Self-management Goals Research Articles

680-P: Impact of Continuous Glucose Monitoring Shared Medical Appointments on Planned Self-Management Changes

Introduction: Continuous glucose monitoring (CGM) measures glucose up to 288 times per day allowing people with diabetes (PWD) to see in real-time how medications, food, exercise, and stress, affect glucose levels. Clinicians interpret this information to make lifestyle and medication recommendations. Objective: To identify common learning outcomes and planned self-management changes resulting from CGM shared medical appointments. Study Design: A two-part CGM Shared Medical Appointment was led by certified diabetes educators (pharmacists, nurses and dieticians). Professional CGM devices were inserted and participants returned the following week for removal, discussion and education in a group format. Inclusion criteria for this study were as follows: age > 18 years, >3 days of CGM data, and attendance of both classes. A post-course survey was given with structured interview questions asking (1) “What is one thing you learned from the CGM class experience?” and (2) “Which changes do you plan to make to your diabetes care?” Questions were answered in written format. After digital transcription entry, data were coded and analyzed using content analysis to devise themes by two reviewers. Findings: A total of 170 PWD participated in the CGM class and 140 (82.35%) completed the post-course survey. Class sizes ranged from 3-6 participants. The most common learning outcomes were nutrition self-management knowledge (35.77%), pattern interpretation (18.25%) and blood glucose awareness (13.87%). The most common planned self-management changes were nutrition related (56.82%), self-management behavioral goals (24.42%) (log patterns, increase monitoring frequency) and medication adjustments (23.48%) (basal rates, carbohydrate ratios, timing and consistency of medications). Conclusion: Continuous Glucose Monitoring Shared Medical Appointments are an innovative strategy to facilitate lifestyle changes and medication adjustments for people with diabetes. Disclosure J.E. Blanchette: Consultant; Self; Dexcom, Inc., Tandem Diabetes Care. D. Noe: None. N. Galloway: None. H. Sullivan: None. A. Ha: Consultant; Self; Tandem Diabetes Care. D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis.

Factorial Structure and Psychometric Analysis of the Persian Version of Perceived Competence Scale for Diabetes (PCSD-P).

As a basic psychological need, the level of perceived competence could expedite the achievement of diabetes self-management goals. Because of a lack of a specific data collection tool to measure the level of self-competence among Persian-speaking patients with diabetes, this study was conducted for (1) cross-cultural adaptation and (2) psychometric assessment of the Persian version of the Perceived Competence Scale for Diabetes (PCSD-P). Standard translation/back-translation procedure was carried out to prepare a preliminary draft of the PCSD-P. Content and face validities of the early draft were checked by an expert panel including 15 scholars in the field of health education and promotion as well as nursing education with experience of working and research on diabetes. The final drafted questionnaire was completed by 177 randomly selected patients with type 2 diabetes. On the basis of the collected data, the structural validity of the contrived version was appraised using exploratory and confirmatory factor analysis (EFA, CFA). Cronbach’s alpha and intraclass correlation (ICC) coefficients were used to check the scale’s reliability and internal consistency. The estimated measures of content validity index (CVI = 0.95) and content validity ratio (CVR = 0.8) were within the acceptable recommended range. The EFA analysis results demonstrated a single factor solution according to the items’ loadings for the corresponding component. The model fit indices, that is, root mean square error approximation (RMSEA = 0.000), comparative fit index (CFI = 1), Tucker–Lewis index (TLI = 1), incremental fit index (IFI = 1), normed fit index (NFI = 0.999), and relative fit index (RFI = 0.995), confirmed the consistency of the hypothesized one-factor solution. The values of the internal consistency and reliability coefficients were also in the vicinity of an acceptable range (α = 0.892, ICC = 0.886, P = 0.001). The study findings revealed good internal validity and applicability of the PCSD-P to measure the degree of self-competence among Persian-speaking type 2 diabetes patients to manage the chronic disease. Owing to unrepresentativeness of the study sample, future cross-cultural tests of PCSD-P are recommended on diverse and broader Persian-speaking populations.

A Novel Approach to Helping People with Glaucoma Use Their Drops Routinely.

Pharmacy data reveal that 70% of patients were missing one or more days worth of drops out of five. Adopting approaches to behavior change and management skills used for people with diabetes may provide insight to improve self-management of glaucoma. Every person who is diagnosed with a chronic health condition such as glaucoma has unique life circumstances that may present barriers to behavior change. An accurate diagnosis and a treatment plan are useless if patients do not use their prescribed eye drops. Active listening and effective communication can result in persons who are more engaged in their self-care behaviors. Collaborative communication using person-centered and strengths-based messages could help eye care providers identify challenges and concerns for people with glaucoma who are experiencing inconsistencies with their eye drops. In an atmosphere where patients can discuss their challenges with treatment recommendations without judgment or fear, they are more likely to trust their provider and therefore share their situation openly and honestly. This is accomplished by choosing language that communicates mutually-agreed-upon self-management goals and addresses and strengthens individual and clinical outcomes. The eye care professional is then seen by the patient as a resource who can empathize when setbacks occur and reinforce the patient's self-management goals. Open-ended questions and tell-ask-tell approaches for identifying barriers to care are keys to more effective communication and trusting relationships. This includes recognizing that glaucoma is associated with increased rates of anxiety or depression that may be an overlooked barrier to self-management. By adopting language recommendations from diabetes care and education, eye care practitioners may be better equipped to help people with glaucoma improve their self-care.

Exploring interventions to increase primary care providers’ use of self-management goals

Accreditors, such as the Joint Commission, consider evidence of patient engagement strategies for awarding Primary Care/Patient-Centered Medical Home (PCMH) accreditation. This project explored the use of brief Motivational Interviewing (MI) training at a local county health center and evaluated the impact on the documented use of self-management goals (SMGs) for patients with diabetes and hypertension. Methods included a professional development program, including an online module, presentation, and educational materials. The goal was to increase providers’ MI knowledge and skills to better construct and document SMGs. The program impact was evaluated by chart review to determine the use of SMGs by providers in patients with diabetes and hypertension. The presentation evaluation included participant scoring of statements based on learning objectives. Results of the presentation objectives included > than 3.88/4 means of each item and indicated satisfaction with the presentation. Pre implementation (N=120) chart review demonstrated that only 7% of the charts contained SMG documentation. One month after the program completion, no change (6%) was noted in providers’ (N= 86) SMG documentation. Informal interviews with providers indicated favorable attitudes toward increasing patient engagement with MI and formation of SMGs but challenges were identified such as too little time with patients, health literacy, and lack of resources. Conclusions indicate that innovative options should be developed to support providers in the development and documentation of SMGs.

Guideline Development for Technological Interventions for Children and Young People to Self-Manage Attention Deficit Hyperactivity Disorder: Realist Evaluation.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. ADHD can affect the individual, the individual’s family, and the community. ADHD is managed using pharmacological and nonpharmacological treatments, which principally involves others helping children and young people (CAYP) manage their ADHD rather than learning self-management strategies themselves. Over recent years, technological developments have meant that technology has been harnessed to create interventions to facilitate the self-management of ADHD in CAYP. Despite a clear potential to improve the effectiveness and personalization of interventions, there are currently no guidelines based on existing evidence or theories to underpin the development of technologies that aim to help CAYP self-manage their ADHD.ObjectiveThe aim of this study was to create evidence-based guidelines with key stakeholders who will provide recommendations for the future development of technological interventions, which aim to specifically facilitate the self-management of ADHD.MethodsA realist evaluation (RE) approach was adopted over 5 phases. Phase 1 involved identifying propositions (or hypotheses) outlining what could work for such an intervention. Phase 2 involved the identification of existing middle-range theories of behavior change to underpin the propositions. Phase 3 involved the identification and development of context mechanism outcome configurations (CMOCs), which essentially state which elements of the intervention could be affected by which contexts and what the outcome of these could be. Phase 4 involved the validation and refinement of the propositions from phase 1 via interviews with key stakeholders (CAYP with ADHD, their parents and specialist clinicians). Phase 5 involved using information gathered during phases 1 to 4 to develop the guidelines.ResultsA total of 6 specialist clinicians, 8 parents, and 7 CAYP were recruited to this study. Overall, 7 key themes were identified: (1) positive rewarding feedback, (2) downloadable gaming resources, (3) personalizable and adaptable components, (4) psychoeducation component, (5) integration of self-management strategies, (6) goal setting, and (7) context (environmental and personal). The identified mechanisms interacted with the variable contexts in which a complex technological intervention of this nature could be delivered.ConclusionsComplex intervention development for complex populations such as CAYP with ADHD should adopt methods such as RE, to account for the context it is delivered in, and co-design, which involves developing the intervention in partnership with key stakeholders to increase the likelihood that the intervention will succeed. The development of the guidelines outlined in this paper could be used for the future development of technologies that aim to facilitate self-management in CAYP with ADHD.

Computer-Mediated Experiences of Patients With Chronic Obstructive Pulmonary Disease

ABSTRACTBackground: The Internet is an important tool for empowering patients with chronic obstructive pulmonary disease (COPD) to learn about and self-manage their condition. Purpose: The purpose of this study was to understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals. Methods: Semistructured interviews were conducted with medically underserved patients with COPD (N = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method. Results: The following themes were derived: (1) desire to associate with “in-group” members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions. Discussion: Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections. Translation to Health Education Practice: Prior to directing patients with COPD to a disease-specific online support platform, Certified Health Education Specialists must assess patients’ information goals and their skills to critically appraise and communicate with other online users.

Achieving self-management goals among low income older adults with functional limitations

Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults’ physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.

Research on Modeling and Hierarchical Scheduling of a Generalized Multi-Source Energy Storage System in an Integrated Energy Distribution System

Energy storage systems play a crucial role in ensuring stable operation. However, the development of system-level energy storage is hindered due to the restrictions of economy, geography, and other factors. Transitions of traditional power systems into integrated energy distribution systems (IEDS) have provided new solutions to the problems mentioned above. Through intelligent control management methods, the utilization of multi-energy-type resources both on the supply and demand sides shows the potential for equivalent storage characteristics. Inspired by the aggregation principles, this paper aims at proposing a novel model named generalized multi-source energy storage (GMSES), including the modeling and cooperation of three kinds of available resources: conventional energy storage (CES), multi-energy flow resources (MFR), and demand response resources (DRR). Compared with the conventional means of storage, GMSES can be regarded as a more cost-effective and flexible participant in the proposed hierarchical energy scheduling framework that can realize system-level storage services in IEDS. On this basis, a multi-timescale energy scheduling strategy is proposed to reshape the regulation of IEDS operations and deal with the fluctuations caused by renewable energy and loads, where the general parameter serialization (GPS)-based control strategy is utilized to select and control the responsive loads in DRR. Furthermore, a hierarchical scheduling algorithm is developed to generate the optimal set-points of GMSES. Case studies are analyzed in an electricity-gas coupled IEDS. The simulation results show that the coupled co-optimization GMSES model is conducive to achieving the goal of self-management and economical operation, while the influence of the underlying IEDS on the upper energy system is reduced, as the tie-line power fluctuations are smoothed out.

Impact of a person-centered intervention for patients with head and neck cancer: a qualitative exploration

BackgroundPeople affected by head and neck cancer (HNC) experience a variety of multifaceted health-related problems during the treatment process, based on both the disease and side effects, several years after the treatment is complete. This study investigated a person-centred intervention using transition theory as a framework.AimThus, the aim of the present study was to explore patients’ experience of the transition and person centred care from diagnosis to the end of the treatment period.MethodsInterviews were conducted with 12 persons included in the person-centred intervention group. The patients were recruited from a randomised controlled study. We used a directed deductive content analysis as an analysis method.ResultsThere was a distinct transition between being a healthy person to being diagnosed with a serious disease. The majority of the participants felt that the diagnosis had put their lives in the balance; they felt both healthy and sick at the same time, and all participants described that their symptoms and side effects were the worst possible and totally unexpected. Of great importance was the health-care plan, comprising self-management goals which were formed in partnership between the patient and the nurse. The participants experienced that their interaction and engagement with lay persons and healthcare professionals supported a gradual acceptance of the situation and a sense of relief with a kind of awareness of the disease.ConclusionThe intervention played a significant role in promoting a healthy transition. Person-centredness and transition theory can help healthcare professionals to be more confident and resourceful in supporting people affected by HNC.

Improving Self-Management Skills Among People With Spinal Cord Injury: Protocol for a Mixed-Methods Study.

BackgroundMost people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury.ObjectiveThis study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users.MethodsThis study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants.ResultsWe expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization.ConclusionsIf the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice.Trial RegistrationClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ)International Registered Report Identifier (IRRID)PRR1-10.2196/11069

ICanCope with Sickle Cell Pain: Design of a randomized controlled trial of a smartphone and web-based pain self-management program for youth with sickle cell disease

Many adolescents with sickle cell disease (SCD) experience recurrent and chronic pain, which has a negative impact on their health-related quality of life (HRQL). Cognitive-behavioral therapy (CBT) interventions can lead to improvement in pain and HRQL, yet due to barriers to care, most youth with SCD will not receive these interventions. To address this need for innovative programs targeting youth with SCD pain, we developed iCanCope, a tailored smartphone and web-based program that delivers a pain self-management intervention to youth with SCD. We describe the rationale, design, and implementation of a three-site parallel group randomized controlled trial with a sample of 160 adolescents with SCD and their parent caregivers. The iCanCope program includes pain self-management skills training (personalized CBT-based coping skills such as deep breathing, relaxation, and cognitive skills), goal setting, and social support. The attention control group is provided with access to a self-guided website with education about SCD. Assessments will occur at baseline (T1), immediately after completion of the intervention (12 weeks; T2) and at 6 months post-intervention (T3). Primary outcomes include coping strategies and pain intensity; secondary outcomes include physical, social, and emotional functioning, treatment satisfaction, health service use and caregiver response to youth pain behavior. Potential mediators (goal setting, self-management, and perceptions of social support) and moderators (e.g., demographic factors) will also be tested. The objective is to offer an effective, convenient, and low-cost psychosocial intervention to youth with SCD to enhance their self-management of pain.

MHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience.

BackgroundGiven the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions.ObjectiveThe objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts.MethodsWe conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method.ResultsIn this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting.ConclusionsThis study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.

Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient-Provider Interactions.

A person-centered approach to goal-setting, involving collaboration between patients and health professionals, is advocated in policy to support self-management. However, this is difficult to achieve in practice, reducing the potential effectiveness of self-management support. Drawing on observations of consultations between patients and health professionals, we examined how goal-setting is shaped in patient-provider interactions. Analysis revealed three distinct interactional styles. In controlled interactions, health professionals determine patients' goals based on biomedical reference points and present these goals as something patients should do. In constrained interactions, patients are invited to present goals, yet health professionals' language and questions orientate goals toward biomedical issues. In flexible interactions, patients and professionals both contribute to goal-setting, as health professionals use less directive language, create openings, and allow patients to decide on their goals. Findings suggest that interactional style of health professionals could be the focus of interventions when aiming to increase the effectiveness of goal-setting.

Development of a safeguarding approach to enable people with traumatic brain injury or spinal cord injury to self-manage their supports

Introduction: The Lifetime Care and Support Authority, NSW Australia (icare lifetime care) aims to enhance opportunities for people with spinal cord injury and traumatic brain injury to have increased choice and control over the way their supports are delivered and managed. Description of policy context and objective: The objectives of this project were to: Develop a service model which provides opportunities for icare lifetime care participants to have increased choice and control over the management of their care and supports. To identify and manage risk to participants and to the scheme associated with icare lifetime care entering into direct funding agreements with an increased number of participants. Provide an approach for icare lifetime care to manage requests for direct funding by participants or their nominees, including planning for appropriate safe guarding strategies prior to approving direct funding agreements. Target population: icare lifetime care funds treatment, rehabilitation and care for people who have been catastrophically injured in a motor vehicle accident in NSW, Australia. Injuries sustained include severe traumatic brain injury, spinal cord injury, multiple limb amputations, burns and blindness. Highlights (innovation, impact and outcomes): The presentation will outline how icare lifetime care developed, and now applies, a safeguard planning approach to participant requests to manage their own supports through a direct funding arrangement. Participants may have cognitive and behavioural disability following their injury, or may have complex social histories. The safeguard planning approach considers individual participant risk and their skills to manage the tasks involved in self-management. Capacity building and other risk mitigation factors are considered as part of the plan. Comments on sustainability: The self-management service model became available for participants in late 2016. Growth is currently slow but steady. To date, 20 participants are self-managing their care, with an annual cost of $3.3mil. icare lifetime care is working with another 40 participants who are interested in moving to self-management. Comments on transferability: The presentation will explore opportunities which will support increased numbers of participants benefitting from self-management, including sharing participant stories, peer support and future online payment systems. The safeguarding approach has been successful in identifying participant risk, skills and strategies to develop capacity and to mitigate risk to participants and the scheme, enabling participants to achieve their goal of self-management. Conclusions (comprising key findings, discussion and lessons learned): icare lifetime care’s self-management service model is presented including the ways participants are currently using the service options within the model to meet their needs. The safeguarding approach will be discussed including the role of monitoring risk to ensure participants achieve successful outcomes. Case examples will be used to demonstrate the model and the application of the safeguarding approach.

Supporting Self-Management in Children and Adolescents With Complex Chronic Conditions.

Self-management improves health outcomes in chronic illness not only by improving adherence to the treatment plan but also by building the individual's capacity to navigate challenges and solve problems. Support for self-management is a critical need among children and adolescents with (medically and/or socially) complex chronic conditions. Self-management support refers to services that health systems and community agencies provide to persons with chronic illness and their families to facilitate self-management; it is a collaboration between the patient, family, and care providers. Evidence has guided the development of self-management support approaches and tools for adults and has led to an increased adoption of best practices in adult chronic illness care. However, adult models fail to account for some key differences between children and adults, namely, the integral role of parents and/or caregivers and youth development over time. There is a need for self-management support models that take into account the developmental trajectory across the pediatric age range. Effective approaches must also recognize that in pediatrics, self-management is really shared management between the youth and the parent(s) and/or caregiver(s). Health systems should design care to address self-management for pediatric patients. Although clinicians recognize the importance of self-management in youth with complex chronic conditions, they need standardized approaches and tools to do the following: assess the self-management skills of youth and families, assess modifiable environmental influences on chronic conditions, collaboratively set self-management goals, promote competence and eventual autonomy in youth, share the responsibility for self-management support among nonphysician members of the health care team, and leverage community resources for self-management support.

Role of Active Versus Passive Complementary and Integrative Health Approaches in Pain Management.

BackgroundA general conclusion about the treatment of chronic, noncancer pain is that the results from traditional, passive modalities are disheartening. Perhaps this may be due to the propensity of patients to seek out passive versus active treatments. In pain management, active treatments should be the primary focus, with passive interventions as an adjunct.ObjectiveThe current study tested the hypotheses that Veterans would report a greater significant increase in active versus transitional and active versus passive complementary and integrative health (CIH) utilization after completing a formal pain education program.MethodsThe current study is a secondary analysis of existing data from an original study. The current study used a quasi-experimental, 1-group, pre-/posttest design. One hundred three Veterans completed a 12-week, “Pain Education School” program at a Midwestern VA Medical Center between November 4, 2011, and October 26, 2012. As part of the introduction and conclusion of the program, all Veterans completed a pre- and posteducation assessment which included an adaptation of the Complementary and Alternative Medicine Questionnaire©, SECTION A: Use of Alternative Health Care Providers measure.ResultsSignificant differences were found between the pre- and posttest measures of use of active (P = .000) (p<.001), transitional (P = .011), and passive (P = .007) CIH modalities.ConclusionThe current findings suggest that an educational intervention in conjunction with the availability of treatment options has the potential to increase the use of those treatments. The current pain education program also seems to be aligned with the goal of pain self-management, which is to utilize more active interventions as a primary therapy.

The Flexible Lifestyle Empowering Change (FLEX) intervention for self-management in adolescents with type 1 diabetes: Trial design and baseline characteristics

The Flexible Lifestyle Empowering Change (FLEX) Intervention Study is a multi-site randomized controlled trial to test the efficacy of an adaptive behavioral intervention to promote self-management for youth with type 1 diabetes mellitus (T1D). This paper details FLEX design, demographic characteristics of the sample, and outcome variables at baseline. Participants were randomized to either an intervention or control arm after their baseline standardized measurement visit. Baseline data for the primary (glycemic levels) and secondary outcome variables (e.g., motivation and problem-solving, health-related quality of life, risk factors associated with T1D complications) as well as the potential mediator variables (e.g., self-management behavior, family conflict and responsibility) suggest that the study sample was representative of the general population of adolescents with T1D and their parents. The FLEX adaptive intervention is an innovative application of a tailored treatment intervention designed to be readily adopted in real-world practice to meet each adolescent's individualized T1D self-management goals.

Disentangling self-management goal setting and action planning: A scoping review.

IntroductionThe ongoing rise in the numbers of chronically ill people necessitates efforts for effective self-management. Goal setting and action planning are frequently used, as they are thought to support patients in changing their behavior. However, it remains unclear how goal setting and action planning in the context of self-management are defined in the scientific literature. This study aimed to achieve a better understanding of the various definitions used.MethodsA scoping review was conducted, searching PubMed, Cinahl, PsychINFO and Cochrane. Inclusion and exclusion criteria were formulated to ensure the focus on goal setting/action planning and self-management. The literature was updated to December 2015; data selection and charting was done by two reviewers. A qualitative content analysis approach was used.ResultsOut of 9115 retrieved articles, 58 met the inclusion criteria. We created an overview of goal setting phases that were applied (preparation, formulation of goals, formulation of action plan, coping planning and follow-up). Although the phases we found are in accordance with commonly known frameworks for goal setting, it was striking that the majority of studies (n = 39, 67%) did not include all phases. We also prepared an overview of components and strategies for each goal setting phase. Interestingly, few strategies were found for the communication between patients and professionals about goals/action plans. Most studies (n = 35, 60%) focused goal setting on one single disease and on a predefined lifestyle behavior; nearly half of the articles (n = 27, 47%) reported a theoretical framework.DiscussionThe results might provide practical support for developers of interventions. Moreover, our results might encourage professionals to become more aware of the phases of the goal setting process and of strategies emphasizing on patient reflection. However, more research might be useful to examine strategies to facilitate communication about goals/action plans. It might also be worthwhile to develop and evaluate goal setting/action planning strategies for people with different and multiple chronic conditions.

Impact of a primary healthcare quality improvement program on diabetes in Canada: evaluation of the Quality Improvement and Innovation Partnership (QIIP)

ObjectivePrimary healthcare (PHC) quality improvement (QI) initiatives are designed to improve patient care and health outcomes. We evaluated the Quality Improvement and Innovation Partnership (QIIP), an Ontario-wide PHC QI program...

Perspectives of Older Kidney Transplant Recipients on Kidney Transplantation.

Older kidney transplant recipients are susceptible to cognitive impairment, frailty, comorbidities, immunosuppression-related complications, and chronic graft failure, however, there has been limited focus on their concerns and expectations related to transplantation. This study aims to describe the perspectives of older kidney transplant recipients about their experience of kidney transplantation, self-management, and treatment goals to inform strategies and interventions that address their specific needs. Face-to-face semistructured interviews were conducted with 30 kidney transplant recipients aged 65-80 years from five renal units in Australia. Transcripts were analyzed thematically. Six themes were identified: restoring vitality of youth (with subthemes of revived mindset for resilience, embracing enjoyment in life, drive for self-actualization); persisting through prolonged recovery (yielding to aging, accepting functional limitations, pushing the limit, enduring treatment responsibilities); imposing sicknesses (combatting devastating comorbidities, painful restrictions, emerging disillusionment, anxieties about accumulating side effects, consuming treatment burden); prioritizing graft survival (privileged with a miracle, negotiating risks for longevity, enacting a moral duty, preserving the last opportunity); confronting health deterioration (vulnerability and helplessness, narrowing focus to immediate concerns, uncertainty of survival); and value of existence (purpose through autonomy, refusing the burden of futile treatment, staying alive by all means). Older kidney transplant recipients felt able to enjoy life and strived to live at their newly re-established potential and capability, which motivated them to protect their graft. However, some felt constrained by slow recuperation and overwhelmed by unexpected comorbidities, medication-related side effects, and health decline. Our findings suggest the need to prepare and support older recipients for self-management responsibilities, clarify their expectations of post-transplant risks and outcomes, and provide assistance through prolonged recovery after kidney transplantation.