Active Self-management Research Articles

Experiences and perceptions of patients with ankylosing spondylitis: A systematic review and meta-synthesis of qualitative studies.

The systematic evaluation of relevant qualitative studies on the experiences of patients with ankylosing spondylitis provides a foundation for the clinical development of personalized disease management programs for this patient category. Multiple databases, including PubMed, Web of Science, Embase, Cochrane Library, CINAHL, Scopus, CNKI, Wanfang, CBM, and VIP, were searched for qualitative research literature on the experiences of patients with ankylosing spondylitis from the inception of databases to March 2024. Eligible studies were included, and quality was assessed using the quality evaluation standard of qualitative research at the Joanna Briggs Institute (JBI), Australia (2016). The results were integrated using the meta-aggregation approach. A total of 11 papers were included in the review. Four themes and 10 subthemes were synthesized: (1) difficulties in diagnosis and treatment; (2) effects of disease symptoms; (3) maladjustment of social roles; and (4) lack of support for disease response. Medical staff should leverage the advantages of the Internet to enhance knowledge and education on ankylosing spondylitis. They should focus on patients' mental health, assist in active self-management, provide personalized interventions, promote recovery, and improve the quality of life for patients. Additionally, society should offer a diverse range of support.

Digital health applications-What we should know as rheumatologists

Digital health applications (DHAs) are revolutionising patient care by improving access to evidence-based therapy and promoting active self-management. The continuously growing number of DHAs enables patients to act more independently through digital support. The budget-neutral prescription and cost coverage by statutory health insurance companies reduce financial barriers for practitioners and patients. Initial studies show that DHAs can be used successfully to treat comorbidities and rheumatic diseases. Several DHAs for inflammatory rheumatic diseases are at an advanced stage of development. The identification of suitable patients and support through shared decision making are crucial for successful implementation. Challenges remain in adherence and acceptance of the applications. This article provides an overview of prescription in clinical routine, initial data and experiences from the reality of rheumatology care, and reports on current developments.

Survivorship preparedness and activation among survivors of lymphoma.

Taking an active role in managing post-treatment care has emerged as a key aspect of promoting a successful transition into survivorship and is associated with better patient outcomes. In this study, we focus on two key aspects of active self-management, activation and preparedness. Activation was defined as understanding one's role in the care process and having the knowledge, skill, and confidence to take on a role in managing self-care. Preparedness was defined as the extent to which individuals perceived they had sufficient information about what to expect after cancer treatments are completed. The study goal was to characterize survivorship preparedness and activation among lymphoma survivors within 5years of treatment completion in New Jersey and examine the association of sociodemographic, medical, care transition experiences, practical concerns, and psychosocial factors with activation and preparedness. One hundred and one Hodgkin lymphoma or non-Hodgkin lymphoma survivors who had completed treatment within 5years completed a survey of survivorship care experiences (response rate = 34.12%). Approximately 60% of survivors reported high activation, with similar percentages for higher preparedness. Less activated survivors were significantly (p < .05) younger, married, resided in a more deprived geographic area, and reported more fatigue and information needs. Less activated survivors reported recalling that their providers were significantly (p < .05) less likely to discuss long-term side effects, psychosocial needs, risk-reducing lifestyle recommendations, and how to manage other medical concerns. Fewer care transition practices were most strongly associated with lower preparedness. A significant proportion were not activated for survivorship, and both activation and preparedness were strongly associated with providers' survivorship transition practices. Implementing programs to foster more activation and preparedness for lymphoma survivorship care would benefit from education about recommended follow-up care and healthy lifestyle practices. Providers should routinely ask about their patients' confidence and preparedness for survivorship and provide referrals for appropriate care as needed.

Design, implementation and usability analysis of patient empowerment in ADLIFE project via patient reported outcome measures and shared decision making

IntroductionThis paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes.BackgroundThe ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up.MethodsADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients’ clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach’ for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox.ResultsUser satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated.ConclusionsHaving finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.

Psychometric properties and factor structure of a motivation scale for higher education students to graduate and stimulate their entrepreneurship

The purpose of this research work is to provide a measurement instrument, through the validation of a proposed scale, to determine the relevant factors that affect the motivation of university students, and that can be used as anticipatory indicators of personal entrepreneurship to achieve educational and work success. To carry it out, exploratory and confirmatory factor analyses have been carried out, based on the principal components’ method, which have been validated through the usual model fit measures in the literature, considering an analysis of reliability and reliability of the measurement instrument. To obtain this purpose, a sample of the university population was selected, through a simple random sampling, considering heterogeneity of courses, subjects, areas, and teaching modalities, of 596 individuals, with a higher percentage of women compared to men, as can be seen from the total number of enrolled in university degrees in the Spanish education system. The scale proved to have good psychometric properties, obtaining good internal consistency and validity. Among the main findings, we can highlight several dimensions for motivation, for instance, emotional self-management and adversity management; and learning strategies, such as: active self-management of study material, study management and self-management of effort, among others. In conclusion, a scale has been validated to determine which dimensions should be considered to promote student motivation as a method of personal entrepreneurship, and which can be used by educational authorities to propose extracurricular training that affects the improvement of students' competence, both in academic and emotional management. The dataset was analyzed using exploratory and confirmatory factor analysis.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis.

Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme. Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

Introducing Australia's clinical care standard for low back pain.

Introducing Australia's clinical care standard for low back pain.

Conceptualising engagement with HIV care for people on treatment: the Indicators of HIV Care and AntiRetroviral Engagement (InCARE) Framework

BackgroundAs the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and development of interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective.MethodsWe used a pragmatic, iterative approach to develop a framework, combining insights from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of important elements of engagement behaviour that could be evaluated by the health system.ResultsThe final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: ‘retention’ (interaction with health services), ‘adherence’ (pill-taking behaviour), and ‘active self-management’ (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes.ConclusionsThis framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic.

A PROACTIVE Coping Scale for U.S. College Students: Initial Evidence and Implications

The present studies report the development of a PROACTIVE coping scale to evaluate actions used by U.S. college students to prevent or prepare for potential future stressors. Results of EFA and CFA using two samples of U.S. college students (total N = 1123) indicated the viability and stability of a 19-item four-factor model of proactive coping: Active Preparation, Ineffective Preparation, Self-Management, and Utilization of Social Resources. The scale demonstrated good psychometric properties, and each factor represents a meaningful and distinctive facet of proactive coping behavior. Concurrent and incremental validity estimates indicated that the subscales of the scale were (a) associated with problem-solving appraisal, future-oriented thoughts, life satisfaction, and optimism in expected ways, and (b) accounted for more variance on life satisfaction beyond the effect of the problem-solving appraisal. The results from this study indicate the importance of broadening coping to include proactive coping and how proactive coping is associated with various psychological outcomes.

Validacija Inventara PROAKTIVNOG prevladavanja na uzorku studenata u Srbiji

The existing literature recognizes the importance of studying proactive coping among university students. There are two different conceptualizations of proactive coping, one by Aspinwall and Taylor (1997) and the other by Greenglass et al. (1999). To date, the Proactive Coping Inventory (Greenglass et al., 1999) is the most frequently used instrument that measures this concept. However, the main aim of the present study was to investigate the psychometric properties of a newly developed measure, the PROACTIVE coping inventory (Tian et al., 2023). The translation process of the PROACTIVE coping inventory followed the back-translation procedure. A series of questionnaires were completed online and a total of 171 respondents were included in the final sample. The age of the respondents ranged from 18 to 26; three quarters of them were female. Confirmatory factor analysis revealed that the Serbian version of the PROACTIVE coping inventory matched the original factor solution (ch2 (df)= 202.350 (129), p= .000, ch2 /df=1.569, CFI= .920, TLI= .908, RMSEA= .053). The active preparation, ineffective preparation, and self-management subscales showed good internal consistency (Cronbach a: .76, .73 and .73 respectively), while the utilization of social resources subscale had a lower but acceptable a= .66. The correlation analysis showed good convergent validity for all subscales except for ineffective preparation. The results obtained, the limitations of the study, and the need for future research have been discussed.

“I am strong and I can get on with my life”: The subjective experience of recovery of patients treated for depression

ABSTRACT Depression has a high prevalence throughout the world, and its management and recovery still constitute a challenge for mental health professionals. Objective : The aim of the study was to characterize the subjective experience of recovery from depression based on the perspective of those who suffer from it. Method : Forty participants from two South American countries, who had been or were currently being treated for depression, took part in semi-structured and in-depth interviews. Most participants were female (78%), with ages ranging from 22 to 63 years. Interviews were analyzed using Grounded Theory, creating a hierarchy of categories that represent participants’ experience of recovery. The categories were subsequently organized around an emergent central phenomenon. Results : “Transformation of the experience of the depressed self” was constructed as the main phenomenon that accounts for the subjective understanding of recovery. This transformation consists in an increase in self-acceptance, self-appreciation, and auto-biographical contextualization, coupled with an increase in agency and empowerment. Conclusion : Recovery is experienced as a multidimensional process that goes beyond the absence of symptoms. Change is experienced as a result of active self-management and commitment. The relevance of person-centered perspectives and their subjectivity for managing depression is discussed.

"The Pain Doesn't Have to Control You." A Qualitative Evaluation of Three Pain Clinics Teaching Nonopioid Pain Management Strategies.

To explore factors related to effectiveness of nonpharmacological treatment for opioid-dependent patients suffering with chronic pain. A qualitative study incorporating individual interviews and focus group interviews. 3 rural Oregon nonopioid pain management clinics. A 10-week nonpharmacological educational program incorporating cognitive-behavioral therapy, movement therapy, mindfulness, and other skills. Across sites, we conducted 9 individual interviews with clinic staff and 3 focus group interviews with 34 patients who had participated in the course. Thematic analysis was used to identify themes within and across respondent groups. Analysis revealed 4 primary themes: program goals; program benefits; characteristics of patients who benefit from the program; coordination of clinic experiences with other care. Several primary findings can be highlighted. The clinics focused on improving patients' quality of life, while opioid use reduction was a potential secondary benefit, driven by patients. Major program benefits included enhanced pain self-management skills, patients' greater assertiveness in communications with healthcare providers, and, in numerous cases, opioid use reduction. Participants were unanimous that predisposition toward active self-management of one's pain was an essential factor for positive outcomes. Patients reported considerable variability in providers' understanding of their clinic participation. Nonpharmacological approaches for treating chronic pain can be effective for many patients. Clinics teaching these approaches should be more fully integrated into the healthcare system.

Core Competency Modeling for Elementary Artificial Intelligence Education

본 연구는 인공지능 교육이 공교육에 도입되기 시작하는 초등학교 고학년을 대상으로 인공지능 핵심역량을 모델링함으로써 인공지능 시대의 인재상을 명확히 하고, 인공지능 교육의 방향성 수립에 기초를 제공하는 것을 목적으로 한다. 이를 위하여 전문가 일대일 면담, 포커스 그룹 인터뷰, 델파이 조사 등 의견수렴 및 타당화 과정을 반복적으로 실시하였고, 이러한 과정에서 초등 인공지능 교육의 핵심역량 구성요인을 도출하고 타당성을 검증하였다. 인공지능 교육 핵심역량은 ‘인공지능 이해’ 범주에 15개 역량, ‘인공지능 윤리’ 범주에 8개 역량, ‘인공지능 사회정서’ 범주에 8개 역량이 포함되어 총 3개 범주 31개 역량이 도출되었다. 최종안에 대한 델파이 조사결과, 전체 응답평균 3.66/4점, CVI 평균 0.930, CVR 평균 0.863으로 CVI 최솟값 0.70과, CVR 최솟값 0.455를 상회하는 등 높은 공감대를 획득하였다. 특히, ‘인공지능 이해’ 범주의 ‘AI 인지’와 ‘AI 활용’, ‘인공지능 윤리’ 범주의 ‘AI 윤리 문제인식’, ‘인공지능 사회정서’ 범주의 ‘인간-AI 협업’과 ‘능동적 자기관리’ 역량의 타당도와 중요도가 높게 나타났다. 본 연구는 초등 맥락의 인공지능 교육 핵심역량 모델링을 통해 인공지능 이해 교육을 넘어 인공지능 윤리와 사회정서 교육까지로 시야를 넓히는데 기여하고자 하였으며, 초중등 인공지능 교육의 체계를 마련하는데 기초를 제시하였다. 또한 인공지능 교육에 역량중심 융합교육을 도입할 수 있도록 토대를 마련한 것에 의의를 가진다.The purpose of this study is to clarify the concept of talent for the artificial intelligence era and to provide the foundation for designing the directivity of artificial intelligence education by modeling core competencies for upper grades of elementary school students where artificial intelligence education is initiated in public education. To this end, experts one-to-one interviews, focus group interviews, and Delphi surveys were repeatedly conducted, in which process, core competency components of elementary artificial intelligence education were derived and validated. The core competencies of artificial intelligence education included 15 competencies in the ‘artificial intelligence understanding’ category, 8 competencies in the ‘artificial intelligence ethics’ category, and 8 competencies in the ‘artificial intelligence social emotions’ category, resulting in a total of 31 competencies in 3 categories. As a result of the Delphi survey on the final draft, the overall response average was 3.66/4 points, the CVI average was 0.930, and the CVR average was 0.863, which exceeded the CVI minimum value of 0.70 and the CVR minimum value of 0.455. In particular, the validity and importance of the competencies of 'AI awareness', 'AI utilization' in the 'artificial intelligence understanding' category, ‘AI ethics problem recognition’ in the 'artificial intelligence ethics’ category, and 'human-AI collaboration', 'active self-management' in the 'artificial intelligence social emotions' category were found to be high. This study attempted to contribute to expanding the perspective beyond artificial intelligence principle education to artificial intelligence ethics and social-emotional education through modeling of core competencies for elementary schoolers and presented the basis for the systematic perspective of artificial intelligence education. It is also meaningful to lay the foundation for introducing competency-based convergence education into artificial intelligence education.

Quality of life and experience with the national multiple sclerosis society strategic plan priorities for people with multiple sclerosis: Findings from a path analysis.

The National Multiple Sclerosis Society (NMSS) strives to ensure that people affected by multiple sclerosis (MS) can live their best lives. This mission is reflected in the Society's strategic plan, which establishes the roadmap for the Society's continued commitment to a world free of MS. The purpose of this article is to add to the understanding of both the scope and complexity of the impact of MS and MS-related supports on quality of life (QOL). A national sample of people with MS (n = 748) participated in the study by completing validated surveys assessing their QOL, physical and mental health, MS self-efficacy, resilience, participation in NMSS, perceived stress, emotional support, and social roles and activities. A path model was used to examine how the frequently identified MS QOL predictors, including demographic, MS, psychosocial, and physical functional status variables relate to each other and to QOL. The model exhibited reasonable model fit with hypothesized paths being statistically significant and in the hypothesized direction. Findings revealed that the relationships among mental health, demographic factors, overall MS experiences, QOL, NMSS participation, and resonance with the mission of the NMSS are complex, highly nuanced, and yet strongly correlated. More importantly, the study highlights the strong influence of variables that are more readily amenable to change through programmatic and clinical intervention, and active self-management and participation.

Supporting People With Type 2 Diabetes in the Effective Use of Their Medicine Through Mobile Health Technology Integrated With Clinical Care to Reduce Cardiovascular Risk: Protocol for an Effectiveness and Cost-effectiveness Randomized Controlled Trial.

BackgroundType 2 diabetes is a common lifelong condition that affects over 400 million people worldwide. The use of effective medications and active self-management can reduce the risk of serious complications. However, people often have concerns when starting new medications and face difficulties in taking their medications regularly. Support provided by brief messages delivered through mobile phone–based SMS text messages can be effective in some long-term conditions. We have identified promising behavior change techniques (BCTs) to promote medication adherence in this population via a systematic review and developed SMS text messages that target these BCTs. Feasibility work has shown that these messages have fidelity to intended BCTs, are acceptable to patients, and are successful in changing the intended determinants of medication adherence. We now plan to test this intervention on a larger scale in a clinical trial.ObjectiveThe aim of this trial is to determine the effectiveness and cost-effectiveness of this intervention for reducing cardiovascular risk in people with type 2 diabetes by comparing it with usual care.MethodsThe trial will be a 12-month, multicenter, individually randomized controlled trial in primary care and will recruit adults (aged ≥35 years) with type 2 diabetes in England. Consenting participants will be randomized to receive short SMS text messages intended to affect a change in medication adherence 3 to 4 times per week in addition to usual care. The aim is to test the effectiveness and cost-effectiveness of the intervention when it is added to usual care. The primary clinical outcome will be a composite cardiovascular risk measure. Data including patient-reported measures will be collected at baseline, at 13 and 26 weeks, and at the end of the 12-month follow-up period. With 958 participants (479 in each group), the trial is powered at 92.5% to detect a 4–percentage point difference in cardiovascular risk. The analysis will follow a prespecified plan. A nested quantitative and qualitative process analysis will be used to examine the putative mechanisms of behavior change and wider contextual influences. A health economic analysis will be used to assess the cost-effectiveness of the intervention.ResultsThe trial has completed the recruitment phase and is in the follow-up phase. The publication of results is anticipated in 2024.ConclusionsThis trial will provide evidence regarding the effectiveness and cost-effectiveness of this intervention for people with type 2 diabetes.Trial RegistrationISRCTN Registry ISRCTN15952379; https://www.isrctn.com/ISRCTN15952379International Registered Report Identifier (IRRID)DERR1-10.2196/32918

Common elements of service delivery models that optimise quality of life and health service use among older people with advanced progressive conditions: a tertiary systematic review

IntroductionHealth and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and...

Organizational technics for developing the leadership potential of students in self-government

Organizational technics for developing the leadership potential of students in self-government has been a topic of debate in recent times. The article aims to describe ways to allow students to develop creative initiatives in self-government, responsibility and professionalism, independence and social activity. Trends have been defined for improving pedagogical forms and methods of work with students. Develop leadership potential in student self-governance. Improvement of research, cultural, educational, athletic, information and communication skills within student union, which allows young people to develop their professional competencies. Leadership skills require active and professional self-management and self-improvement. A communication culture develops as a result of student autonomy and the manifestation of leadership potential. The authors argue that students, as active participants in the university’s public life, develop their leadership potential by participating in the formation of traditions. Quality preparation of students for a future professional career is possible only if the leadership potential of professional responsibility is developed.&#x0D; &#x0D; Keywords: communication culture; free will; leadership potential; self-government; self-improvement; оrganisational technics&#x0D;

Development of career capital during expatriation: partners' perspectives

PurposeThe purpose of this qualitative study is to examine the effects of expatriation on the development of career capital among the partners of expatriates.Design/methodology/approachThe study draws on in-depth interviews with 30 Finnish partners of expatriates.FindingsThe results reflect the various learning experiences reported by partners of expatriates that developed their career capital during expatriation. The learning experiences related to the experience of living abroad itself and to the specific activities undertaken when abroad. The extent to which partners developed knowing-why, knowing-how and knowing-whom career capital was found to partly reflect their situation abroad as stay-at-home partners or as employees in less-demanding or more-demanding jobs. Though the experiences were developmental for all partners as have been reported among expatriates, the authors also identified several aspects in which partners' experiences differed from the typical developmental experiences of expatriates.Practical implicationsThe results also highlight the influence of initiative, an active role and career self-management skills in partners' career capital development.Originality/valueThis paper advances the understanding of how expatriation affects expatriate partners' career capital, a topic that has not previously been studied in-depth.

Effect of patient activation interventions on health-related behavioral outcomes in adults with chronic kidney disease: a systematic review protocol.

This review aims to examine the effect of patient activation interventions compared with usual care on health-related behavioral outcomes in adults with chronic kidney disease stages 3-5. Chronic kidney disease is a global health problem associated with a high mortality, reduction of health-related quality of life, and high health care costs. The chronic nature requires active involvement and self-management of the person with chronic kidney disease. Patient activation is a self-management approach that refers to the knowledge, confidence, and skills of people to enable them to manage their own health needs. However, the effectiveness of patient activation interventions on health-related behavioral outcomes in this population have not yet been systematically evaluated. This systematic review will include primary research studies measuring the effect of behavioral change interventions addressing beliefs, knowledge, confidence, and/or skills to optimize self-management in adult patients with chronic kidney disease stages 3-5 who are not receiving dialysis. Studies included in this review will be randomized controlled trials. Published studies will be searched in MEDLINE, Embase, Emcare, and PsycINFO. Unpublished studies and gray literature sources will also be searched. Titles and abstracts of search results published in English from 2005 onward will be screened, and the full text of potentially relevant studies will be assessed in detail. Studies selected for inclusion will undergo critical appraisal. Data extracted will include specific details about population, study methods, interventions, and outcomes. Studies will be pooled in statistical meta-analysis, if possible. PROSPERO CRD42020205084.

Chronic disease health literacy in First Nations people: A mixed methods study.

To explore chronic disease education, self-management andhealth literacy abilities from First Nations Australian adults with chronic disease through the integration of qualitative and quantitative findings. Chronic disease management requires good health literacy abilities to manage long-term health needs. First Nations people have a higher burden of chronic disease although little is known regarding chronic disease health literacy of First Nations people. A concurrent embedded mixed methods study reported using the Consolidated Criteria for Reporting Qualitative Research guidelines. Data were collected from First Nations people with one or more chronic diseases living in remote Australia between February-November 2017. Quantitative data (n=200) were collected using the Health Literacy Questionnaire along with demographic and health data. Qualitative data (n=20) were collected via face-to-face interviews to examine chronic disease education and self-management experiences. Data were analysed separately then integrated to develop meta-inferences. Poor communication from healthcare providers coupled with low health literacy abilities is a major barrier to both active and successful management of chronic disease. Communicating in medical jargon resulted in individuals being placed in a power differential causing lack of trust and relationship breakdowns with healthcare providers affecting active chronic disease self-management. The perception of inevitability and ambivalence towards chronic disease and the notion of futility towards self-management were concurred with the low level of active engagement in health care. Yarning is an important strategy used by First Nations people for communication. For nurses, understanding and developing skills in yarning will facilitate cultural safety, communication and understanding about chronic disease self-management in contexts where health literacy abilities are challenged. Using yarning, and plain language visual aids, and teach-back will readdress the power differential experienced by First Nations people and may also improve understanding of chronic disease self-management.