DFU occurred. Engagement in self-management of an active DFU is complex and a developmental process that differs from participant to participant and changes over time. Although most participants preferred to take a more passive role in self-management of DFU (seen in phase 4), others demonstrated confidence to advance to another stage (seen in phase 5). At the advanced stage, they took an active role in self-management by expressing their needs and preferences, and were involved in their own care and decision-making related to treatment options.

Predicting antecedents of wearable healthcare technology acceptance by elderly: A combined SEM-Neural Network approach

Wearable healthcare technology (WHT) has the potential to improve access to healthcare information especially to the older population and empower them to play an active role in self-management of their health. Despite their potential benefits, the acceptance and usage of WHT among the elderly are considerably low. However, little research has been conducted to describe any systematic study of the elderly's intention to adopt WHT. The objective of this study was to develop a theoretical model on the basis of extended Unified Theory of Acceptance and Use of Technology (UTAUT2) with additional constructs- resistance to change, technology anxiety, and self-actualization, to investigate the key predictors of WHT adoption by elderly. The model used in the current study was analyzed in two steps. In the first step, a Structural Equation Modeling (SEM) was used to determine significant determinants that affect the adoption of WHT. In the second step, a neural network model was applied to validate the findings in step 1 and establish the relative importance of each determinant to the adoption of WHT. The findings revealed that social influence, performance expectancy, functional congruence, self-actualization, and hedonic motivation had a positive relationship with the adoption of WHT. In addition, technology anxiety and resistance to change posed important but negative influences on WHT acceptance. Surprisingly, the study did not find any significant relationship between effort expectancy and facilitating conditions with behavioral intention to use WHT by the elderly. The results of this research have strong theoretical contributions to the existing literature of WHT. It also provides valuable information for WHT developers and social planners in the design and execution of WHT for the elderly.

Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions.

Engaging chronic obstructive pulmonary disease (COPD) patients to actively participate in self-management has proven difficult. Digital health technology (DHT) promises to facilitate a patient-centred care model for the management of COPD by empowering patients to self-manage effectively. However, digital health studies in COPD have yet to demonstrate significant patient outcomes, suggesting that this research has still to adequately address the needs of patients in the intervention development process. The current study explored COPD patients' perceptions of the potential benefits of DHT in the self-management and treatment of their disease.A sample of convenience was chosen and participants (n=30) were recruited from two Dublin university hospitals and each underwent a qualitative semi-structured interview. Thematic analysis of the data was completed using NVivo 12 software.Six themes were identified: symptom management, anxiety management, interaction with physician, care management, personalising care and preventative intervention.In our findings, patients reported a willingness to take a more active role in self-management using DHT. They perceived DHT potentially enhancing their self-management by improving self-efficacy and engagement and by supporting healthcare professionals to practise preventative care provision. The findings can be used to inform patient-centred COPD digital interventions for researchers and clinicians who wish to develop study aims that align with the needs and preferences of patients.

Spanish-Speaking Hispanic Patients' Information-Sharing Preferences During Hospitalization: An Exploratory Pilot Study.

BackgroundSelf-management of chronic conditions, such as cancer or diabetes, requires the coordination of care across multiple care settings. Current patient-centered, hospital-based care initiatives, including bedside nursing handoff and multidisciplinary rounds, often focus on provider information exchange and roles but fall short of the goals of participatory medicine, which recognize the right of patients to partner in their own care and play an active role in self-management.ObjectiveThis study aimed to elicit Spanish-speaking Hispanic patients’ perspectives on the exchange and sharing of information during hospitalization.MethodsThis exploratory pilot study incorporated a qualitative descriptive approach by using Spanish language focus groups, posthospitalization, to determine patient-identified information needs during hospitalization.ResultsParticipants preferred paper-based Spanish language medical information. Doctors and nurses were key information providers and communicated with participants verbally, usually with the assistance of a translator. Participants expressed a desire to be informed about medication and treatments, including side effects and why there were changes in medication during hospitalization. In addition, they expressed interest in knowing about the progress of their condition and when they could expect to go home. Emotional readiness to receive information about their condition and prognosis was identified as an individual barrier to asking questions and seeking additional information about their condition(s).ConclusionsOverall, participants shared positive experiences with providers during hospitalization and the usefulness of self-care instructions. Language was not recognized as a barrier by any of the participants. Nevertheless, future research on the influence of emotional readiness on the timing of medical information is needed.

Self-management challenges and support needs among kidney transplant recipients: A qualitative study.

This study investigated self-management challenges and support needs experienced by kidney transplant recipients. After kidney transplantation, recipients are expected to take an active role in self-management. However, evidence suggests that nurses experience difficulties operationalizing self-management support. Greater insight into the recipients' perspective could help to improve the adequacy and efficacy of nurse-led self-management support. A cross-sectional qualitative study. Focus groups and individual interviews were carried out with kidney transplant recipients treated in a Dutch university hospital. Directed content analysis (DCA) was used. Forty-one kidney transplant recipients participated. Challenges after transplantation included becoming an expert patient, adjusting daily life activities, dealing with medical regimen, forming relationships with nurses, dealing with social consequences, dealing with emotions related to transplantation and the donor and improving self-image. To be able to deal with these challenges, participants wished to receive disease specific knowledge and instruction, share personal experiences with fellow patients, share and discuss not only medical but also emotional and social issues with nurses and wanted to be encouraged through positive feedback. "One-size fits all" education was considered insufficient in meeting their needs. After kidney transplantation, recipients experienced various challenges in dealing with the medical, emotional and social tasks. Current support from nurses overlooked recipients' emotional and social support needs. Nurses need adequate tools and training to be able to meet recipients' self-management support needs.

The Chronic Knee Pain Program: A self-management model

BackgroundIt is vital that patients take an active role in self-management of their chronic knee pain condition. The Chronic Knee Pain Program was developed to assist patients in managing their chronic condition and to improve their overall well-being. PurposeThe purpose of this pilot study was to determine the feasibility of a six-week self-management program and to explore whether it may assist in decreasing body mass index (BMI) and depression symptom severity and increase physical activity levels in obese adults with chronic knee pain. DesignA one group, pre-test/post-test pilot study. SettingA pain management clinic in the northeastern United States. SampleConvenience sample of twelve adult patients with chronic knee pain and a BMI of 30 or greater were recruited, however, six participants completed the full program. ResultsThis type of intervention has potential value to improve the lifestyles of those individuals with chronic knee pain, including improvements in BMI, depression symptom severity and physical activity levels. In this study there was a decrease in mean BMI overtime; 41.2 (at week 1), 40.8 (at week 6), and 40.7 (at week 10). ConclusionsThe Chronic Knee Pain Program had a small sample size and high attrition rate, though yielded positive outcomes for some participants. Future research could focus on depression management, using conservative measures to help manage pain, and increasing pain coping skills. Implementing this program with a larger sample size is recommended to see if BMI, depression symptom severity and physical activity levels reach statistical significance.

What support is needed to self-manage a rheumatic disorder: a qualitative study

BackgroundToday, patients are expected to take an active role in the form of self-management. Given the burden of a rheumatic disorder, the patients cannot be expected to self-manage on their own. In order to develop self-management interventions that fit patients’ needs and preferences, it is essential to examine patients’ perspective on how support can be optimized. This study aimed to identify support needs of outpatients with rheumatic disorders and preferences for who should provide self-management support.MethodsA qualitative study was conducted using focus groups and individual interviews with outpatients with rheumatic disorders treated in a Dutch university hospital. Interview data was analysed with Directed Content Analysis and coded with predetermined codes derived from our model about support needs of chronically ill patients. This model distinguished three types of support: instrumental, psychosocial and relational support.ResultsFourteen patients participated in two focus group interviews and six were interviewed individually. Most patients preferred an active role in self-management. Nonetheless, they notably needed support in developing skills for self-managing their rheumatic disorder in daily life. The extent of support needs was influenced by disease stage, presence of symptoms and changes in one’s situation. A trusted relationship and partnership were conditional for receiving any kind of professional support. Patients wanted to be seen as experienced experts of living with a rheumatic disorder. Acquiring specific disease-related knowledge, learning how to deal with symptoms and fluctuations, talking about emotional aspects, and discussing daily life issues and disease-related information were identified as important elements of self-management support. It was considered crucial that support be tailored to individual needs and expertise. Professionals and relatives were preferred as support givers. Few patients desired support from fellow patients.ConclusionSelf-management was primarily seen as patient’s own task. Above all, patients wanted to be seen as the experienced experts. Professionals’ self-management support should be focused on coaching patients in developing problem-solving skills, for which practical tools and training are needed.

A qualitative study of the experiences of care and motivation for effective self-management among diabetic and hypertensive patients attending public sector primary health care services in South Africa.

BackgroundDiabetes and hypertension constitute a significant and growing burden of disease in South Africa. Presently, few patients are achieving adequate levels of control. In an effort to improve outcomes, the Department of Health is proposing a shift to a patient-centred model of chronic care, which empowers patients to play an active role in self-management by enhancing their knowledge, motivation and skills. The aim of this study was to explore patients’ current experiences of chronic care, as well as their motivation and capacity for self-management and lifestyle change.MethodsThe study involved 22 individual, qualitative interviews with a purposive sample of hypertensive and diabetic patients attending three public sector community health centres in Cape Town. Participants were a mix of Xhosa and Afrikaans speaking patients and were of low socio-economic status.ResultsThe concepts of relatedness, competency and autonomy from Self Determination Theory proved valuable in exploring patients’ perspectives on what a patient-centred model of care may mean and what they needed from their healthcare providers. Overall, the findings of this study indicate that patients experience multiple impediments to effective self-management and behaviour change, including poor health literacy, a lack of self-efficacy and perceived social support. With some exceptions, the majority of patients reported not having received adequate information; counselling or autonomy support from their healthcare providers. Their experiences suggests that the current approach to chronic care largely fails to meet patients’ motivation needs, leaving many of them feeling anxious about their state of health and frustrated with the quality of their care.ConclusionsIn accordance with other similar studies, most of the hypertensive and diabetic patients interviewed for this study were found to be ill equipped to play an active and empowered role in self-care. It was clear that patients desire greater assistance and support from their healthcare providers. In order to enable healthcare providers in South Africa to adopt a more patient-centred approach and to better assist and motivate patients to become effective partners in their care, training, resources and tools are needed. In addition, providers need to be supported by policy and organisational change.

Smartphone application for rheumatoid arthritis self-management: cross-sectional study revealed the usefulness, willingness to use and patients' needs.

Patient-centered smartphone applications have potential to support rheumatoid arthritis (RA) self-management but remain almost unexplored in literature. Therefore, this study evaluated the usefulness of a smartphone application to support RA self-management, the willingness of RA patients to use and pay for it and the features the application should have. In this cross-sectional study, a questionnaire was developed to collect information on population, device ownership, usefulness and willingness to use and pay for a RA self-management application and application features. Descriptive statistics, Chi-square, Fisher's exact test, t test or Mann-Whitney's test and multivariate analysis were used. One hundred RA patients answered the questionnaire. Patients' mean age was 57±11.9years, most were females (91%), with multiple drug regimens and a 40% treatment non-compliance rate. Most patients believed that could have a more active role in self-management (94%) and reported it would be useful to develop a RA self-management application (86%). Patients willing to use an application (83%) were younger, with a possible more active role in self-management, with access to a smartphone, and using short message service, electronic mail and Internet. Multivariate analysis confirmed these results, except the associations regarding access to a smartphone and use of electronic mail and Internet. Fifty-eight patients (82%) were willing to pay for a RA self-management application and the most requested feature for it was information in a simple format. This study suggested the usefulness and patients' willingness to use and pay for a RA self-management application and provided insight on patients' needs.

Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation

ObjectivesTo assess the effect of telecare on health related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals.MethodsPatients were randomly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station. Patients had congestive heart failure (Site A), chronic obstructive pulmonary disease (Site B), or any long-term condition, mostly diabetes (Site C). Site C contributed only intervention patients – they considered a usual care option to be unethical. The study took place in New Zealand between September 2010 and February 2012, and lasted 3 to 6 months for each patient. The primary outcome was health-related quality of life (SF36). Data on experiences were collected by individual and group interviews and by questionnaire.ResultsThere were 171 patients (98 intervention, 73 control). Quality of life, self-efficacy and disease-specific measures did not change significantly, while anxiety and depression both decreased significantly with the intervention. Hospital admissions, days in hospital, emergency department visits, outpatient visits and costs did not differ significantly between the groups. Patients at all sites were universally positive. Many felt safer and more cared-for, and said that they and their family had learned more about managing their condition. Staff could all see potential benefits of telecare, and, after some initial technical problems, many staff felt that telecare enabled them to effectively monitor more patients.ConclusionsStrongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes. Telecare led to patients and families taking a more active role in self-management. It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data, especially feelings of safety and being cared-for.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610000269033

The Use of Motivational Interviewing in Physical Therapy Education and Practice: Empowering Patients Through Effective Self-Management

BACKGROUND AND PURPOSEIn 2012, the United States Department of Health and Human Services outlined a list of public health priorities related to cardiovascular, pulmonary, musculoskeletal, neuromuscular, integumentary, and metabolic health. This document, known as Healthy People 2020, focuses on health conditions including heart disease and stroke, respiratory disease, arthritis, osteoporosis and chronic back conditions, diabetes, and chronic kidney disease.1 As specialists in human movement and exercise, these issues are particularly pertinent to physical therapists (PTs) and physical therapist assistants (PTAs), on account of limited physical activity being a common risk factor in the development of each of these health conditions.2,3 Sedentary behaviors are inherently linked to a significant burden of chronic disease and disability, as well as diminished health-related quality of life. The lack of appropriate levels of physical activity results in at least 300,000 cases of premature mortality and more than $90 billion in direct medical costs annually within the United States alone.4 Less than 5% of Americans currently meet the minimum recommendations of 30 minutes of moderate physical activity per day, and only 8% of adolescents and 45% of children meet recommendations for 60 minutes per day.5 Lack of exercise and the pervasiveness of a sedentary lifestyle represent a large unmet need for exercise promotion as a key strategy in chronic disease prevention and management.6 Given our level of professional knowledge and expertise, PTs and PTAs have a moral obligation to address the current health care crisis by empowering individuals to assume an active role in health promotion and wellness through changes in personal behaviors. This role is reflected by the American Physical Therapy Associations revised Vision Statement for the Physical Therapy Profession,7 adopted in 2013-transforming society by optimizing movement to improve the human experience-and is consistent with guiding principles enabling PTs and PTAs to achieve this vision through the prevention and treatment of impairments, activity limitations, and restrictions related to movement, function, and health.Most people are aware that exercise is good for their health; however, an inability to overcome ambivalence and perceived barriers to an active lifestyle can interfere with participation in physical activity. While advice and personalized exercise prescription can be helpful, further consideration of additional factors is warranted. These factors often involve an individuals readiness to change, his or her interest in pursuing improved health and fitness, and a belief in his or her capacity to engage in new behaviors.8 Therefore, it is essential that PTs and PTAs possess not only the expertise to prescribe and administer the correct exercises, but the knowledge and skill to encourage individual motivation in establishing lifelong health habits known to reduce the risk of morbidity, disability, and premature mortality. PTs and PTAs can achieve these goals by working collaboratively. By including an assessment of the patients readiness to change as part of the initial patient interview and follow-up evaluations, the PT can determine the best approach for empowering patients in choosing healthy behaviors. The PTA can further these goals by working with the PT in applying appropriate evidence-based strategies that engender and support these changes.Motivational interviewing (MI) is a patient-centered approach to promoting changes in personal health behaviors, including improved nutrition, weight loss, and physical activity.9 Professional training in the use of MI and associated patient education methods can improve PT and PTA skill level and self-confidence in helping patients recognize the importance of behavioral risks. Through the use of motivational interviewing, PTs can assess an individuals readiness to change, deliver tailored patient education, and empower patients and clients to play an active role in self-management. …