Person-centered Interventions Research Articles

CE Workshop 08: Theory and Practice in the Design and Evaluation of Cognition-Oriented Treatments in Aging and Dementia

Abstract & Learning Objectives:Cognition-Oriented Treatments (COTs) such as cognitive training and rehabilitation are increasingly recognized for their potential benefits for older people at risk of or with dementia, as well as for people with other conditions. An effective and well-informed use of such approaches depends on researchers and clinicians developing a careful understanding of key theoretical assumptions and of practical considerations. The workshop will provide participants with background theory and practical knowledge related to the application of COTs in research and practice, including review of the evidence, and demonstration of key principles in designing and delivering person-centered interventions likely to result in clinically meaningful outcomes. After attending this workshop, participants will be able to summarize the basic assumptions and techniques associated with different COTs, recognize important person and intervention-related factors likely to moderate treatment response, and able to apply those in designing COTs in research and clinical practice. Upon conclusion of this course, learners will be able to: 1.Summarize basic theoretical assumptions and key techniques underpinning cognition-oriented treatments2.Recognize key person-related and intervention-related factors moderating response to cognition-oriented treatments3.Design appropriate clinical trials to evaluate cognition-oriented treatments

Monitoring hearing and vision functions in older adults: rationale and process.

Hearing and vision impairment are highly prevalent in ageing individuals and are significant public health concerns given their meaningful impacts on individuals and society. Yet, many cases of both visual and hearing impairment remain unidentified and thus, unaddressed. This article describes the rationale and process of monitoring for visual and hearing impairment in older adults, by summarising guidance and resources available from the World Health Organisation (WHO) that were developed based upon the best current available evidence. It is recommended that vision screening be offered at least annually to adults aged over 50years and hearing screening be offered every 5years to adults aged 50-64years, and every 1-3years to adults aged 65years or older. Both hearing and vision screening can be conducted in community, home or clinical settings by trained health workers with simple equipment. More specifically, vision screening can be conducted with a simple eye chart. Hearing screening can be conducted without specialised equipment by using pure tones set to a fixed level, an automated mobile- or web-based digits-in-noise test, or the whispered voice test. Hearing screening can also be conducted in audiology clinics using pure-tone air conduction threshold testing. There exists WHO guidance to support the monitoring of hearing and vision impairment, which, when warranted, can facilitate referral for comprehensive assessment and prompt appropriate, person-centred interventions to mitigate the negative consequences of hearing and vision impairment.

Cancer prevention for people experiencing homelessness: Co-designing the Health Navigator Model

Abstract Introduction Cancer is the second leading cause of death for people experiencing homelessness (PEH) due to limited access to cancer prevention services. This study aimed to co-adapt the Health Navigator Model (HNM), integrating end-users’ and organizations’ voices in the design of a care delivery model combining Patient Navigation and Patient Empowerment - models that have been shown to benefit different health outcomes by reducing health inequalities and improving access to cancer prevention services. Methods Participatory qualitative research was conducted through focus groups between December 2021 and January 2022 across four European countries (Austria, Greece, Spain, and United Kingdom). Seven focus groups with an overall sample size of 56 participants were conducted, including 41 professional stakeholders and 15 PEH. Focus groups were audio-recorded, transcribed verbatim, and thematically analyzed. Results Analysis identified four key features of the HNM, including (1) assessment of needs and barriers to access health care (e.g., seeking solutions regarding barriers to care); (2) promoting cancer awareness and self-management (e.g., encouraging user involvement in health-related decisions); (3) facilitating access to preventive services (e.g., coordinating and supporting attendance of clinical appointments); (4) providing practical assistance (e.g., assisting with paperwork). Regarding the profile of health navigators, a health or social care professional background accompanied by active engagement with relevant/local stakeholders to improve intervention delivery is enhanced. Conclusions The HNM is a person-centered intervention to improve self-care and build relationships with PEH. Health Navigators should provide practical assistance, coordinate access to cancer prevention care and promote cancer awareness and self-management. The HNM is currently piloted and evaluated across four European countries as part of the Horizon 2020 CANCERLESS project (GA 965351). Key messages • The Health Navigator Model is a person-centered intervention responsive to the needs of people experiencing homelessness, building trusting relationships, and improving levels of self-care. • Health Navigators should provide people experiencing homelessness with practical assistance and coordinated access to cancer prevention care while promoting cancer awareness and self-management.

Effectiveness of a person-centred eHealth intervention in reducing symptoms of burnout in patients with common mental disorders – secondary outcome analysis of a randomized controlled trial

BackgroundThe number of people with common mental disorders (CMDs), especially stress-related disorders, has increased in several countries, including Sweden, during the past decade. Patients seeking care for long-term stress report severe symptoms. Although person-centred care (PCC) has shown several benefits, studies evaluating the effects of a PCC eHealth intervention on patients with CMDs are scarce.ObjectiveThe aim of this study was to compare levels of self-reported symptoms of burnout between a control group receiving treatment as usual (TAU) and an intervention group receiving TAU with the addition of a person-centred eHealth intervention, in patients on sick leave for CMDs.MethodsThis study reports analysis of a secondary outcome measure from a randomized controlled trial. Patients (n = 209) on sick leave for CMDs were recruited from nine primary health care centres and allocated to either a control group (n = 107) or an intervention group (n = 102). The intervention consisted of phone support and an interactive digital platform built on PCC principles. Self-reported symptoms of burnout were assessed using the Shirom-Melamed Burnout Questionnaire (SMBQ) at baseline and at 3 and 6 months.ResultsOur findings showed changes in SMBQ scores over time in both the control and the intervention group. There was no significant difference in SMBQ scores between the groups; however, a difference in change over time between the groups was observed. The SMBQ scores decreased significantly more in the intervention group than in the controls between 0 and 3 months and between 0 and 6 months. No differences in change between the two groups were seen between the 3- and 6-month follow-ups.ConclusionThis person-centred eHealth intervention for patients on sick leave for CMDs showed a slight initial effect in reducing symptoms of burnout. Taking into account that both groups reported comparable SMBQ scores throughout the study period, the overall effect may be considered limited.Trial registration: The trial was registered in ClinicalTrials.gov (Identifier NCT03404583). Date of registration: 19/01/2018. https://clinicaltrials.gov/ct2/show/NCT03404583.

Effectiveness of INOSEL program consisting of Integrative Nursing and Omaha System for older women feeling loneliness: a randomised controlled trial.

To evaluate the effectiveness of an intervention combining Integrative Nursing and Omaha System on physical, mental, social, spiritual health of older women living with high level of loneliness. The second aim was to determine the effect of Omaha System interventions on knowledge, behaviour and status scores. A randomised controlled trial was conducted with 69 older women feeling loneliness (INOSEL n = 36, control n = 33 groups). INOSEL group received group-based and person-centered intervention and control group received routine care. INOSEL and control groups showed an improvement in loneliness score. The decrease in loneliness score and level was higher in the INOSEL group. The physical activity, health status perception, social support, social inclusion, well-being, and spirituality scores increased in the INOSEL group. INOSEL group experienced an increase in the knowledge, behaviour and status. INOSEL program, a theoretical structure, reduced loneliness and positively affected women's health. Health professionals can use this program based on Integrative Nursing and Omaha System in nursing caring. NCT03695133.

Patients’ experiences with participating in a team-based person-centred intervention for patients at risk of or diagnosed with COPD in general practice

BackgroundSymptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner. Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, an interdisciplinary follow-up program was designed based on the Guided Self-Determination counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the Guided Self-Determination-program to investigate feasibility issues.MethodsA qualitative design was used to get insights in the experiences of receiving the Guided Self-Determination counselling program. In total, 13 patients with COPD (mean age 71.7 ± 7.7 years) 4 were current smokers, and 7 at risk of COPD (mean age 54.1 ± 9.9 years) all current smokers, received the Guided Self-Determination program. The researchers performed individual semi-structured telephone interviews after the 12 months Guided Self-Determination program with two patients at risk of COPD, four patients with COPD, three nurses, and five general practitioners. The intervention consisted of structured consultations with the nurse and patient in collaboration with the general practitioner at baseline and after 3, 6, and 12 months. The Guided Self-Determination method comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 min. The interviews were analysed using thematic analyses.ResultsTwo themes were identified: (1) A structured follow-up is challenging but motivating. (2) A counselling method that opens for conversation, but it requires resources.ConclusionsThe findings indicated that patients with or at risk of COPD experienced enhanced self-management skills after participating in a structured and systematic team-based follow-up in general practice with use of the Guided Self-Determination method. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to increase health benefits. However, the Guided Self-Determination method was experienced as time consuming among the general practitioners and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation.Trial registrationThe trial is registered in ClinicalTrials.gov (ID: NCT04076384).

94 Polypharmacy in older adults: the role of the advanced nurse practitioner

Abstract Background Polypharmacy is the concurrent use of five or more medications and is more prevalent in the care of Older Persons. Polypharmacy is a global issue and is linked to poor health outcomes especially in Older Persons. It is estimated that 20% of people over 65 years of age in Ireland, are prescribed at least 10 drugs repeatedly and 5% are prescribed at least 15 drugs repeatedly. Prescribing and deprescribing medication is a complex process and it can be challenging for people who are over 65 years of age It is estimated that people taking more than 10 medicines are twice as likely to develop frailty; frail cohort were twice as likely to be prescribed a potentially inappropriate medication and three times likely to be admitted to hospital. Over 10% of emergency hospital admissions in this cohort were estimated to be related to adverse drug reactions. Appropriate deprescribing will improve patient outcomes and reduce healthcare costs. Methods The Registered Advanced Nurse Practitioner populated a database of all medications that were prescribed and deprescribed within the caseload over the two year period. STOPP/START tool was used for deprescribing. Results The study confirmed that Appropriate Prescribing is a person-centred intervention, which required up-to-date knowledge of the patient’s condition, review of medical notes and/or co-ordinating with Pharmacist and/or General Practitioner (GP) to obtain the full list of medication, shared decision-making, monitoring for adverse effects, monitoring laboratory values and routine follow up. Patient engagement and education was vital to achieve positive outcomes. Encouraging the use of unit dose packaging for this cohort was noted to be an effective method of medication adherence. Conclusion The study recommends regular medications reviews for patients on Polypharmacy. Future changes in the healthcare should include electronic prescribing, improved access to medical records for Primary and Secondary care to improve prescribing in Older Persons.

225 The pattern of ICPOP service use according to the clinical frailty scale

Abstract Background We are a specialist integrated team working with older people to co-ordinate and provide enhanced health and social care services through Comprehensive Geriatric Assessment (CGA) and intervention working across a large geographical region. Methods New patients who underwent CGA from January–May 2023 were suitable for inclusion in this retrospective study. Key parameters including demographics, cognitive and functional status were recorded and analysed according to the following categories of clinical frailty scale (CFS); 1–3 (non-frail), 4–6 (frail) and ≥ 7 (severely frail). Results Of 249 patients who underwent CGA, 64% (n = 159) were female with a mean age of 82, and median MOCA score of 17. Reasons for referral were new or unexpected change in cognition (52%) frailty (40%) and falls (37%). Among this cohort 20% (n = 51) were non-frail, 71% (n = 177) were frail and 8.4% (n = 21) were severely frail. There was no significant difference in mean MOCA score by level of frailty (p = 0.49). Impairment in Instrumental Activities of Daily Living (IADL) was identified in 26% of non-frail, 77% of frail and 100% of severely frail patients. 27% of non-frail, 43% of frail and 33% of severely frail patients were living alone with carer strain reported in 70% of those with severe frailty. Informal care was regularly provided to 35% of non-frail, 60% of frail and 90% of severely frail patients. Conclusion Patients attending our service are frail, older and predominantly female. We identified a cohort who are not classified as frail but have cognitive impairment, are dependent for support in IADLs and reliant on informal care to allow them to live independently. In addition, we are supporting a severely frail, heavily dependent cohort and their caregivers. This demonstrates the complex case load within our ICPOP service which requires ongoing evaluation to ensure delivery of high quality person-centred interventions.

Association between Johns Hopkins Adjusted Clinical Groups risk scores and self-reported outcome measures: an observational study among individuals with complex or long-term conditions in Norway

ObjectiveInvestigate the association between Johns Hopkins Adjusted Clinical Groups (ACG) risk scores and low scores in self-reported outcome measures (SROMs) among individuals with complex or long-term conditions.DesignLongitudinal study using five...

What makes Chinese adolescents “trapped” in severe mental illness? An interactionist perspective on self and identity

ABSTRACT The aim of this study was to explore the self and identity perspectives among Chinese adolescents with severe mental illness (SMI), with a focus on their illness experience and subjective meaning of a formal diagnosis. Thirty-one Chinese adolescents were interviewed and the interview data were analysed strictly according to principles suggested by the constructivist grounded theory approach. Five theoretical codes emerged in this study, including changes of personal values and beliefs, accumulated persistent developmental challenges and personal stresses, ineffective coping strategies and development, symptoms and development of mental illness, and changed perceptions and understandings of self. A proposed model of “The dynamic interactions of Chinese adolescents’ identity and mental illness”, was constructed and visualized. The results revealed that adolescents’ identity formation is a fluctuating and non-linear process, but tends to be predominantly negative. The negative self, as informed by long-term ineffective coping with accumulated persistent developmental challenges and stressful events, develops towards a more serious status of negative identity and contributes to relapse symptoms, although this impact occurs variably with perceived personal characteristics. Besides, some participants who had achieved a state of “Buddha-like numbness” made a conscious decision to live a seemingly normal life while coexisting with their illness. The study also highlighted the positive aspects of identity formation that can arise from the experience of illness, including an enhanced sense of realism and increased empathy. Our findings will imply much the need for person-centred treatment plan and services that take into account of individual situations.

Protocol for the feasibility and implementation study of a model of best practice in primary care led postdiagnostic dementia care: PriDem

IntroductionCare is often inadequate and poorly integrated after a dementia diagnosis. Research and policy highlight the unaffordability and unsustainability of specialist-led support, and instead suggest a task-shared model, led by...

What matters most? A qualitative study exploring priorities for supportive interventions for people with tuberculosis in urban Viet Nam

IntroductionThe health and economic burden of tuberculosis (TB) in urban Viet Nam is high. Social protection and support interventions can improve treatment outcomes and reduce costs. However, evidence regarding optimal...

“It’s called homophobia baby” exploring LGBTQ + substance use and treatment experiences in the UK

Introduction Gender and sexual minority/minoritized groups are at a higher risk of substance misuse and related harm compared to the rest of the population. However, limited research has focused on understanding the extent of these issues and the support needs of all minoritized groups within the LGBTQ + population. Methods This qualitative cross-sectional survey sought to explore LGBTQ + individuals’ perspectives on substance use and treatment experiences. Researchers used a manual thematic analysis approach to thoroughly study the data, examining each part closely to uncover themes and patterns. Co-produced with stakeholders and developed with input from LGBTQ + individuals with lived experience, the survey included 38 participants across the UK. Results Cannabis (83% n = 20), ecstasy (68% n = 15), and cocaine (67% n = 16) were commonly used substances, while some participants (19% n = 6) reported consuming high levels of alcohol. Many respondents highlighted the role of “stigma” and peer pressure within the LGBTQ + communities as a motivator for substance use. Participants expressed a preference for informal support due to fears of “discrimination” from formal treatment services. Conclusions The study underscores the need for research inclusive of all LGBTQ + groups and highlights the importance of tailored interventions that address the diverse needs of LGBTQ + individuals. Further exploration of peer-led interventions is necessary to assess their effectiveness. The findings emphasize the necessity of person-centered treatment approaches that recognize the heterogeneity of service users.

Pilot Study: Assessing Personal and Clinical Impacts from a Recovery-Centric Intervention in Inpatient Psychiatry Using Mixed Methods

Objective: The conventional model of biomedical mental healthcare focused on diagnosis, crisis stabilization, and pharmaceutical treatment might be enriched with recovery-oriented programming and improve the overall inpatient experience. This study aimed to assess the impacts of a person-centered intervention on patient-reported recovery measures and clinical progression over time. Methods: Eighteen patients from a tertiary-level regional unit enrolled in the pilot program over an eight-month intervention period. Clinical and proxy recovery data was collected and compared before and after the intervention in a combination of within group and between group assessments using unit clinical performance as a control. Results: Contrary to expectation, intervention participants reported a decline in four of five proxy recovery scores from the pretest to the post-test and concurrent deterioration in routine clinical monitoring scores. Research cohort scores declined in three of six domains with a statistically significant change in one category while unit clinical scores declined in five of six domains with statistically significant changes in three categories. A comparison of mean coefficients indicated more favourable outcomes for research participants in five clinical domains. Conclusions: Concurrent declines in recovery-focused and clinical measures suggest a risk of inpatient regression over time in hospital. The findings support the need for innovative approaches to inpatient service delivery including recovery-focused interventions which might improve clinical progression. The results also indicate the need for rigorous program evaluation which can be facilitated by leveraging existing clinical assessment tools and in considering patient perspectives in determining the effectiveness of interventions.

Adolescents' experiences of Help Overcoming Pain Early-A school based person-centred intervention for adolescents with chronic pain.

To illuminate adolescents' experiences of Help Overcoming Pain Early (HOPE), a person-centred intervention delivered in a school setting by school nurses. Twenty-one adolescents with chronic pain recruited from secondary school, who had completed the HOPE intervention, were included in the interview study. The HOPE intervention was built on person-centred ethics and consisted of four meetings between school nurses and adolescents on the subject of stress and pain management. A qualitative method using content analysis with an inductive approach was employed. In the interviews, the adolescents describe how they reclaim their lives with the help of HOPE. They use different strategies and parts of the intervention to move on with their lives. A trustful relationship, as that with the school nurse, was essential to dare to change. The overarching theme summarizes in Becoming myself again and is built up by three sub-themes: Trust a pillar for growth, Making sense of my life with pain, and Putting myself into the world again. A person-centred intervention such as HOPE applied in a school context is promising for promoting confidence in adolescents with chronic pain. A trust-building process emerged, in terms of both the adolescents' trust in the healthcare staff they meet and their confidence in their own ability to handle and influence their situation, which in the long term can promote trust in themselves as a person.

Development, Feasibility, Impact and Acceptability of a Community Pharmacy-Based Diabetes Care Plan in a Low-Middle-Income Country.

Informed by existing research, mostly from high-income countries, this study aimed to develop and test the feasibility of a community pharmacy person-centred goal-setting intervention for people living with type 2 diabetes in a low-middle-income country-Nigeria. The Medical Research Council (MRC) guidance for developing complex interventions framed the intervention development. Patients participated in monthly community pharmacist consultations over six months. Self-reported and clinical outcome measures were collected at baseline and study completion and analysed in STATA V.14. Twenty pharmacists in 20 pharmacies completed the research and enrolled 104 patients. Of these, 89 patients had complete study data, and 70 patients also completed a post-study evaluation questionnaire. In addition, 15 patients and 10 pharmacists were interviewed. All outcome measures showed statistically significant improvements (p < 0.05). Clinical outcomes (BMI, waist circumference, and fasting plasma glucose) improved significantly. Mean patient activation measure (PAM©), quality of life (EQ-VAS©), and medication adherence improved from baseline to study completion. Eighty-eight per cent of questionnaire respondents were satisfied with the service. Interviews indicated care plan acceptability, patient satisfaction, empowerment, and service enthusiasm. Identified barriers to the consultations included time and technology. This study developed a feasible, effective, well-perceived community pharmacy diabetes care plan in Nigeria.

A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

BackgroundTreatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients’ lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services.MethodsFive databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted.ResultsEleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse—“I don’t think it’s individualised here”; (2) restrictive practice—living in a “bubble”; (3) myself, others and “a similar demon”; and (4) I am “not just another anorexic”. The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity.ConclusionsThese findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.

Acne scar management and treatment: a review of the options

Although cosmetic and dermatological in nature, scarring from acne vulgaris can have a huge psychosocial impact on patients and merits its own treatment and management strategy. There is a plethora of modalities for the treatment of acne scarring, each with their own unique benefits and adverse effects; as such, it is critical to have an overview of the available options when consulting with patients to enable appropriate and effective person-centred treatment. Here, Francesca Ramadan discusses a selection of treatment modalities, providing evidence of their efficacy and reviewing their suitability for a range of scar presentations.

Developmental profiles of young children with autism spectrum disorder and global developmental delay: A study with the Griffiths III scales.

The purpose of this study was to identify developmental profiles associated with autism spectrum disorder (ASD) and global developmental delay (DD) in pre-school aged Italian children. Developmental profiles were evaluated by means of a standardized tool widely used for the assessment of psychomotor development in early childhood, the Griffiths III scales, recently adapted and standardized for the Italian population. Specifically, we compared the Griffiths III profiles of children with ASD and DD (ASD + DD) with those of children with DD alone. Moreover, we inspected the psychometric function of single items by comparing children with ASD + DD and children with DD with typically developing (TD) children from the Griffiths III normative sample. In this way, we aimed to isolate the effects of each diagnostic class on psychomotor abilities and on the psychometric function of single items. The ASD + DD and DD groups were found to share the presence of lower age equivalent scores relative to their chronological age in all the developmental domains considered: Foundations of Learning, Language and Communication, Eye and Hand Coordination, Personal-Social-Emotional and Gross Motor Skills. However, the DD group displayed a homogeneous profile with similar levels of delay in all developmental domains, while children with ASD + DD exhibited relative weaknesses in the Language and Communication and Personal-Social-Emotional scales. The analysis of the psychometric function drawn for each item has confirmed different profiles in social-communicative and non-verbal items between the two diagnostic groups and in relation to TD normative sample. The Griffiths III is a valid psychometric tool for identifying atypical developmental profiles and its use may be recommended during the diagnostic process of ASD and DD, to detect specific strengths and weaknesses and guide person-centered treatment.

Patient engagement practice within perinatal eHealth: A scoping review.

There is a gap in knowledge about how perinatal eHealth programs function to support autonomy for new and expectant parents from pursuing wellness goals. To examine patient engagement (access, personalization, commitment and therapeutic alliance) within the practice of perinatal eHealth. Scoping review. Five databases were searched in January 2020 and updated in April 2022. Reports were vetted by three researchers and included if they documented maternity/neonatal programs and utilized World Health Organization (WHO) person-centred digital health intervention (DHI) categories. Data were charted using a deductive matrix containing WHO DHI categories and patient engagement attributes. A narrative synthesis was conducted utilizing qualitative content analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses 'extension for scoping reviews' guidelines were followed for reporting. Twelve eHealth modalities were found across 80 included articles. The analysis yielded two conceptual insights: (1) The nature of perinatal eHealth programs: (1) emergence of a complex structure of practice and (2) practising patient engagement within perinatal eHealth. Results will be used to operationalize a model of patient engagement within perinatal eHealth.