Chronic Disease Self-management Support Research Articles

Association of Burnout With Primary Care Clinician Perception of Team-Based Scheduling Support.

Primary care clinician burnout is pervasive and detrimental. How components of teamwork and clinic culture might contribute to burnout remains unsettled. To examine associations between primary care clinician perceptions of specific components of teamwork and of organizational culture, and perceived stress and burnout. Cross-sectional survey study of primary care clinicians from 5 county health system clinics. Measures: Perceptions of teamwork related to coordination of care, and clinic provision of chronic disease self-management support; values alignment and workplace equity; and demographics. Descriptive statistics and Spearman's correlations to examine associations, controlling for clinic and examining response variability by clinic. Of 72 clinicians, 64% were female and 32% non-white. About 56% had worked at least 4 years and half worked 5 to 6 half days/week or more in their clinic. Clinicians who reported having someone on the clinician's care team routinely schedule follow-up appointments for patients with complex chronic illnesses reported lower stress and burnout. Those who perceived greater values alignment with their clinic and greater personal and employee equitable treatment had lower stress and burnout. Teamwork among clinicians and non-clinical staff, a component of teamwork that is not well-considered in current literature, could be an important piece of the puzzle to decrease the persistent and challenging issue of stress and burnout among primary care clinicians.

SELF-MANAGEMENT SUPPORT STRATEGIES BASED ON THE RNAO GUIDELINES IN AECOPD PATIENTS: A RANDOMISED CONTROLLED TRIAL

Abstract Abstract Chronic disease management is a key intervention for the management of AECOPD patients. We conducted a Chinese-based trial according to RNAO’s chronic disease management guidelines.The aim of this study was topply an evidence-based guideline practice protocol for self-management in patients with chronic disease to improve the clinical outcomes, as well as reduce the economic costs for patients discharged with AECOPD.In this study, the “Strategies to Support Self-Management in Chronic Conditions: Collaboration with Clients”, published by RNAO, was used as a practice guideline to be applied in the follow-up of patients discharged from COPD to understand patients’ post-discharge self-management ability, pulmonary function, and readmission within one year, and to compare the cost-effectiveness for patients after discharge. The follow-up of both groups was conducted over time, and the patients’ self-management ability and pulmonary function in the observation group were effectively improved at month 6 and month 12 and was significantly different in comparison with the control group (P< 0.05). The observation group showed significant differences in readmission rates and economic costs at month 12 as compared to the control group (P< 0.05).Application of the guideline’s chronic disease self-management support strategies could stabilize patients’ blood oxygenation levels, better maintain pulmonary function, significantly improve patients’ self-management ability, and reduce patients’ medication costs. Keywords: COPD;Chronic disease self-management; RCT; economic analysis

Social Cognitive Predictors of Health Promotion Self-Efficacy among Older Adults during the COVID-19 Pandemic

<h3>Research Objectives</h3> To examine the relative importance of social cognitive predictors on health promotion self-efficacy among community-living adults, aged >65 years during COVID-19. <h3>Design</h3> This cross-sectional study was a secondary analysis of baseline data from a larger chronic disease self-management support intervention. <h3>Setting</h3> This study was conducted in the general community setting. <h3>Participants</h3> The mean age of participants (n=75) was 72.4 years old (SD=5.8; 44 female). Seventy participants (93%) reported living with long term disability resulting from arthritis (n=33), degenerative disk disease (n=18), stroke (n=6), and other conditions (n=18). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale [3]. Independent predictors of performance including performance accomplishment, vicarious learning, verbal persuasion, and affective states [4] were assessed using the health directed behavior subscale of the Health Education Impact Questionnaire [5], positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS) [6], informational support subscale of MOS-SSS, and the Depression Anxiety Stress Scale [7], respectively. <h3>Results</h3> After controlling for age and sex, linear regression analyses revealed statistically significant associations between health promotion self-efficacy and: (i) performance accomplishment (health-directed behavior; β=2.98, p=0.04); (ii) verbal persuasion (informational support; β=5.30, p=0.01); and (iii) affective state (depressive symptoms; β=-0.84; p< 0.001). Vicarious learning (positive social interaction; β=-1.23; p=0.55) did not significantly predict health promotion self-efficacy. Overall, this model was statistically significant (p< 0.001) and explained 48% of the health promotion self-efficacy variance. <h3>Conclusions</h3> Verbal communication supports and strategies to address depressive symptoms and facilitate health-directed behaviors may improve health promotion self-efficacy in the context of physical and social distancing (i.e., COVID prevention strategies). A lack of relationship between self-efficacy and vicarious learning highlights the overall impact COVID had on in-person engagement. <h3>Author(s) Disclosures</h3> We report no real or perceived conflicts of interest.

217 - ECN Award: Effect of a Chronic Disease Self-Management Support Program for Spouse Caregivers of Relatives with Dementia in Shanghai, China: A Randomised Controlled Study

Background:Research found that caregivers of relatives with dementia（RWD)were more vulnerable to chronic diseases than those caring for relatives with other diseases. Unfamiliarity with and/or difficulty in balancing their own health needs was common among the caregivers, from the findings of our previous studies and relevant literatures. Therefore, an educational and psycho-social support program named Chronic Disease Self-Management Support (CD-SMS) program was developed for spouse caregivers of RWD in Shanghai, China.Research Objective:This study was to examine the effectiveness of the CD-SMS program on spouse caregivers’ health-related results, including caregiving self-efficacy, self-efficacy for chronic condition management, and their health behavior.Method:This study was a randomised, wait-list controlled design. A total of 53 participants with common chronic conditions were recruited and assigned to experimental (n = 25) and waiting-list control group (n=28) by stratified randomization. All participants received an illustrated psychoeducation booklet. The intervention group received six bio-weekly support group sessions, and the control group will receive the same support group sessions after the posttest. Participants in both groups received baseline and post-test assessments. The caregivers were assessed with the Chinese versions of Self-Efficacy for Managing Chronic Disease 6-item Scale, Self-Efficacy Questionnaire for Chinese Family Caregivers and Self-Management Behaviors Scale. The care recipients were measured with the Chinese version of Disability Assessment in Dementia.Preliminary results of the ongoing study:A significant interaction between time and group was found in total scores of self-efficacy for managing chronic disease and caregiving self-efficacy for gathering information (P＜0.05). After intervention, caregivers in experimental group reported significant improvements in the total scores of self-efficacy for managing chronic disease, caregiving self-efficacy, and three self-management behaviors (stretching and strengthening exercise, cognitive symptom management, and communication with physicians). The care recipients’ levels of activities of daily living in each group were worse at posttest compared to those at baseline (P＜0.01).Conclusion:The findings indicated that the CD-SMS program was effective in improving the caregivers’ confidence in balancing their caregiving management and their chronic health conditions management, and their main health behaviors were also improved.

Healthcare professionals\u2019 perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities

BackgroundThe challenges of chronic disease self-management in multimorbidity are well-known. Shippee’s Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies.MethodsParticipants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity.ResultsThe framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term ‘treatment burden’, but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with.ConclusionsThe ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.

My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults.

Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management. To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore. A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed. Three salient themes emerged from the data. Firstly, 'Regaining self-control, avoiding complications' describes the participants' journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, 'Preserving social identities and roles' illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, 'Accessing proximal support systems' highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed. Findings can prompt primary healthcare providers to leverage on the patients' life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

BackgroundThe social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes.MethodsSix databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results.ResultsNineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura’s concept of self-efficacy.ConclusionsThe limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity.Trial registrationPROSPERO registration CRD42019124760. Registration date 17/4/19.

Adding value to remote monitoring: Co-design of a health literacy intervention for older people with chronic disease delivered by telehealth - The telehealth literacy project

ObjectiveTo co-design, test and evaluate a health literacy, chronic disease self-management and social support intervention for older people delivered by group videoconferencing into the home. MethodThe Telehealth Literacy Project (THLP) was a mixed methods, quasi-experimental, non-randomised trial nested within a telehealth remote monitoring study. An intervention group (n = 52) participated in five, weekly videoconference group meetings lasting for 1.5 h and a control group (n = 60) received remote monitoring only. Outcomes were measured using the nine-scale Health Literacy Questionnaire (HLQ) and two scales of the Health Education Impact Questionnaire (heiQ). Semi-structured interviews and focus group data were thematically analysed. ResultAt 3 month follow-up, univariate analysis identified small effects in the intervention group only, with improved health literacy behaviours (five HLQ scales) and self-management skills (two heiQ scales). ANOVA of HLQ scales indicated no significant differences between the two groups over time indicating a contributing effect of the remote monitoring project. Intervention participants reported improved perception of companionship, emotional and informational support. ConclusionThe THLP delivered with telemonitoring indicates potential to improve social support and some health literacy factors in older people. Practice implicationsPatient education can be delivered by group videoconferencing.

Network Diffusion and Technology Acceptance of A Nurse Chatbot for Chronic Disease Self-Management Support : A Theoretical Perspective.

Telenursing is one type of telehealth service delivery proposed to resolve the predicted gap between healthcare workforce demand and supply globally. The aim of this article is to explore the 'Nurse Chatbot' for chronic care on the benefits of increasing patient/client access to healthcare information and maximizing the potential of artificial intelligence/AI to bridge the 'demand-supply gap' of human healthcare providers. Moreover,closing this gap through the establishment of a 'Nurse Chatbot' will be innovative, favorably scalable and customizable within a decentralized health network, and potentially sustainable in the new digital economy. Following are the assumptions : 1) "caring" communicated textually is highly 'transactive' in chronic disease selfmanagement support/CDSMS for goal agreements between agents and for overcoming the system noise in the form of cross-entropy, perplexity, and information wastage ; 2) 'Nurse Chatbot' is the interlocutor in nursing care and the nursing agency by superpositioning and entanglement ; and 3) possible effects of chatbot-user transactions are information flows, management of health, and patient satisfaction. This article also looks into 'Nurse Chatbot' development for CDSMS, simulation of its diffusion capacity egocentrically, technology acceptance model/TAM to inquire the engagement of users, and possible approaches to ethical and safety issues. J. Med. Invest. 66 : 24-30, February, 2019.

Pilot of Community-Based Diabetes Self-Management Support for Patients at an Urban Primary Care Clinic.

Diabetes is the seventh leading cause of death in the United States (1). Furthermore, diabetes prevalence, diabetes-related hospital admissions and re-admissions, and risk factors are disproportionately higher in racial and ethnic minorities, indicating the need to focus efforts on reducing these disparities while also improving outcomes for all (2–4). Diabetes care and management vary significantly by race/ethnicity and insurance status and are less likely to be optimal in certain minority groups and the uninsured (5,6). Because most resources and barriers to diabetes management are present within the broader context in which patients carry out their daily lives, the ability to support self-management from within health care delivery systems is limited. Conversely, the capacity for health care systems to partner with community-based programs to manage diabetes is almost limitless. For example, an expert synthesis of strategies to reduce diabetes disparities concluded that community-based efforts and health information technology are the “new frontier” for eliminating diabetes disparities (7). Health care is shifting from volume to value, from treatment to prevention, from patients to populations, and from discrete clinical encounters to whole-person care. In this new model, collaborative partnerships to promote health and well-being within communities are increasingly relevant. Evidence suggests that chronic disease self-management support provided in the community setting improves outcomes in patients with complex chronic conditions (8–10). Previous studies on peer-led support have shown improvements in participant self-care (i.e., nutrition, physical activity, and glucose monitoring), psychosocial outcomes (i.e., quality of life, self-efficacy, and depression), and treatment and appointment engagement (8,11). Positive social support has been shown to influence diabetes self-management practices such as eating a healthy diet, exercising, and monitoring blood glucose (8). Peer-led diabetes social support in a community setting is gaining traction among people with diabetes (12). Pairing …

Close to 1 million US adults aged 55 years or older have active epilepsy—National Health Interview Survey, 2010, 2013, and 2015

Epilepsy is common in older adults because known risk factors—such as traumatic brain injury, stroke, cerebrovascular disease, neurodegenerative disorders, and neoplasms—increase with age. This study uses the most recent data from the 2010, 2013, and 2015 National Health Interview Survey (NHIS) to provide updated national estimates of epilepsy prevalence among US adults aged 55 years or older to help guide public health action. We used the following validated surveillance case definition for active epilepsy: adults with self-reported doctor-diagnosed epilepsy or seizure disorder who reported either currently taking medications to treat their epilepsy or seizure disorder or at least one seizure during the past 12 months. We estimated the prevalence of active epilepsy to be 1.4% (about 529,000) among US adults aged 55–64, 0.9% (225,000) for those aged 65–74, and 1.0% (178,000) for those aged ≥75 years. The prevalence of a history of epilepsy and active epilepsy among adults aged 55–64 years was significantly higher than the prevalence in older age groups. Collectively, close to 1 million adults aged 55 years or older reported active epilepsy. Epilepsy stakeholders should ensure that older adults with epilepsy have access to age-appropriate clinical preventive services, chronic disease self-management support, specialty care for epilepsy and other comorbidities, and appropriate community services to promote quality of life.

Operationalizing Surveillance of Chronic Disease Self-Management and Self-Management Support.

Sixty percent of US adults have at least one chronic condition, and more than 40% have multiple conditions. Self-management (SM) by the individual, along with self-management support (SMS) by others, are nonpharmacological interventions with few side effects that are critical to optimal chronic disease control. Ruiz and colleagues laid the conceptual groundwork for surveillance of SM/SMS at 5 socio-ecological levels (individual, health system, community, policy, and media). We extend that work by proposing operationalized indicators at each socio-ecologic level and suggest that the indicators be embedded in existing surveillance systems at national, state, and local levels. Without a robust measurement system at the population level, we will not know how far we have to go or how far we have come in making SM and SMS a reality. The data can also be used to facilitate planning and service delivery strategies, monitor temporal changes, and stimulate SM/SMS–related research.

A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial.

To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions. Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only. Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide. The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation. 254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13-5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant. CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education. Australian New Zealand Clinical Trials Registry ACTRN12609000726257.

Integrating Community Health Workers Into Medical Homes.

Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team. We conducted 51 semistructured, key-informant interviews of clinic leaders, clinicians, care coordinators, CHWs, and staff from 9 clinics (5 with community health workers, 4 without). Qualitative analysis consisted of thematic coding aligned with interview topics. Four key conceptual themes emerged as facilitators and barriers to utilizing a CHW model: the presence of leaders with knowledge of CHWs who championed the model, a clinic culture that favored piloting innovation vs maintaining established care models, clinic prioritization of patients' nonmedical needs, and leadership perceptions of sustainability. These health care workers performed common and clinic-specific roles that included outreach, health education and coaching, community resource linkage, system navigation, and facilitating communication between clinician and patient. We identified facilitators and barriers to adopting CHW roles as part of PCMH care teams in Minnesota and documented their roles being played in these settings. Our findings can be used when considering strategies to enhance utilization and integration of this emerging workforce.

Chronic disease self-management support for persons with dementia, in a clinical setting.

The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person’s ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure) varies according to the cognitive domain(s) affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function) impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient’s current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient’s skill set. The increasing prevalence of age-related chronic illness along with a decline in the availability of informal caregivers calls for innovative programs to support self-management at a primary care level.

Mobile applications for chronic disease self-management : building a bridge for behavior change

Mobile applications for chronic disease self-management : building a bridge for behavior change

Chronic disease self-management support: public health perspectives.

1 Arthritis Program, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA 2 Healthy Aging Program, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA 3 Rollins School of Public Health, Emory University, Atlanta, GA, USA 4 Epilepsy Program, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA *Correspondence: tob9@cdc.gov

The eHealth Enhanced Chronic Care Model: a theory derivation approach.

BackgroundChronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools.ObjectiveThe first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses.MethodsUsing Theory Derivation processes, we identified a “parent theory”, the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms “CCM or Chronic Care Model” AND “eHealth” or the specific identified components of eHealth. Additionally, “Chronic Illness Self-management support” AND “Technology” AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM.ResultsWe identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider.ConclusionsThe revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

Establishing an independent mobile health program for chronic disease self-management support in bolivia.

Background: Mobile health (m-health) work in low- and middle-income countries (LMICs) mainly consists of small pilot programs with an unclear path to scaling and dissemination. We describe the deployment and testing of an m-health platform for non-communicable disease (NCD) self-management support in Bolivia.Methods: Three hundred sixty-four primary care patients in La Paz with diabetes or hypertension completed surveys about their use of mobile phones, health and access to care. One hundred sixty-five of those patients then participated in a 12-week demonstration of automated telephone monitoring and self-management support. Weekly interactive voice response (IVR) calls were made from a platform established at a university in La Paz, under the direction of the regional health ministry.Results: Thirty-seven percent of survey respondents spoke indigenous languages at home and 38% had six or fewer years of education. Eighty-two percent had a mobile phone, 45% used text messaging with a standard phone, and 9% had a smartphone. Smartphones were least common among patients who were older, spoke indigenous languages, or had less education. IVR program participants completed 1007 self-management support calls with an overall response rate of 51%. IVR call completion was lower among older adults, but was not related to patients’ ethnicity, health status, or healthcare access. IVR health and self-care reports were consistent with information reported during in-person baseline interviews. Patients’ likelihood of reporting excellent, very good, or good health (versus fair or poor health) via IVR increased during program participation and was associated with better medication adherence. Patients completing follow-up interviews were satisfied with the program, with 19/20 (95%) reporting that they would recommend it to a friend.Conclusion: By collaborating with LMICs, m-health programs can be transferred from higher-resource centers to LMICs and implemented in ways that improve access to self-management support among people with NCDs.

Programmes to support chronic disease self-management: should we be concerned about the impact on spouses?

Chronic disease self-management support (CDSMS) programmes are widely advocated as an essential element of chronic disease care and have demonstrated increased engagement with self-care activities such as improving diet but may place additional strain on spouses. This study used an embedded mixed methods approach to explore the impact of CDSMS on spouses. Spouses were recruited as part of a larger randomised controlled trial to assess the efficacy of a health professional-led CDSMS programme (the Flinders Program) in older adults with multiple chronic conditions, compared with an attention control group. Spouses were recruited from the general community through General Practitioners located in the southern areas of Adelaide, Australia. Quantitative and qualitative data were collected between September 2009 and March 2011; a total of 25 spouses from each of the CDSMS and control groups provided data. Spousal strain was measured by the Caregiver Risk Screen (CRS). Few spouses had CRS scores indicative of moderate or high strain at baseline or upon completion of the study and CRS scores did not differ by programme allocation. Spouses of participants with poorer self-management (r = 0.34, P = 0.016) and more illness intrusiveness (r = 0.35, P = 0.013) had higher CRS scores at baseline (quantitative) and spousal strain was found to increase as a partner's well-being and capacity to self-manage decreased (qualitative). Spouse presence at CDSMS sessions (20%) frequently signalled a reduced level of partner well-being. Overall, our findings suggest that CDSMS programmes in many cases will have little impact (either positive or negative) on spousal strain. A significant increase in spousal strain may occur, however, if there is deterioration in the health status of a CDSMS participant. The impact of decline in participant health status on carer strain needs to be considered in CDSMS programmes.