Health Education Impact Questionnaire Research Articles

Social Cognitive Predictors of Health Promotion Self-Efficacy Among Older Adults During the COVID-19 Pandemic.

To examine the relative importance of social cognitive predictors (ie, performance accomplishment, vicarious learning, verbal persuasion, affective state) on health promotion self-efficacy among older adults during COVID-19. Cross-sectional. Data collected online from participants in British Columbia (BC), Canada. Seventy-five adults (n = 75) aged ≥65years. Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale. Performance accomplishment was assessed using the health directed behavior subscale of the Health Education Impact Questionnaire; vicarious learning was measured using the positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS); verbal persuasion was assessed using the informational support subscale from the MOS-SSS; and affective state was assessed using the depression subscale from the Depression Anxiety Stress Scale (DASS-21). Multiple linear regression was used to investigate the relative importance of each social cognitive predictor on self-efficacy, after controlling for age. Our analyses revealed statistically significant associations between self-efficacy and performance accomplishment (health-directed behavior; β = .20), verbal persuasion (informational support; β = .41), and affective state (depressive symptoms; β = -.44) at P < .05. Vicarious learning (β = -.15) did not significantly predict self-efficacy. The model was statistically significant (P < .001) explaining 43% of the self-efficacy variance. Performance accomplishment experiences, verbal persuasion strategies, and affective states may be the target of interventions to modify health promotion self-efficacy among older adults, in environments that require physical and social distancing.

Influence of central aspects of pain on self-management in people with chronic low back pain

ObjectiveThis observational study investigated whether central aspects of pain are associated with self-management domains in individuals with chronic low back pain (CLBP) undertaking a pain management program. MethodsIndividuals with CLBP provided pain sensitivity and self-management data at baseline (n = 97) and 3-months (n = 87). Pressure pain detection threshold (PPT) at the forearm, temporal summation (TS) and conditioned pain modulation (CPM), Widespread Pain Index (WPI), and a Central Aspects of Pain factor (CAPf) were considered as central aspects of pain. Self-management was measured using the 8 domains of the Health Education Impact Questionnaire, as well as Pain Self Efficacy and Health Care Utilisation questionnaires. ResultsPPT, CPM, WPI and CAPf predicted worse performance in several self-management domains at 3-months (r = 0.21 to 0.54, p < 0.05 overall). In multivariable regression models (adjusted for baseline scores of self-management, depression, catastrophization, pain and fatigue) low PPT, high TS, and high CAPf at baseline predicted poorer self-management at 3 months (R2 =0.14 to 0.52, β = −0.37 to 0.35, p < 0.05). ConclusionsCentral aspects of pain are associated with impaired self-management, over and above effects of pain intensity, fatigue, depression and catastrophizing. Practice implicationsTreatments that target central aspects of pain might help improve self-management in people with CLBP.

The Experience of Home Parenteral Therapy: A Thematic Analysis of Patient Interviews.

A limited number of studies have explored patients' experience with home parenteral (injectable) therapy (HPT) in the UK. To explore the immediate-, short-, and long-term experience of patients with self-management of any home parenteral therapy with the intention for developing a guideline for service development in the United Kingdom. An interview-based study of patients receiving HPT. Invitations were posted to all patients on the hospital HPT register. The sessions were conducted by telephone for all consenting patients. The interviews were recorded, transcribed, and analysed thematically. Participants completed the 'Health Education Impact Questionnaire' (heiQ) before and after the education session. Of the 640 patients invited to participate in the study, 45 (7%) patients completed the interviews and the education session. An interview analysis revealed that the patients' experiences of HPT were generally positive, but the levels of training and support received showed wide individual variations. The patients had experienced periods of doubt and uncertainty, where they would have appreciated quick access to professional advice to alleviate their concerns. There was a reliable positive change (10.5-18.4%) from before and after the education sessions in six out of the eight domains on the heiQ questionnaire (health-directed behaviour, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, and emotional distress) and moderate change in two domains (5.3% in positive and negative engagement in life, and 2.6% in health services navigation). Self-administered parenteral therapy at home is a valuable option, but training and preparation standards should be optimised across hospitals and the wider NHS.

Heat-stone massage for patients with chronic musculoskeletal pain: a protocol for multicenter randomized controlled trial.

Chronic musculoskeletal pain bothers the quality of life for approximately 1.71 billion people worldwide. Although pharmacological therapies play an important role in controlling chronic pain, overuse of opioids, persistent or recurrent symptoms, and pain-related disability burden still need to be addressed. Heat-stone massage is using the heated stone to stimulate muscles and ligaments followed by massage for relax, which can potentially treat the chronic musculoskeletal pain. To determine the efficacy and safety of heat-stone massage for patients with chronic musculoskeletal pain is needed. This multicenter, 2-arm, randomized, positive drug-controlled trial will include a total of 120 patients with chronic musculoskeletal pain. The intervention group will receive a 2 week heat-stone massage, 3 times per week, whereas the control group will receive the flurbiprofen plaster twice per day for 2 weeks. The primary end point is the change in Global Pain Scale from baseline to the end of the 2 week intervention. The secondary outcomes include the pain severity (Numerical Rating Scale), pain acceptance (Chronic Pain Acceptance Questionnaire), self-management (Health Education Impact Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (Short Form-36). The intention-to-treat dataset will be used for analysis. The pain management remains the research topic that patients always pay close attention to. This will be the first randomized clinical trial to evaluate whether heat-stone massage, a non-pharmacological therapy, is effective in the chronic musculoskeletal pain management. The results will provide evidence for new option of daily practice. World Health Organization Chinese Clinical Trial Registry [ChiCTR2200065654; https://www.chictr.org.cn/showproj.html?proj=185403]; International Traditional Medicine Clinical Trial Registry [ITMCTR2022000104; http://itmctr.ccebtcm.org.cn/en-US/Home/ProjectView?pid=51776b6f-77b8-4811-9b5a-a0fec10f2cee].

Self-management-competency as a new target in Hidradenitis suppurativa care

Background: Hidradenitis suppurativa affects approximately 1% of the population.Objective: Highlighting the relevance of self-management-competency as a new therapeutic target.Method: 258 patients from the ‘Epidemiology and Care in Acne inversa (EpiCAi)’ project were included in the study. Disease burden was measured by patient-rated questionnaires in terms of disease activity, pain, quality of life, depression and insomnia and correlated with the domains of the health education impact questionnaire (heiQ) measuring self-management-competency.Results: 66 male (25.6%) and 192 female (74.4%) patients, with a mean age of 40.3 ± 10.24 years were included. Mean scores of pain on the numeric rating scale (NRS), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) were 5.11 ± 2.68, 11.35 ± 7.79 and 13.71 ± 7.57, respectively. The Insomnia severity index (ISI) showed a mean of 9.58 ± 5.76. The HADS has the highest increased total risk across all heiQ domains. With respect to the heiQ domains, the highest exposure can be attributed to improving constructive attitudes and approaches as well as decreasing emotional distress.Conclusion: There is a clear association of self-management-competency with overall disease burden, which underlines the need for psychoeducational support. This study provides ideas to develop new possible strategies of care.

The self-regulation skills instrument in transplantation (SSIt): Development and measurement properties of a self-report self-management instrument

ObjectiveTo develop a self-management instrument for organ transplant recipients that incorporates self-regulations skills and to determine its measurement properties. MethodsThe instrument includes concepts from social cognitive models: problem awareness, attitude, self-efficacy, motivation, social support, goal setting, goal pursuit, skills and goal affect. The measurement properties were evaluated based on the COSMIN guidelines. Face and content validity were determined through patient assessment, Three-Step Test-Interview and expert assessment using the Content Validity Index. Structural validity and reliability were tested using exploratory factor analysis and Cronbach’s alpha. Construct validity was tested by comparing subscales with the Health Education Impact Questionnaire (heiQ). ResultsAfter face and content validity assessment 47 items were entered into the exploratory factor analysis. The analysis showed two meaningful factors, with internal consistency of 0.90 and 0.89. Spearman correlations between the subscales and heiQ were moderate (0.55; 0.46). The final version consists of 21 items, divided into two scales: ‘Setbacks’ and ‘Successes’. ConclusionsThe Self-regulation skills instrument in transplantation (SSIt) is a valid and reliable instrument to asses necessary skills for self-management after transplantation and may be useful for other patients as well. Practice implicationsInsight into self-regulation competencies can help healthcare professionals to tailor self-management support.

Predictors of self-management in patients with chronic low back pain: a longitudinal study

BackgroundSelf-management (SM) is a key recommended strategy for managing chronic low back pain (CLBP). However, SM programmes generate small to moderate benefits for reducing pain and disability in patients with CLBP. The benefits of the SM programme can potentially be optimised by identifying specific subgroups of patients who are the best responders. To date, no longitudinal study has examined the predictive relationships between SM and biopsychosocial factors in patients with CLBP. The aim was to determine whether biopsychosocial factors predict SM and its change over time in patients with CLBP.MethodsIn this multi-centre longitudinal cohort study, we recruited 270 working-age patients with CLBP (mean age 43.74, 61% female) who consulted outpatient physiotherapy for their CLBP. Participants completed self-reported validated measures of pain intensity, disability, physical activity, kinesiophobia, catastrophising, depression and SM at baseline and six months. SM constructs were measured using eight subscales of the Health Education Impact Questionnaire (heiQ), including Health Directed Activity (HDA), Positive and Active Engagement in Life (PAEL), Emotional Distress (ED), Self-Monitoring and Insight (SMI), Constructive Attitudes and Approaches (CAA), Skill and Technique Acquisition (STA), Social Integration and Support (SIS) and Health Service Navigation (HSN). Data were analysed using General Linear Model (GLM) regression.ResultsPhysical activity and healthcare use (positively) and disability, depression, kinesiophobia, catastrophising (negatively) predicted (p < 0.05, R2 0.07–0.55) SM constructs at baseline in patients with CLBP. Baseline depression (constructs: PAEL, ED, SMI, CAA and STA), kinesiophobia (constructs: CAA and HSN), catastrophising (construct: ED), and physical disability (constructs: PAEL, CAA and SIS) negatively predicted a range of SM constructs. Changes over six months in SM constructs were predicted by changes in depression, kinesiophobia, catastrophising, and physical activity (p < 0.05, R2 0.13–0.32).ConclusionsSelf-reported disability, physical activity, depression, catastrophising and kinesiophobia predicted multiple constructs of SM measured using the heiQ subscales in working-age patients with CLBP. Knowledge of biopsychosocial predictors of SM may help triage patients with CLBP into targeted pain management programmes.Trial registrationThe study protocol was registered at ClinicalTrials.gov on 22 December 2015 (ID: NCT02636777).

Spinal Cord Injury & You Study Participants Health Education Impact Questionaire Scores

<h3>Research Objectives</h3> To explore how SCI&U study participants rated satisfaction, acceptability, and relevance post-intervention. SCI&U is a virtual health self-management program that utilizes the Peer Health Coaching model to support health, well-being, and enhanced quality of life for those living with spinal cord injury (SCI). <h3>Design</h3> The SCI-Peer Health Coach (PHC) plays a powerful role in promoting health-management among community-dwelling adults with spinal cord injury. PHCs are experienced peer mentors with SCI who are specifically trained to coach others with SCI. <h3>Setting</h3> PHCs used an online platform combining videoconferencing with an SCI health resource library, talking points, and conversation flow charts. Coaching also occurred using smart phones. <h3>Participants</h3> 8 community-dwelling adults 1- 23 years post-traumatic SCI. <h3>Interventions</h3> Person-centered coaching supported participants with identifying and managing barriers related to any health issue they wanted to address. PHCs completed up to 14 coaching calls during 30-45-minute-long scheduled coaching sessions with participants for up to 5 months. PHCs tracked the progress of their peers in setting and reaching their goals on a password protected portal. Peers completed assessments through the secure SCI&U platform post-intervention. <h3>Main Outcome Measures</h3> Participants rated satisfaction, acceptability, and relevance post-intervention using the Health Education Impact Questionnaire (heiQ) measure, which has high construct validity and is a reliable measure of a broad range of patient education program benefits for chronic condition management. <h3>Results</h3> heiQ mean scores averaged 3.7/4 for goal setting, information sharing, relevance, feeling validated, and the coaching relationship. <h3>Conclusions</h3> The SCI&U program was highly valued by program participants. Virtual coaching provided by a PHC is a viable role for future programs that aim to support addressing health needs and increasing the quality of life for the SCI community. <h3>Author(s) Disclosures</h3> The authors do not have any conflicts to declare.

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.

Evaluating the feasibility, effectiveness and costs of implementing person-centred follow-up care for childhood cancer survivors in four European countries: the PanCareFollowUp Care prospective cohort study protocol

IntroductionLong-term survival after childhood cancer often comes at the expense of late, adverse health conditions. However, survivorship care is frequently not available for adult survivors in Europe. The PanCareFollowUp Consortium...

Effectiveness of the “Living with Cancer” peer self-management support program for persons with advanced cancer and their relatives: study protocol of a non-randomized stepped wedge study

BackgroundPersons with advanced cancer and their relatives experience physical, emotional, and psychosocial consequences of the illness. Most of the time, they must deal with these themselves. While peer self-management support programs may be helpful, there is little evidence on their value for this population. We present the research protocol of our SMART study that will evaluate the effectiveness of the “Living with Cancer” peer self-management support program, aimed at improving self-management behaviors, self-efficacy, and health-related quality of life of persons with advanced cancer and their relatives.MethodsWe will conduct a non-randomized stepped wedge study in the Netherlands. We will include 130 persons with advanced cancer and 32 relatives. Participants can choose to either start the program within 4 weeks after inclusion or after eight to 10 weeks. The “Living with Cancer” is a peer self-management support program, based on the Chronic Disease Self-Management Program. It consists of six 1,5 hours video-conferencing group meetings with eight to 12 participants, preceded by two or three preparatory audio clips with supportive text per session. The program has the following core components: the learning of self-management skills (action-planning, problem-solving, effective communication, and decision-making), discussing relevant themes (e.g. dealing with pain and fatigue, living with uncertainty, and future planning), and sharing experiences, knowledge, and best practices. The primary outcome for both persons with advanced cancer and relatives is self-management behavior assessed by the subscale “constructive attitudes and approaches” of the Health Education Impact Questionnaire. Secondary outcomes are other self-management behaviors, self-efficacy, health-related quality of life, symptoms, depression and anxiety, and loneliness. Participants complete an online questionnaire at baseline, and after eight and 16 weeks. After each session, they complete a logbook about their experiences. Group meetings will be video recorded.DiscussionSMART aims to evaluate an innovative program building on an evidence-based self-management program. New features are its use for persons with advanced cancer, the inclusion of relatives, and the video-conferencing format for this population. The use of both quantitative and qualitative analyses will provide valuable insight into the effectiveness and value of this program.Trial registrationThis study was registered in the Dutch Trial Register on October 2021, identifier NL9806.

A Review of General Self-Management Assessment Tools in Chronic Diseases

Background and Aims One of the biggest challenges of the health systems in the 21st century is the increasing burden of chronic diseases. To address this challenge, many developed countries have begun to adopt self-management education programs. There are various tools for measuring the effectiveness of these programs in patients with chronic diseases. Some of these tools are designed to measure self-management in a particular disease, while some tools are used generally for a wide range of chronic diseases. This study aim to review the general tools used for measuring self-management in chronic diseases. Methods This is a narrative review. To find the studies used the tools for assessing self-management, a searched in online databases such as PubMed, Web of Science, Scopus, and Google Scholar on related studies published from 2000 to 2020. Results The general tools available for assessing self-management in chronic diseases were: Self-Management Screening (SeMaS) Scale, Self-Management Ability Scale (SMAS), Self-Control and Self-Management Scale (SCMS), Partners in Health Scale (PIH), and Health Education Impact Questionnaire (heiQ). Conclusion There are various general tools for self-management evaluation in chronic diseases. It is necessary to select the appropriate tool based on the goals.

Personality and its association with self-management in multiple sclerosis

BackgroundIn a healthcare system which aims to empower the patient, self-management becomes increasingly important. In Multiple Sclerosis, an effective self-management is associated with various favorable health-related outcomes like improvement in quality of life, the reduction of depression and anxiety symptoms, and reduced healthcare costs. This study investigates the association between the Big Five personality traits and self-management including activity in self-help groups. MethodsPeople with MS were recruited via several paths within Germany (e.g. medical practices, social events and the German MS society). The final study sample consisted of 682 participants who answered a multidimensional questionnaire. This comprised the Big-Five-Inventory-10 for personality, the Health Education Impact Questionnaire (heiQ) for self-management competencies, questions for participation in self-help groups, and socio-demographic and clinical variables. ResultsMultivariate regression analyses showed that personality could explain a greater amount of variance of self-management than socio-demographic and clinical variables. Neuroticism was the strongest predictor and correlated negatively with all heiQ-dimensions of self-management. In contrast, in logistic regression analysis none of the Big Five traits became significant in predicting the activity in self-help groups. ConclusionAs expected, personality plays an important role regarding self-management. Ideally, a time-saving personality assessment should be considered in routine clinical practice to identify patients at risk; however, at a minimum, personality traits should be considered in consultations with their neurologists. They may need help to understand the benefits of effective self-management and should receive support to improve their self-management skills and to reduce their neuroticism to lower the risk of secondary complications.

Positive impact of a co-designed digital resource for women with early menopause.

To evaluate a co-designed early menopause digital resource, including audio/video clips, question prompt list, and information links. Pre/post-test study. Women with early menopause, defined as menopause before age 45 years, were recruited from the community. Following online informed consent, participants were emailed links to the digital resource and online surveys to complete before (baseline) and, immediately and 1 month after viewing the resource. Main outcome measures: Health-related empowerment (Health Education Impact Questionnaire), illness perception (Brief Illness Perception Questionnaire), menopause symptoms (Greene Climacteric Scale), risk perception, and knowledge change. One hundred fifty women participated. Compared to baseline, at 1-month health-related empowerment, 'health directed behavior' scores increased (mean change: +0.13; 95% CI: 0.01-0.24; and P = 0.03), 'emotional distress' decreased (mean change: -0.15; 95% CI: -0.25 to -0.05; and P = 0.003) and physical and emotional menopause symptom scores decreased (P = 0.001 and P = 0.02, respectively). Illness perception scores increased at both immediate and 1-month follow-up versus baseline for 'personal control' (P < 0.001 and P = 0.02) and 'coherence' (P = 0.003 and P < 0.001). After viewing the digital resource, more women perceived that hormone therapy decreases heart disease risk, reduces hot flashes, and prevents fractures versus baseline (all P < 0.05). More women correctly answered questions regarding early menopause prevalence (60% vs 35%), cause (46% vs 33%), risk (76% vs 55%), effect of phytoestrogens (60% vs 27%), and osteoporosis prevention (64% vs 44%) at immediate or 1-month follow-up versus baseline (all P < 0.05). A co-designed early menopause digital resource may improve women's health-related empowerment, illness perception, menopause symptoms, risk perception, and knowledge.

A Student-Led Community Outreach Telehealth Program for COVID Education and Health Promotion (COACH)

While public health measures of quarantining, socially isolating, and physical distancing are important to minimize the spread of coronavirus (COVID-19), these actions may also compromise the ability to manage one’s own health, thereby increasing the risk of adverse health events. The purpose of this study was to evaluate a student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) to community-living adults (age ≥65 years). We hypothesized that COACH would improve health promoting behaviour as measured by the Health Directed Behaviour subscale of the Health Education Impact Questionnaire. We also anticipated COACH would improve secondary outcomes of perceived stress, depressive and anxiety (Depression, Anxiety, and Stress Scale-21), social support (Medical Outcomes Study Social Support Survey), health-related quality of life (Short Form-36), and health promotion self-efficacy (Self-Rated Abilities for Health Practices Scale). In this single-group pre-post study, we recruited 75 community-living adults with access to telephone/video-conferencing technology to participate in six 30-45 minute sessions with trained medical students over a two-month period. The mean age of participants was 72.4 years (58.7% female), with 80% reporting two or more chronic conditions. No participants were diagnosed with COVID-19 during participation. Paired sample t-tests showed significant improvement in health directed behaviour (p < .001, d = 0.45) and self-efficacy (p <.001, d = 0.44), but significant decrease in mental health-related quality of life (p < .001, d = -1.69). Overall, COACH may help improve health directed behaviour and health promotion self-efficacy, despite decreases in mental health possibly associated with COVID-19 restrictions.

Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Context Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. Conclusion The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual’s self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.

The Use of SMS Text Messaging to Improve the Hospital-to-Community Transition in Patients With Acute Coronary Syndrome (Txt2Prevent): Results From a Pilot Randomized Controlled Trial.

BackgroundAcute coronary syndrome (ACS) is a leading cause of hospital admission in North America. Many patients with ACS experience challenges after discharge that impact their clinical outcomes and psychosocial well-being. SMS text messaging has the potential to provide support to patients during this postdischarge period.ObjectiveThis study pilot tested a 60-day SMS text messaging intervention (Txt2Prevent) for patients with ACS. The primary objective was to compare self-management domains between usual care and usual care plus Txt2Prevent. The secondary objectives were to compare medication adherence, health-related quality of life, self-efficacy, and health care resource use between groups. The third objective was to assess the feasibility of the study protocol and the acceptability of the intervention.MethodsThis was a randomized controlled trial with blinding of outcome assessors. We recruited 76 patients with ACS from St. Paul’s Hospital in Vancouver, Canada, and randomized them to 1 of 2 groups within 7 days of discharge. The Txt2Prevent program included automated 1-way SMS text messages about follow-up care, self-management, and healthy living. Data were collected during the index admission and at 60 days after randomization. The primary outcome was measured with the Health Education Impact Questionnaire (heiQ). Other outcomes included the EQ-5D-5L, EQ-5D-5L Visual Analog Scale, a modified Sullivan Cardiac Self-Efficacy Scale, and Morisky Medication Adherence Scale scores, and self-reported health care resource use. Analyses of covariance were used to test the effect of group assignment on follow-up scores (controlling for baseline) and were considered exploratory in nature. Feasibility was assessed with descriptive characteristics of the study protocol. Acceptability was assessed with 2 survey questions and semistructured interviews.ResultsThere were no statistically significant differences between the groups for the heiQ domains (adjusted mean difference [Txt2Prevent minus usual care] for each domain—Health-directed activity: –0.13, 95% CI –0.39 to 0.13, P=.31; Positive and active engagement in life: 0.03, 95% CI –0.19 to 0.25, P=.76; Emotional distress: 0.04, 95% CI –0.22 to 0.29, P=.77; Self-monitoring and insight: –0.14, 95% CI –0.33 to 0.05, P=.15; Constructive attitudes and approaches: –0.10, 95% CI –0.36 to 0.17, P=.47; Skill technique and acquisition: 0.05, 95% CI –0.18 to 0.27, P=.69; Social integration and support: –0.12, 95% CI –0.34 to 0.10, P=.27; and Health services navigation: –0.05, 95% CI –0.29 to 0.19, P=.69). For the secondary outcomes, there were no statistically significant differences in adjusted analyses except in 1 self-efficacy domain (Total plus), where the Txt2Prevent group had lower scores (mean difference –0.36, 95% CI –0.66 to –0.50, P=.03). The study protocol was feasible, but recruitment took longer than expected. Over 90% (29/31 [94%]) of participants reported they were satisfied with the program.ConclusionsThe Txt2Prevent study was feasible to implement; however, although exploratory, there were no differences between the 2 groups in adjusted analyses except for 1 self-efficacy domain. As the intervention appeared acceptable, there is potential in using SMS text messages in this context. The design of the intervention may need to be reconsidered to have more impact on outcome measures.Trial RegistrationClinicalTrials.gov NCT02336919; https://clinicaltrials.gov/ct2/show/NCT02336919International Registered Report Identifier (IRRID)RR2-10.2196/resprot.6968

Pulmonary Rehabilitation Improves Self-Management Ability in Subjects With Obstructive Lung Disease.

Optimizing self-management is a key element in multidisciplinary pulmonary rehabilitation in patients with asthma or COPD. This observational study aimed to investigate the changes in self-management following pulmonary rehabilitation in subjects with chronic lung disease. Data were prospectively and routinely gathered at initial assessment and discharge in subjects taking part in a 12-week multidisciplinary out-patient pulmonary rehabilitation program. Measures of self-management included the Patient Activation Measure (PAM), the Health Education Impact Questionnaire (HEIQ) (8 subscales), a Self-Efficacy Questionnaire (2 subscales), the Lung Information Needs Questionnaire (LINQ), and the Health Literacy Questionnaire (HLQ) (9 subscales). Mean differences with 95% CI and effect sizes were computed. A total of 70 subjects (62.9% women) were included, with a median age of 63.5 y; most of the subjects had been diagnosed with COPD (77%). Between admission and discharge, all measures of self-management increased significantly except for the HEIQ subscales of constructive attitudes and approaches, social integration and support, and health services navigation; and the HLQ subscale of social support for health. The largest improvements (effect size > 0.55) were seen for the PAM (0.57); the HEIQ subscales of health-directed behavior (0.71), self-monitoring and insight (0.62), and skill and technique acquisition (1.00); the HLQ subscales of having sufficient information to manage my health (1.21) and actively managing my health (0.66); and the LINQ (1.85). Self-management, including activation, improved significantly in subjects with asthma or COPD who took part in a multidisciplinary pulmonary rehabilitation program.

Self-management and adherence to recommended follow-up after gynaecological cancer: results from the international InCHARGE study

ObjectiveTo assess the relationship between self-management skills and adherence to follow-up guidelines among gynecological cancer survivors in the Netherlands, Norway, and Denmark, and to assess the relationship between adherence to...

A study protocol for a multicenter randomized pilot trial of a dyadic, tailored, web-based, psychosocial, and physical activity self-management program (TEMPO) for men with prostate cancer and their caregivers

BackgroundProstate cancer predisposes patients and caregivers to a wide range of complex physical and psychosocial challenges, and interventions must incorporate a wide range of self-management strategies to help patients and their caregivers effectively cope with cancer challenges. To palliate this need, our team recently developed and evaluated the initial acceptability of a dyadic, Tailored, wEb-based, psychosocial, and physical activity self-Management PrOgram (TEMPO). TEMPO is a 10-week, interactive, web-based intervention consisting of five modules designed to help dyads manage their physical and psychosocial needs. It aims to teach dyads new self-management strategies and encourages them to increase their physical activity (PA) levels, mainly through walking and strength-based exercises. Initial acceptability evaluation of TEMPO revealed high user satisfaction, in addition to having a number of potential benefits for participants. After integrating suggested changes to TEMPO, the proposed pilot study aims to further test the acceptability and feasibility of TEMPO.MethodsThis study is a multicenter, stratified, parallel, two-group, pilot randomized control trial (RCT), where patient–caregiver dyads are randomized (stratified by anxiety level) to receive (a) TEMPO or (b) usual care. Participants (n goal = 40) are recruited across Canada at participating cancer centers and through self-referral (e.g., online recruitment). Patient inclusion criteria are (a) having received prostate cancer treatment within the past 2 years or scheduled to receive treatment, (b) identified a primary caregiver willing to participate in the study, and (c) has access to the Internet. Eligible caregivers are those identified by the patient as his primary source of support. Dyads complete a baseline questionnaire (T1) and another one 3 months later (T2) assessing various aspects of physical and emotional functioning (e.g., the Medical Outcomes Study (MOS) 12-item Short Form Health Survey (SF-12), the Hospital Anxiety and Depression Scale (HADS), and the Perceived Stress Scale (PSS)), self-management behaviors (e.g., the Health Education Impact Questionnaire (heiQ)), physical activity (the International Physical Activity Questionnaires (IPAQ) and the Multidimensional Self-efficacy for Exercise Scale (MSES)), and dyadic coping (the Dyadic Coping Inventory (DCI)). Dyads that used TEMPO are also asked to participate in a semi-structured exit interview exploring their overall experience with the program.DiscussionThis feasibility analysis will begin to develop the knowledge base on TEMPO’s value for men with prostate cancer and their caregivers to inform a larger trial.Trial registrationNCT04304196