Facilitators Of Self-management Research Articles

Barriers and Facilitators of Self-Management in Older People with Type 1 Diabetes: A Narrative Review Focusing on Cognitive Impairment.

Over the past decades, life expectancy of people with type 1 diabetes has increased considerably, which brings potential challenges due to the process of aging. Cognitive aging and dementia, as well as reductions in visual acuity, hearing and dexterity, can influence the frequency and quality of daily self-management activities, including medication taking and insulin dosing, glucose self-monitoring, and healthy eating. This can increase the risk for hypo- and hyperglycemic events, which, in turn, may contribute to cognitive decline. Because there is a gap in understanding the barriers and facilitators of self-management in older adults with type 1 diabetes and the relationship to cognitive functioning, the authors 1) review the available literature on cognitive aging and type 1 diabetes, 2) describe what self-management in later adulthood entails and the cognitive functions required for effective self-management behaviors, 3) analyze the interaction between type 1 diabetes, cognition, aging, and self-management behaviors, and 4) describe the barriers and facilitators for self-management throughout the life span and how they may differ for older people. Potential evidence-based practices that could be developed for older adults with type 1 diabetes are discussed. There is need for further studies that clarify the impact of aging on T1D self-management, ultimately to improve diabetes care and quality of life.

Barriers and facilitators of self-management using digital technology in older adults living alone

Barriers and facilitators of self-management using digital technology in older adults living alone

All in the Family: A Qualitative Study of the Early Experiences of Adults with Younger Onset Type 2 Diabetes.

Adults with type 2 diabetes diagnosed at a younger age are at increased risk for poor outcomes. We examined life stage-related facilitators and barriers to early self-management among younger adults with newly diagnosed type 2 diabetes. We conducted 6 focus groups that each met twice between November 2017 and May 2018. Participants (n = 41) were aged 21 to 44 years and diagnosed with type 2 diabetes during the prior 2 years. Transcripts were coded using thematic analysis and themes were mapped to the Capability-Opportunity-Motivation-Behavior framework. Participants were 38.4 (±5.8) years old; 10 self-identified as Latinx, 12 as Black, 12 as White, and 7 as multiple or other races. We identified 9 themes that fell into 2 categories: (1) the impact of having an adult family member with diabetes, and (2) the role of nonadult children. Family members with diabetes served as both positive and negative role models, and, for some, personal familiarity with the disease made adjusting to the diagnosis easier. Children facilitated their parents' self-management by supporting self-management activities and motivating their parents to remain healthy. However, the stress and time demands resulting from parental responsibilities and the tendency to prioritize children's needs were perceived as barriers to self-management. Our results highlight how the life position of younger-onset individuals with type 2 diabetes influences their early experiences. Proactively addressing perceived barriers to and facilitators of self-management in the context of family history and parenthood may aid in efforts to support these high-risk, younger patients.

Developing a Problem-Solving Intervention to Address Methods of Self-Management and Transition Challenges in Adolescents with Sickle Cell Disease: A Qualitative Investigation

Introduction: Given recent advances in medical care for children with Sickle Cell Disease (SCD), families are now seeing their children survive into adulthood. This presents new challenges around transition from pediatric to adult medical care, with responsibility for self-management shifting from parent to child. Interventions to improve self-management skills, such as problem solving education (PSE), have been used to increase self-efficacy and medication adherence in youth with other chronic diseases. The present study sought to explore common barriers and facilitators of disease management during the transition period and the acceptability of adapting PSE to improve transition readiness in adolescents with SCD.Methods: We purposively sampled adolescents with SCD ages 13 to 18 who received care at either Boston Medical Center (BMC) or Boston Children's Hospital and their primary caregiver to participate in focus groups. Each focus group was audio recorded and transcribed. Data were analyzed through use of grounded theory and coded with NVivo, a qualitative analysis software. Transcripts were double-coded until thematic saturation was achieved.Results: A total of 17 adolescents and 15 adult caregivers participated in five focus groups. Groups initially met together to discuss barriers and facilitators of self-management and then split into separate groups of teens and parents to discuss PSE. Teens and parents identified common methods of disease management includingtaking medication, staying warm and dressing appropriately, maintaining hydration and a healthy diet, and staying rested. Teens identified having a daily routine and sharing responsibility with a caregiver as facilitators of self-management. Caregivers commonly mentioned using a set of reminder techniques to help teens manage their health. Barriers to increasing teens' self-management included wanting to fit in with peers and lacking appropriate knowledge. Parents found it challenging to allow teens more responsibility.Parents and teens unanimously approved the adaption of PSE to SCD management and transition. Though a small number of parents stated low interest in participating either for social reasons or lack of perceived need, many identified the potential benefits of the intervention for both parents and teens. Parents felt that educational support would be most beneficial to them, while teens prioritized the benefits of emotional support during the transition period. Most participants would prefer that parents and teens meet separately in a group setting at the hospital or a comfortable environment outside of the home, then join together for a final session. Groups would be held on a weekly basis for a minimum of two months. However, some participants felt the support was imperative and thus could be effective for a year. Participants favored a mentor-style structure where a knowledgeable, college-aged individual with sickle cell disease would serve as the interventionist. This appeared to be a common preference for both parents and teens as they felt it was important to work with an individual that excelled independently and academically, despite any challenges with SCD.Parents and teens willingly identified specific scenarios where they felt PSE would be most valuable. Common PSE scenarios for teens were related to disclosing the diagnosis to peers, enhancing methods of management, and addressing identified barriers to transitioning. PSE scenarios for parents involved working with healthcare and school systems on select adaption issues and learning to “let go” of their teen.Conclusion: Though parents and teens have adapted management techniques to facilitate their transition from pediatric to adult medical care, barriers still exist across medical, personal and educational environments. Applying PSE as an intervention for both parents and teens of a sickle cell population could improve self-management and transition readiness in this vulnerable population. DisclosuresNo relevant conflicts of interest to declare.

567-P: The Role of Family History In Self-Management of T2D: A Qualitative Examination

Adults diagnosed with type 2 diabetes (T2D) at a younger age are at increased risk for poor outcomes. We examined how family history of diabetes shaped the experiences and self-management perspectives of younger-onset individuals newly diagnosed with T2D. We conducted six focus groups between Nov 2017 and May 2018. Participants (n=41) were members of an integrated healthcare delivery system, had been diagnosed with T2D during the prior two years, and were 21-44 years old at the time of diagnosis. Each group met twice for 60-90 minutes, two weeks apart. Groups were led by an experienced facilitator, audio-recorded, transcribed verbatim, and coded by two reviewers using thematic analysis. The average age of participants was 38.4 years (±5.8 years); 20 were women, 10 self-identified as Latinx, 12 as Black, 12 as White and 7 as multiple or other races. Over 65% had a family history of T2D. Having a family member with T2D facilitated self-management in several ways. First, personal familiarity with T2D and related lifestyle changes, as well as advice from older relatives, led individuals to feel that they were capable of modifying behaviors and made adjusting to the diagnosis easier. In addition, family members with T2D served as both positive and negative role models that motivated individuals to adapt relatives’ health-promoting behaviors and take steps to avoid adverse outcomes. Conversely, for some, the perception that T2D diagnosis was inevitable was a barrier to initial self-care. Perceived lack of control over developing T2D due to family history of the disease led to feelings of self-blame and futility regarding self-management efforts. Our results highlight the importance of recognizing how familial experiences impact patients’ ability to navigate a new T2D diagnosis. Proactively addressing perceived barriers to and facilitators of self-management in the context of family T2D history may aid in efforts to educate and support high-risk, younger patients establish a trajectory towards improved health. Disclosure M. A. Blatchins: None. K. Xu: None. A. Altschuler: None. R. W. Grant: None. A. Gopalan: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116968); Kaiser Permanente Northern California

The challenges and facilitators of self-management in pediatric asthma.

Self-management education in asthma can dramatically reduce asthma morbidity, but specific pediatric challenges need to be addressed. The purpose of this review is to discuss the most recent and significant advances regarding self-management interventions in pediatric asthma. Recent evidence supports school-based programs including asthma self-management skills for children to significantly improve asthma control. A defined theoretical intervention framework, parent involvement, child satisfaction, and running the intervention outside the child's own free time are suggested drivers of successful implementation. Real-time telemedically delivered asthma education may also improve asthma-related outcomes in children. Moreover, mobile applications supporting self-management are generally welcomed by children and parents. Current evidence supports the use of models of health behaviors change in mobile application design and content development; self-monitoring alone is ineffective but useful when coupled with decision support for proactive care. School-based and e-health interventions are potential facilitators for the implementation of successful self-management asthma programs, providing access to large numbers of children with asthma. This supports the healthcare practitioners to work together with researchers to promote these interventions, while following current recommendations for the effective transition of children into competent and confident adults to continue to successfully self-manage their asthma.

A model to facilitate self-management of human immunodeficiency virus in students within a university setting and promoting their mental health.

BackgroundThe introduction of antiretroviral treatment (ART) has resulted in people with HIV living longer. Antiretroviral treatment demands a lifelong commitment from patients not only in terms of adherence to the medication but also in relation to lifestyle changes in general. This poses a challenge to a student living with HIV (SLHIV) who only spends a few years at university before entering the workplace and relocating. It also means that the care, support and treatment received at the university will no longer be available to them as these services are only offered to enrolled students. It is imperative for practitioners at universities to help SLHIV effectively manage their illness.AimThe aim of the article is to illustrate the process followed to develop a model that could serve as a frame of reference to facilitate the management of HIV as an integral part of the mental health of SLHIV within a university.SettingThe model is designed for professional practitioners in university settings who support students living with HIV in managing their illness.MethodsA theory-generative, qualitative, exploratory, descriptive and contextual study design was utilised. The central concept was derived from the experiences of practitioners and SLHIV by conducting individual interviews using appreciative inquiry. The common themes and categories identified in the interviews served as a basis for the identification of the central concept for the study. The process included the identification, definition and classification of the central concept and essential attributes. The conceptual framework was then described. Measures to ensure trustworthiness were also adhered to in the study and approval for the study was granted (Ethical clearance #2014-071).ResultsThe central concept was identified as the ‘facilitation of self-management’. It was defined and classified, and these definitions and classifications were used as the basis for the model. Thereafter, the model was described.ConclusionThe model can be used as a frame of reference to assist SLHIV in effectively managing their illness.

The Barriers and Facilitators of Self-Management Among Adults with Type 2 Diabetes Mellitus: A Trans Theoretical Model (TTM)-Based Mixed Method Study in Iran.

AimThis study planned to determine:( 1) the behavioral intention or profile of patients with type 2 diabetes mellitus (T2DM) based on the stages of the change model, and( 2) to explore the perceived facilitators and barriers of self-management (SM) in a sample of Iranian patients with T2DM.MethodsThis was a mixed method study, accomplished in two phases. In the quantitative phase, 246 subjects with T2DM participated. They were classified according to items such as regular use of blood-glucose-lowering drugs, having a healthy diet and performing physical activity to pre-action and action groups. Socio-demographic and anthropometric information were collected, and a phenomenological qualitative study was conducted, and data collection continued until saturation achieved by 10 subjects in pre-action and 12 subjects in action groups. Four focus group discussions in the field of SM were accomplished. Analysis of quantitative and qualitative data was conducted by the SPSS and MAXQDA software, respectively.ResultsThe mean age and duration of illness among the subjects were 53.9±7.1 and 6.9±4.9 years, respectively. The barriers of SM in action and pre-action stages were as follows: lower socio-economic status, poor performance of treatment team, physical-intellectual factors and lack of planning to change. The facilitators stated in the pre-action and action stage in the field of SM were satisfaction from treatment, planning, belief in diabetes, treatment team’s support, nutritional knowledge, and religious beliefs.ConclusionThis study indicated facilitator and barrier factors in SM based on TTM in action and pre-action groups. Healthcare professionals should consider these findings to improve the patients’ outcomes.

The implications of the Canadian Stroke Best Practice Recommendations for design and allocation of rehabilitation after hospital discharge: a problematization

Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planningMethods: Critical discourse analysis modeled on Alvesson and Sandberg’s method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them.Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles.Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life.Implications for RehabilitationImplicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident.Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure.This biomedical image makes it difficult to provide care that meets the guideline’s explicit goals of client- and family-centeredness.Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care.

Developing a Problem-solving Intervention to Improve Self-Management and Transition Readiness in Adolescents with Sickle Cell Disease

PurposeAdolescents and young adults (AYA) with sickle cell disease (SCD) are at risk for serious complications including increased morbidity and early mortality during their transition from pediatric to adult care. Self-management support may help improve transition outcomes in this vulnerable population. Interventions based on teaching problem solving skills have been shown to improve adherence to therapy for AYA with other chronic disease and is a promising intervention in SCD. We sought patient and parent perspectives on improving self-management and input on the development of a problem-solving education (PSE) intervention. Design and methodsWe held focus groups with AYA with SCD and caregivers to discuss barriers and facilitators of self-management, acceptability of PSE and intervention content and delivery. ResultsFive focus groups were held with AYA (n = 17) and caregivers (n = 15). Groups participated jointly to discuss self-management and then separately to discuss PSE. Data were analyzed using grounded theory and double-coded until thematic saturation was achieved. ConclusionsBoth groups endorsed PSE as an acceptable intervention. Barriers to self-management included wanting to fit in with peers (AYA) and trouble letting go (parents); facilitators included having a regular routine (AYA) and sharing responsibility (parents). Participants suggested meeting in small groups for PSE sessions rather than individually and adding group sessions for parents. Practical implicationsUnderstanding AYA and caregivers' perceptions of barriers and facilitators of transition in SCD can help us better prepare AYA for transition. The specifics both groups identified as helpful will guide intervention development.

Facilitators and Barriers to Self-Management of Tuberculosis Patients: A Qualitative Study

Introduction: Patient self-management improves health and well-being. In 2015, 10.4 million was infected with Tuberculosis TB. TB is curable but treatment is ineffective without patient self-management. When patient perform self-management, it reduces treatment abandonment, prevents hospital admissions, and increases confidence and sense of control. TB self-management involves managing medication regimens, monitoring laboratory indicators, maintaining nutrition, coping to the psychological and social demands, and lifestyle regulation. However, little has been known about the conditions that facilitate or inhibit self-management of TB patients. Therefore, the purpose of this paper is to describe the facilitators and barriers of self-management of TB patients receiving treatment in an urban community health center. Methods: Qualitative data were collected through individual interview conducted at the dwelling place of the participants. The participants were recruited through maximum variation sampling from 15 adults with pulmonary TB with different gender, education, and occupation receiving treatment in an urban community health center in the Philippines. Data were analyzed using content analysis. Trustworthiness was established through respondent validation to check for accuracy and credibility of analysis. The respondents evaluated the interview transcript for the correctness and consistency of the identified categories between the researcher’s view and the participants. Bracketing and audit trailing from the verbatim transcriptions were done to establish trustworthiness. Results: Facilitators of self-management of TB patients are the self, family support, health care providers, environment, and spirituality. On the other hand, the barriers to self-management are the physical and emotional stress, social stigma, dissatisfaction to the healthcare system, and the self. Discussions: The self is the most important facilitator of self-management because it is voluntary and conscious will of the patient to improve their health and well-being. However, the self may also be the barrier especially if there is no support of the family, acceptance of the community, and the over-all health care system. Conclusions: Identification of the facilitators and barriers to self-management is a prerequisite in order to develop an integrated care model that will improve the over-all care of TB patients. Health care providers must educate patients about the importance of self-management, use therapeutic communication with patients, and engage patients to spiritual activities that promote healing. Moreover, involving the family in the care, and ensuring accessible, available, appropriate, and acceptable services of health and care system are also important to promote self-management of patients. Lessons learned: Patient self-management is not a one-way process. It involves participation of the family, health care providers, and the different factors that interact with the patient. Limitations: The study is limited to qualitative data derived from pulmonary TB patients living in an urban community in the Philippines. Suggestions for future research: Qualitative data may be triangulated using quantitative data for future research using a large number of participants.

A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation.

BackgroundThe increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure).ObjectiveThis study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances.MethodsA qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants’ experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA1c).ResultsTwenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c.ConclusionsSelf-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed.

Jane Speight: tackling diabetes and its stigma Down Under

Jane Speight is not fond of the label “diabetic”—she feels that calling people by their medical condition contributes to stigma. Australia has a growing number of people who, to her chagrin, might be labelled as diabetics. Out of a total population of about 24·5 million, Australia has more than 1·25 million people with diagnosed diabetes, including about 1·1 million with type 2 diabetes (about 500 000 more are estimated to have undiagnosed type 2 diabetes). Speight has called for increased research investment—particularly regarding behavioural and psychological research—from the Government. Since May, 2010, she has served as the Foundation Director of the Australian Centre for Behavioural Research in Diabetes (ACBRD), which is a partnership between Diabetes Victoria (a charitable organisation) and Deakin University (Geelong, VIC), where Speight holds the Chair in Behavioural and Social Research in Diabetes. She emphasises that the ACBRD serves not only as a research centre, but also as a national resource and a national voice; indeed it is becoming an increasingly international voice. Diabetes structured self-management education programmes: a narrative review and current innovationsBoth type 1 and type 2 diabetes are associated with long-term complications that can be prevented or delayed by intensive glycaemic management. People who are empowered and skilled to self-manage their diabetes have improved health outcomes. Over the past 20 years, diabetes self-management education programmes have been shown to be efficacious and cost-effective in promotion and facilitation of self-management, with improvements in patients' knowledge, skills, and motivation leading to improved biomedical, behavioural, and psychosocial outcomes. Full-Text PDF Distal technologies and type 1 diabetes managementType 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. Full-Text PDF

Perceptions of healthcare professionals regarding self-management by kidney transplant recipients in South Africa: A qualitative study

BackgroundKidney transplant is the recommended treatment for patients with end-stage renal disease. Healthcare professionals involved in kidney transplant management are the main stakeholders in facilitating quality evidence-based care to improve overall kidney transplant self-management, ultimately improving long-term durability of the transplanted kidney. PurposeThe purpose of the study was to explore perceptions of healthcare professionals regarding self-management by kidney transplant recipients in South Africa. MethodologyPurposive sampling was used to select study participants. Data were collected through semi-structured interviews developed from an in-depth reading of appropriate literature. A qualitative design was used. A sample size of 20 was determined by data saturation. Data were analyzed through the use of a thematic template. ResultsPerceptions of healthcare professionals regarding kidney transplant self-management were categorized in terms of benefits, barriers and consequences. The identified benefits included independence, procreation, improved quality of life, and decreased physical, financial and social burden. The perceived barriers included negative attitudes, lack of support, non-adherence, lack of education and insight on kidney transplant self-management. Perceived consequences of poor self-management included, financial burden, increased workload and low staff morale. Success of kidney transplant self-management is largely attributed to the healthcare professionals. ConclusionUnderstanding the perceptions of healthcare professionals regarding kidney transplant self-management may assist in developing in-service training programmes to remove barriers and to alter negative perceptions of healthcare professionals. This may enable them to improve their facilitation of self-management by kidney transplant recipients.

Self-management of musculoskeletal hand pain and hand problems in community-dwelling adults aged 50years and older: results from a cross-sectional study in a UK population.

BackgroundMusculoskeletal pain is common in adults, with the hand being frequently affected. Healthcare services have the potential to be of benefit to adults with hand pain and problems, through promotion and facilitation of self-management.MethodsThis paper explores existing self-management in a UK population of community-dwelling adults aged 50 years and over using data from surveys and a nested clinical cohort study. Self-management of hand problems was considered in three ways: self-directed treatment approaches used, adaptation behaviours adopted and choice to consult with a healthcare professional.ResultsThe treatment approaches most commonly used were ‘exercise/movement’ (n = 151, 69 %) and ‘resting’ the hands (n = 139, 69 %). The use of adaptation behaviour was widespread: 217 (99 %) people reported using one or more adaptation behaviours. Under half of survey respondents who reported hand pain (n = 783, 43 %) had consulted a healthcare professional about their problem during the last year: the lowest rate of consultation was for occupational therapy (n = 60, 3 %).ConclusionsSelf-directed treatment and adaptation behaviours were widespread in adults aged 50 years and over with hand problems, but consultation with a healthcare professional was low.

Narrowing the “digital divide”—facilitating access to computer technology to enhance the lives of those with aphasia: a feasibility study

Background: Despite advances in technology and the universal accessibility of the Internet, the aptly named “digital divide” still prevents equal access to, and use of, computer technology by people with aphasia. The use of technology has clear potential for improved quality of life in terms of increased methods for communicating as well as the facilitation of self-management; however, substantial barriers still pervade.Aims: The aims of this study were to evaluate a bespoke computer training course appropriate for people with aphasia and examine the personal experiences of a small sample of individuals with aphasia following their participation on the course.Methods & Procedures: This feasibility study with mixed-methods evaluation recruited participants with a range of aphasia severity and different experiences in using computers. Participants (n = 17) discussed their personal experiences of attending the computer course, gathered through topic-guided small focus groups, immediately postcourse and follow-up Refresher class. A Framework Method approach was considered an appropriate methodological design and data were analysed using thematic analysis. Participants also self-rated their skills in using computers before and following this bespoke computer course (n = 16) and at follow-up (n = 10), which was statistically analysed.Outcomes & Results: Statistically significant differences were found in the improved self-rated ability of a range of computer skills following course attendance. However, participants who attended a Refresher class (5, 9, or 12 months following course completion) reported that without support a number of these skills had notably declined. Three main themes emerged from the focus group data: (i) Facilitation of Social Engagement—technology offered new opportunities to communicate and more independently self-manage day-to-day tasks; (ii) Course Framework—participants reflected on their preferred model of delivery of the course; and finally (iii) Overcoming Barriers to Technology—the advantages of bespoke computer training, and requirements for ongoing support were highlighted as essential components of a training course appropriate for people with aphasia.Conclusions: The personal experiences of this group of people with aphasia highlight the advantages of accessing technology as a way of facilitating increased communication and an enhanced ability to manage their day-to-day lives. Yet, despite these benefits and the necessity for many people with aphasia to learn or relearn computer skills, finding courses that can accommodate individual needs is problematic. This research highlights the need for bespoke computer training and follow-on support, and highlights the necessary components of such training as identified by this group of people with aphasia.

Help yourself: perspectives on self-management from people with dementia and their caregivers.

Self-management interventions are increasingly offered to people with chronic health conditions. However, there has been limited exploration of how applicable such an approach is in early stage dementia. In this study we explored the views of people with dementia and family caregivers on the use of self-management in dementia. We conducted semistructured interviews with 13 people with early stage dementia and 11 caregivers. We analyzed transcripts using thematic analysis. We found eight themes in the analysis, and they indicated that self-management occurs in the context of peoples' family and social relationships as well as relationships with professional services. Six of the themes involved barriers to and facilitators of self-management. It is evident from these findings that people with dementia and caregivers use self-management techniques. Their use of such techniques could be enhanced by the development of interventions designed to help people with dementia to develop their self-management skills.

A systematic review of research into black and ethnic minority patients' views on self-management of type 2 diabetes.

Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population. To synthesize black and ethnic minority patients' views on the barriers and facilitators influencing the self-management of type 2 diabetes. A systematic search of international literature published in nine electronic databases was undertaken in 2008. Search strategies used both MeSH and free-text terms. Two relevant journals were also hand searched. Any primary empirical study published in the English language since 1986 that reported black and ethnic minority patients' views on type 2 diabetes self-management. Data were extracted and study quality was formally assessed. Data were analysed using thematic synthesis. Fifty-seven studies were included, of qualitative (n = 54), mixed-method (n = 2) or quantitative (n = 1) design. Studies were from North America (n = 41), Europe (n = 14) and Australia (n = 2), including 1735 participants in total. Three analytical themes emerged: 'Importance of identity'; 'Being understood by others' and 'Making sense of condition', all linked conceptually under the overarching theme 'Sense of self'. The quality of the studies varied. The findings provide insight into what black and minority ethnic people regard as the barriers to, and facilitators of self-management, as opposed to what health professionals, policy makers and trial researchers may have assumed. Recognition of the views of people with diabetes is essential for the design and delivery of patient-centred care and policies.

Perceptions of barriers and facilitators: Self-management decisions by older adolescents and adults with CF

Background Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. Methods Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. Results Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). Conclusions Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.

Self-management in Type 2 Diabetes

The purpose of this study was to document barriers and facilitators of self-management as perceived by adolescents with type 2 diabetes. Focus groups were conducted with adolescents diagnosed with type 2 diabetes. Adolescents aged 13 to 19 years were recruited from an academic medical center diabetes clinic. Between 2003 and 2005, 6 focus groups were used to elicit responses from the adolescents related to self-management of their diabetes. Questions were asked by trained group facilitators. Transcripts were coded by 3 reviewers. Qualitative analyses were conducted using NVIVO software. A total of 24 adolescents participated in 6 focus groups. Coding resulted in 4 common domains affecting self-management: adolescent psychosocial development; the role of others with diabetes; environmental influences; and adolescents' problem-solving/coping skills. Adolescents identified both barriers to and facilitators of self-management within each domain. Barriers often related to social situations, embarrassment, seeking acceptance or perceived normalcy, and balancing competing interests. Adolescents viewed having another family member with diabetes as both a positive and a negative influence. Environmental influences, including school and family situations, had a large impact on self-management behaviors. Making sensible food choices was a common challenge. Descriptions of problem-solving or coping skills were limited, but cognitive techniques, such as reframing, were described. Adolescents with type 2 diabetes identified many barriers to self-management, particularly related to interpersonal interactions, the influence of others with diabetes, and environmental influences. Results suggest that improving self-management in adolescents may require multimodal interventions to address individual, family, and social processes.