Improve Self-management Behaviors Research Articles

Improving Diabetic Care Through Education and Innovation.

Background: Despite the innovative advancements in diabetes care, providers may not recognize patients with type 2 diabetes mellitus (T2DM) who qualify for a continuous glucose monitoring (CGM) device or the benefits of a telemedicine program for improving self-management behaviors. Objective: This quality improvement (QI) project aimed to determine if an advanced practice registered nurse (APRN)-led telemedicine program using CGM could improve glycemic control and self-management in patients with insulin-dependent T2DM. Methods: A 6-week telemedicine program was developed and implemented using the CGM's time-in-range to deliver patient-specific education. Clinical metrics were collected at each visit. All patients completed a pre- and postintervention Diabetes Self-Management Questionnaire-Revised (DSMQ-R) survey. Results: A repeated measures analysis of variance revealed that the telemedicine program had a statistically significant impact on time-in-range outcomes, F(2, 14) = 18.203, p < .001. Paired-samples t tests indicate that APRN-led education improved body mass index, t(8) = 4.232, p = .002; decreased systolic blood pressure, t(8) = 2.90, p = .010, and diastolic blood pressure, t(8) = 3.21, p = .007; and increased self-management skills as evidenced by DSMQ-R, t(8) = -5.498, p < .001. Conclusions: This QI project highlights multiple interventions for improving diabetes management in a primary care facility. Implications for Nursing: An APRN-led telemedicine program integrating CGM time-in-range data can improve glycemic control and self-management skills in patients with T2DM who administer insulin.

Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence.

Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.

Intertemporal decision-making as a mediator between personality traits and self-management in type 2 diabetes: a cross-sectional study.

The aims to investigate the mediating effect of intertemporal decision-making on the association between personality traits and self-management among individuals with in Type 2 Diabetes (T2DM). Patients with T2DM in the early stages of hospitalization at two tertiary hospitals in Shenyang and Jinzhou, Liaoning Province, May 2022 to January 2023. Questionnaires, including General Demographic, Self-Management, Big Five Personality, and Intertemporal Decision-Making, were administered. Pearson correlation analysis examined relationships between personality traits, intertemporal decision-making, and self-management. Hierarchical regression analysis identified self-management predictors. Mediation analysis used the PROCESS SPSS Macro version 3.3 model 4 to investigate intertemporal decision-making as mediator between personality traits and self-management. Pearson correlation analysis revealed significant associations between self-management scores, personality traits, and intertemporal decision-making. Hierarchical regression revealed that Neuroticism and Conscientiousness accounted for 20.8% of the variance in self-management, while intertemporal decision-making explained 4.5% of the variance. Finally, using the Bootstrap method, the mediation analysis showed that intertemporal decision-making partially mediated the effect of personality traits on self-management. This study emphasizes the importance of intertemporal decision-making in improving self-management behaviors among patients with T2DM. Interventions targeted at modifying intertemporal decision-making preferences could be effective in enhancing self-management behaviors, leading to better health outcomes.

Relationship between illness perception and self-management behaviors among Chinese diabetic foot patients.

The aims of the present study are to describe the status of self-management behaviors and illness perception, and explore the relationship between illness perception and self-management behaviors among Chinese diabetic foot patients. A cross-sectional study was conducted at the endocrinology department of a comprehensive tertiary hospital in Guangzhou, China. Data were collected on illness perception, self-management behaviors, and demographic and clinical characteristics over 9 months among 156 subjects. Data were analyzed using Pearson correlation analysis, univariate analysis and multiple linear regression analysis. Only 3.2% of participants maintained excellent self-management behaviors. Additionally, the participants perceived diabetic foot as chronic and could be well controlled through treatment. Multiple linear regression analysis revealed that illness perception was associated with self-management behaviors. Patient illness perception is an important factor influencing self-management behaviors. It may be helpful to improve self-management behaviors by tailoring the content of the intervention to fit the patients' illness perceptions.

A chatbot for hypertension self-management support: user-centered design, development, and usability testing.

Health-related chatbots have demonstrated early promise for improving self-management behaviors but have seldomly been utilized for hypertension. This research focused on the design, development, and usability evaluation of a chatbot for hypertension self-management, called "Medicagent." A user-centered design process was used to iteratively design and develop a text-based chatbot using Google Cloud's Dialogflow natural language understanding platform. Then, usability testing sessions were conducted among patients with hypertension. Each session was comprised of: (1) background questionnaires, (2) 10 representative tasks within Medicagent, (3) System Usability Scale (SUS) questionnaire, and (4) a brief semi-structured interview. Sessions were video and audio recorded using Zoom. Qualitative and quantitative analyses were used to assess effectiveness, efficiency, and satisfaction of the chatbot. Participants (n = 10) completed nearly all tasks (98%, 98/100) and spent an average of 18 min (SD = 10 min) interacting with Medicagent. Only 11 (8.6%) utterances were not successfully mapped to an intent. Medicagent achieved a mean SUS score of 78.8/100, which demonstrated acceptable usability. Several participants had difficulties navigating the conversational interface without menu and back buttons, felt additional information would be useful for redirection when utterances were not recognized, and desired a health professional persona within the chatbot. The text-based chatbot was viewed favorably for assisting with blood pressure and medication-related tasks and had good usability. Flexibility of interaction styles, handling unrecognized utterances gracefully, and having a credible persona were highlighted as design components that may further enrich the user experience of chatbots for hypertension self-management.

#3956 PRIORITY OUTCOMES FOR EDUCATION AND SELF-MANAGEMENT IN NON-DIALYSIS CHRONIC KIDNEY DISEASE: A PATIENT AND PROFESSIONAL DELPHI SURVEY

Abstract Background and Aims It is important for people living with Chronic Kidney Disease (CKD) to develop the knowledge, skills, and confidence (patient activation) to effectively self-manage their health in partnership with their healthcare team. Resources intended to educate and support self-management should be subject to robust evaluation to provide the evidence base for clinical implementation. Trials in both research and clinical practice settings should include outcomes which are meaningful and valued by all users, but these are not known for CKD education and self-management interventions. We carried out a Delphi survey to identify the priorities valued by both CKD patients and healthcare professionals (HCPs) in the UK. Method Kidney patients and multidisciplinary kidney HCPs based in the UK were invited to complete two sequential rounds of an online Delphi survey. People with CKD and their significant others (SOs) were invited via social media, and HCPs via direct email. For Round One, participants were asked to identify in their own words the 3 potential benefits (outcomes) for CKD self-management that they personally considered to be most important. These free-text responses were collated and analysed inductively using conventional content analysis to identify dominant themes and constituent items. In Round Two, participants were asked to rate each of these items on a 9-point Likert scale from 1 (least important) to 9 (most important), and overall median ratings were calculated for each theme. Results 135 participants contributed to Round One: 47% (64) CKD patients/SOs; 51% (69) kidney HCPs; 2 individuals identified in both groups. 58% of HCPs who were invited by email agreed to take part. Round One analysis identified 28 outcome items which fell into 5 main themes: clinical; knowledge, skills, and confidence to manage own health; behaviour and self-care; psychological and social factors; healthcare usage. 69% (44) of invited CKD patients/SOs and 77% (53) HCPs took part in Round Two. Table 1 shows the median ratings for each theme. The highest-ranked overall and for both groups was “clinical”, while “healthcare usage” was ranked the lowest. Conclusion Our UK Delphi survey has identified a range of potential benefits for successful self-management in non-dialysis CKD, which were categorised into 5 main themes. Clinical outcomes such as improving blood pressure management or avoiding progression to end stage kidney disease were the top priority for both CKD patient/SO and HCP participants. Aspects of patient activation (knowledge, skills, and confidence to manage health) were also rated as important by both groups. This Delphi survey identified which benefits kidney patients and HCPs value most from effective CKD education and self-management. It is important that the views of intended users of new interventions are consulted throughout the development process to ensure that the product meets their needs and expectations. The information we present here is vital for the successful design, evaluation and implementation of interventions and support tools to educate people with CKD and enable them to improve self-management behaviours.

Effect of nutritional promotion intervention on dietary adherence among type II diabetes patients in North Shoa Zone Amhara Region: quasi-experimental study

BackgroundDiabetes is a major global public health problem that requires self-management behavior. However, this is difficult to implement in practice and requires new approaches. The purpose of this study was to evaluate nutritional promotion interventions for dietary adherence and lessons learned to improve self-management.MethodsA quasi-experimental study was conducted from January 2020 to February 2021 in North Shoa Zone public hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Study participants were randomly assigned to intervention and control groups at an individual level. Data were measured twice (baseline and end line survey after six months using interviewer-administered questionnaires). Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t tests. A p-value less than 0.05 was considered significant for all statistical tests.ResultsA total of 216 type II diabetics participated in this study. Nutritional promotion intervention programs increased adherence to the mean number of days adhering to a healthy diet (p < 0.0001). Specifically, the nutrition promotion program improved daily intake of fruits and vegetables, low glycemic index foods, high fiber foods, healthy fish oils, low sugar foods, and healthy eating plans (p ≤ 0.050). Mean fasting blood glucose levels were significantly decreased after the educational intervention (p ≤ 0.05).ConclusionThis study demonstrates that a nutrition-promoting intervention can significantly change patients' adherence to healthy eating behaviors and effectively improve their glycemic control. Health care providers should integrate programs that promote nutrition education into existing health systems service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.

Effect of physical activity promotion program on adherence to physical exercise among patients with type II diabetes in North Shoa Zone Amhara region: a quasi-experimental study

BackgroundDiabetes is a significant global public health issue that necessitates self-management. However, this is difficult to put into practice and requires a new approach. The purpose of this study was to assess the effects of a physical activity promotion program on adherence to recommended physical activity and lessons to improve self-management.MethodsA quasi-experimental study was conducted from January 2020 to February 2021 at North Shoa Zone Public Hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t-tests. A p-value less than 0.05 was considered significant for all statistical tests.ResultsA total of 216 type II diabetics participated in this study. Physical activity promotion programs increased adherence to the recommended number of days and duration (spending time) of physical activity (p < 0.0001). Participants who engaged in the physical activity promotion program significantly increased the mean scores for exercising moderate-intensity activities and spending time (p < 0.05), walking for at least 10 min continuously and spending time (p < 0.05), exercising moderate-intensity recreational activities and spending time (p < 0.05).There was a significant reduction in mean fasting blood glucose after participating in a physical activity program (p < 0.05).ConclusionThis study demonstrates that a physical activity promotion program makes a significant difference in patient compliance with recommended physical activity and effectively improves patient glycemic control. Health care providers should integrate physical activity programs into existing systems as a common therapeutic service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.

Self-Management Program in Adults with Colorectal Cancer: A Pilot Study

Objective: To design and validate a nursing intervention and its effect on improving self-management behaviors in patients with colorectal cancer following surgery within eight weeks after discharge. Method: Pilot study using Sidane and Braden’s intervention design proposal, which included determining the guiding theoretical model, characterization of the intervention, validation with eight experts through content validity, and a pilot test with ten patients during the second semester of 2020. Results: The intervention obtained, called the Program for Self-Management Training in Colorectal Cancer (PEACCR, by its acronym in Spanish), is based on the theory of individual and family self-management in the dimensions proposed by Ryan and Sawin. The validity with experts indicates that it meets the criteria of clarity, precision, comprehension, relevance, and pertinence. The pilot reports an increase in self-management behaviors and the dimensions of knowledge, coping, and health personnel-patient alliance in months 1 and 2, with statistical significance. Conclusions: The designed and validated intervention increases the self-management behaviors of patients with colorectal cancer. The proposed scheme is highly acceptable to participants.

Self-Management Program in Adults with Colorectal Cancer: A Pilot Study

Objective: To design and validate a nursing intervention and its effect on improving self-management behaviors in patients with colorectal cancer following surgery within eight weeks after discharge. Method: Pilot study using Sidane and Braden’s intervention design proposal, which included determining the guiding theoretical model, characterization of the intervention, validation with eight experts through content validity, and a pilot test with ten patients during the second semester of 2020. Results: The intervention obtained, called the Program for Self-Management Training in Colorectal Cancer (PEACCR, by its acronym in Spanish), is based on the theory of individual and family self-management in the dimensions proposed by Ryan and Sawin. The validity with experts indicates that it meets the criteria of clarity, precision, comprehension, relevance, and pertinence. The pilot reports an increase in self-management behaviors and the dimensions of knowledge, coping, and health personnel-patient alliance in months 1 and 2, with statistical significance. Conclusions: The designed and validated intervention increases the self-management behaviors of patients with colorectal cancer. The proposed scheme is highly acceptable to participants.

Self-management and illness perception among cervical cancer patients: A cross-sectional study.

This study aimed to describe self-management among cervical cancer patients and to elucidate the relationship between illness perception and self-management in patients with cervical cancer. This was a cross-sectional study. A convenience sample of 220 cervical cancer patients was recruited from the gynaecology outpatient department of a cancer hospital. Data were collected from September 2018 to February 2019. Self-management and illness perception were assessed using the Cancer Self-Management Assessment Scale and the Revised Illness Perception Questionnaire for cervical cancer, respectively. Data were analysed using Pearson correlation analysis, univariate analysis and hierarchical linear regression analysis. The mean score of self-management was 3.87 ± 0.53, and daily life management showed the highest score (4.18 ± 0.58), while symptom management was the lowest (3.11 ± 082). Hierarchical linear regression analysis showed that family monthly income per person, types of surgery and personal control were factors that significantly influenced self-management. The results demonstrate that self-management among patients with cervical cancer needs to be improved. The significant influence of illness perception offers an opportunity for nurses to improve self-management behaviours of patients with cervical cancer.

Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China.

Chronic kidney disease (CKD) is an incurable disease requiring lifelong management. China has a high prevalence of CKD, which disproportionately affects older adults and those with chronic risk factors for CKD development. The rising prevalence of CKD in China places a substantial burden on the general population and the healthcare system. In China, there are currently many unmet needs for patients with CKD and high-risk individuals, resulting from a lack of education and support to reduce risk factors, delayed diagnoses, limited knowledge of CKD among primary-care physicians, and poor access to treatments among some patient populations. An integrated, nationwide approach is required to improve the current situation of CKD management in China. There are currently several national healthcare frameworks in place that focus on new major health policies to prevent disease and encourage people to adopt healthier lifestyles, and while they do not directly target CKD, they may have a positive indirect impact. We explore the unmet needs for patients with CKD in China and discuss the potential strategies that may be required to overcome them. Such strategies include improving physician and patient education, establishing a targeted screening programme, supporting patients to improve self-management behaviours, accelerating the creation of medical consortia and medical satellite centres, and migrating from hospital- to community-based management. In addition to policy-driven strategies, development of novel therapies will be key to providing new solutions for the long-term management of CKD. An integrated, nationwide approach is required, incorporating policy-driven changes to the clinical management of CKD, as well as the development of novel CKD treatments.

Practical Guidance for Healthcare Providers on Collaborating with People with Type 2 Diabetes: Advancing Treatment and Initiating Injectable Therapy.

Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.Infographic and video abstract available for this article.

The law of non-usage attrition in a technology-based behavioral intervention for black adults with poor cardiovascular health.

Digital health innovations, such as telehealth and remote monitoring, have shown promise in addressing patient barriers to accessing evidence-based programs and providing a scalable path for tailored behavioral interventions that support self-management skills, knowledge acquisition and promotion of relevant behavioral change. However, significant attrition continues to plague internet-based studies, a result we believe can be attributed to characteristics of the intervention, or individual user characteristics. In this paper, we provide the first analysis of determinants of non usage attrition in a randomized control trial of a technology-based intervention for improving self-management behaviors among Black adults who face increased cardiovascular risk factors. We introduce a different way to measure nonusage attrition that considers usage over a specific period of time and estimate a cox proportional hazards model of the impact of intervention factors and participant demographics on the risk of a nonusage event. Our results indicated that not having a coach (compared to having a coach) decreases the risk of becoming an inactive user by 36% (HR = .63, P = 0.04). We also found that several demographic factors can influence Non-usage attrition: The risk of nonusage attrition amongst those who completed some college or technical school (HR = 2.91, P = 0.04) or graduated college (HR = 2.98, P = 0.047) is significantly higher when compared to participants who did not graduate high school. Finally, we found that the risk of nonsage attrition among participants with poor cardiovascular from "at-risk" neighborhoods with higher morbidity and mortality rates related to CVD is significantly higher when compared to participants from "resilient" neighborhoods (HR = 1.99, P = 0.03). Our results underscore the importance of understanding challenges to the use of mhealth technologies for cardiovascular health in underserved communities. Addressing these unique barriers is essential, because a lack of diffusion of digital health innovations exacerbates health disparities.

Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial

BackgroundDiabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs’ social networks. Fifty to 75% of AWDs have an unpaid family member or friend (“support person”) who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs’ diabetes management.MethodsThis parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach.The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months.The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient’s diabetes. We also will assess the effect of the COVID-19 pandemic on patient’s ability to manage diabetes.DiscussionThis study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.Trial registrationClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

Effects of a theory-based training program with follow-up home visits on self-management behavior, glycemic index, and quality of life among Iranian patients with type 2 diabetes mellitus

BackgroundUncontrolled diabetes is an important public health problem that endangers the quality of life of patients. Promoting self-management through well-planned training is an essential strategy to control diabetes effectively. This study aimed to examine the effects of a training program based on social cognitive theory (SCT) on self-management behavior, glycemic index, and quality of life among patients with type 2 diabetes mellitus.MethodsThis is a quasi-experimental study with a pretest–posttest design. The statistical population included 106 adults with type 2 diabetes mellitus assigned to the intervention and control groups [n1 = n2 = 53], who received services from two urban health centers. A multi-method, SCT-based training program consisting of six 60–80-min sessions was run, followed by 2–3 follow-up home visits [once a month for each participant] for the intervention group. The data were collected before and three months after the intervention and were analyzed in SPSS 19.ResultsBefore the intervention, there was no significant difference between the two groups regarding the main variables. After the intervention, there was a significant increase in the intervention group's mean scores of knowledge, self-efficacy, social support, outcome expectations, self-regulation, self-management behavior, glycemic index, and quality of life. There were no significant changes in these constructs in the control group after the intervention. The regression analysis results indicated that social cognitive theory and self-management could explain the variance in quality of life [adjusted R-squared = 0.476].ConclusionsThe findings support the effectiveness of the multi-method, SCT-based educational intervention in improving self-management behaviors, glycemic index, and quality of life among patients with type 2 diabetes mellitus. It is suggested that the quality of type 2 diabetes care programs should be promoted. However, further research is needed to evaluate the long-term outcomes.

Consensus on Recommended Functions of a Smart Home System to Improve Self-Management Behaviors in People With Heart Failure: A Modified Delphi Approach.

BackgroundSmart home systems could enhance clinical and self-management of chronic heart failure by supporting health monitoring and remote support, but evidence to guide the design of smart home system functionalities is lacking.ObjectiveTo identify consensus-based recommendations for functions of a smart home system that could augment clinical and self-management for people living with chronic heart failure in the community.MethodsHealthcare professionals caring for people living with chronic heart failure participated in a two-round modified Delphi survey and a consensus workshop. Thirty survey items spanning eight chronic health failure categories were derived from international guidelines for the management of heart failure. In survey Round 1, participants rated the importance of all items using a 9-point Liket scale and suggested new functions to support people with chronic heart failure in their homes using a smart home system. The Likert scale scores ranged from 0 (not important) to 9 (very important) and scores were categorized into three groups: 1–3 = not important, 4–6 = important, and 7–9 = very important. Consensus agreement was defined a priori as ≥70% of respondents rating a score of ≥7 and ≤ 15% rating a score ≤ 3. In survey Round 2, panel members re-rated items where consensus was not reached, and rated the new items proposed in earlier round. Panel members were invited to an online consensus workshop to discuss items that had not reached consensus after Round 2 and agree on a set of recommendations for a smart home system.ResultsIn Round 1, 15 experts agreed 24/30 items were “very important”, and suggested six new items. In Round 2, experts agreed 2/6 original items and 6/6 new items were “very important”. During the consensus workshop, experts endorsed 2/4 remaining items. Finally, the expert panel recommended 34 items as “very important” for a smart home system including, healthy eating, body weight and fluid intake, physical activity and sedentary behavior, heart failure symptoms, tobacco cessation and alcohol reduction, medication adherence, physiological monitoring, interaction with healthcare professionals, and mental health among others.ConclusionA panel of healthcare professional experts recommended 34-item core functions in smart home systems designed to support people with chronic heart failure for self-management and clinical support. Results of this study will help researchers to co-design and protyping solutions with consumers and healthcare providers to achieve these core functions to improve self-management and clinical outcomes in people with chronic heart failure.

A smartphone application of diabetes coaching intervention to prevent the onset of complications and to improve diabetes self-management: A randomized control trial

Background and aimDiabetes mellitus (DM) has been a worldwide public health problem during the last two decades. To examine the effect of a smartphone application of diabetes coaching intervention on improving self-management behaviors and preventing onset diabetes complications. MethodsA randomized control trial, two groups, pre-test, and post-test design with a non-equivalent control group was conducted. The intervention group received a 12-week smartphone application of diabetes coaching intervention to improve diabetes self-management behaviors and to prevent onset diabetes complications. While the control group received the usual care from the community health centers. The smartphone application consisted of narrative App-based coaching, a printed user guide, mindfulness-based coaching; skill-based coaching, and a small App-interaction. ResultsAfter implementation, the self-management behaviors among the experimental group were improved than the control group in terms of dietary control, physical exercise, blood glucose monitoring, medication adherence, and screening of complications. The clinical outcomes were also significantly improved among the experimental group and to the control group. ConclusionsA smartphone application-based diabetes coaching intervention was feasible to apply as a nationwide program to promote diabetes self-management (DSM) during the covid-19 pandemic

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.

MO1052: Feasibility of ‘Smile-K’, a Remote Randomized Controlled Trial of an Online Self-Management Programme for People Living with Kidney Disease

Abstract BACKGROUND AND AIMS It is desirable for people with non-dialysis chronic kidney disease (ND-CKD) to take an active role in the management of their own health, but this requires the appropriate knowledge, skills and confidence (termed patient activation) to effectively self-manage. Currently, there is a lack of resources available to improve self-management behaviours and actively involve individuals in their own healthcare. Our group has developed a 10-week online self-management programme for people with non-dialysis CKD, called ‘My Kidneys &amp; Me’ (MK&amp;M), currently undergoing evaluation in the ‘SMILE-K’ multi-centre randomized control trial (RCT), which is conducted entirely online (remotely). The primary outcome of ‘SMILE-K’ is patient activation, but to ensure that the full-scale trial protocol is feasible and to minimize methodological weaknesses, we conducted a nested single-blind pilot with feasibility outcomes. Here we report the results of the nested pilot and preliminary usage data for ‘MK&amp;M’. METHOD The ‘SMILE-K’ trial employs an entirely remote recruitment method, with a 2:1 randomization into intervention and control arms. The first 60 participants were included in the nested pilot and followed up for 10-weeks. Assessment surveys, including the Patient Activation Measure, were conducted electronically at baseline (pre-randomization) and 10 weeks later. Progression criteria were set a priori, using the ‘red’ (stop), ‘amber’ (make changes) and ‘green’ (go) system to specify targets for progression, based on recruitment rates, acceptability of recruitment and randomization methods, the feasibility and acceptability of outcome assessments, and engagement with and usage of ‘MK&amp;M’. RESULTS Of the first 128 people approached who expressed interest in ‘SMILE-K’, 77/128 (60%) consented to participate. Of these, 60/77 (78%) completed the baseline outcome survey and were subsequently randomized and included in the pilot. The average age of pilot participants was 63 (range: 20–88) years and 63% (n = 38) were male. Sending study invitations via post was the most common method of recruitment, although additional discussion of the study with potential participants (either face-to-face or via telephone) increased recruitment rates. All of the pre-specified ‘stop’ progression criteria thresholds were exceeded, indicating that the full planned RCT is feasible. Access to and engagement with ‘MK&amp;M’ were high, with 36/41 (88%) participants activating their accounts and logging in. Participants logged into ‘MK&amp;M’ a mean of 35 times during the 10-week follow-up period and spent a mean of 14 min/login. CONCLUSION This nested pilot study provided evidence for the feasibility of the full-scale ‘SMILE-K’ trial. Numerous lessons were learnt from conducting this entirely remote trial design, and from the pilot findings, we identified areas for improvement and have made subsequent small amendments to the trial protocol to improve the delivery of ‘MK&amp;M’ and ‘SMILE-K’. The ‘SMILE-K’ trial is currently ongoing, and we anticipate that the results will be available in 2023.