Self-management Process Research Articles

Dementia Prevention Self-Management in Older Thai Adults with Type 2 Diabetes: Development and Psychometric Properties of Two Questionnaires.

The prevalence of dementia, a complication of uncontrolled type 2 diabetes (T2DM), is rising among older adults. Effective self-management for dementia prevention is essential, but no validated questionnaires currently exist to evaluate these behaviors. The Dementia Preventive Individual and Family Self-Management Process Questionnaire (DP-IFSM-PQ) and the Dementia Preventive Self-Management Behavior Questionnaire (DPSMBQ) were developed based on the Individual and Family Self-Management Theory to evaluate dementia prevention self-management behaviors in older adults with T2DM. Items for the DP-IFSM-PQ (30 items) and DPSMBQ (29 items) were generated through literature review and tested for face validity. A quantitative cross-sectional study evaluated their psychometric properties using exploratory factor analysis (EFA) (n = 311) and confirmatory factor analysis (CFA) (n = 254). The final DP-IFSM-PQ comprises four factors and 29 items, showing acceptable fit with limited discriminant validity. The DPSMBQ includes seven factors and 27 items, demonstrating good fit and acceptable discriminant validity. The Thai-language DP-IFSM-PQ and DPSMBQ show reasonable psychometric properties for application in Thai older adults, but revisions of certain items and further studies are recommended to reassess their properties.

Teachers’ knowledge about the principles of dealing with a student with type 1 diabetes mellitus

IntroductionA proper self-management and therapy process, and the involvement of patients and their carers in this process, influences the effectiveness of T1DM therapy. The responsibility for the self-management process lies with children and adolescents with T1DM, as well as their parents and other carers.AimsThe aim of this study was to assess the level of teachers’ knowledge of the principles of the treatment and self-management of T1DM in children and to demonstrate the influence of various factors influencing teachers’ knowledge.Materials and methodsA cross-sectional survey was conducted among the teachers in the Pomeranian Voivodeship. The first part of the survey contained questions on sociodemographic data, the second part contained questions on personal attitudes towards a student with T1DM, and the third part contained twenty-nine questions assessing the basic knowledge of the self-management and treatment principles of T1DM.ResultsTests were conducted with 698 (86.4%) female teachers and 110 (13.6%) male teachers. The median (25thQ ÷ 75thQ) score of the test on the teachers' knowledge was 20 (18 ÷ 21) points, with a maximum of 29 and a minimum of 0 points. Male teachers, aged between 26–40 years, with 6–10 years of seniority, working in rural areas, having a person with T1DM in their immediate environment or having a student with T1DM in their class had a higher knowledge level. Teachers who worked in schools where no nurse was employed and those who had not completed specific training on the principles of caring for a child with T1DM at school had a lower level of knowledge.Conclusions1. Knowledge of teachers is insufficient to ensure safe stay at school for a child with T1DM.2. The ongoing training of teachers on the principles of the self-management and treatment of T1DM is necessary to improve and increase the safety of children and adolescents with T1DM in school units.3. There is a need to improve the quality of health care for children with T1DM in the learning environment by increasing the number of school nurses and improving their knowledge, and by the ongoing training of teachers and other staff in school units.4. Detailed care plans should be developed for children with T1DM, adapted to the school conditions.

Prevalence and predictors of annual asthma reviews in Scottish primary care data.

People with asthma are recommended to have regular reviews in primary care, with assessment of symptoms, adjustment of treatment and self-management processes, and the delivery of a written action plan for emergencies. Our study aimed to investigate the incidence and factors associated with attendance of annual reviews. electronic health records for approximately 50 000 Scottish asthma patients, between 2008 and 2016. Multivariable logistic regression using linked primary care prescription data and primary care registration demographic data. There was a median of 381 days between subsequent reviews. Reviews in the index year were strongly associated with reviews in the following year (odds ratio 1.76 [1.68-1.84]). In contrast, asthma consultations (excluding reviews) in the index year were associated with a lower odds of having a review in the following year (0.48 [0.46-0.51]). Those aged 18-35 in the index year, or with missing address in the practice registration data, were the least likely age group to have an asthma review in the following year. Reviewing the delivery of asthma care identifies patients who may be slipping through the gaps by receiving only reactive asthma care rather than the structured, preventative care which can be delivered through annual reviews. Understanding the risk factors for not receiving an annual review can be leveraged to create more effective review invitations, such as explaining the specific content of reviews, introducing new contact methods to improve health equity, and reviewing the algorithm used to determine who is invited.

METHODS OF PEDAGOGICAL CORRECTION: ADVANCED FOREIGN EXPERIENCE

Introduction. In the organization of pedagogical correction, general and special methods are selected based on the goals of correction. It would be wrong to divide the methods into good or bad methods. The effectiveness of educational influence depends on several factors and the fulfilment of pedagogical requirements, the logic of choosing and using methods, and the sequence of their practical application. By logically approaching the choice of correction methods, it is necessary to take into account the content of the problem, the purpose of correction, the characterological characteristics of students, the existing material and technical base, and the social environment of objects of correctional influence. Methods. Analysis of foreign scientific literature, dissertations and articles on methods of pedagogical correction of students and their practical application. Results. The methods used in the implementation of pedagogical correction measures in secondary general education schools in developed foreign countries, first of all, help students to understand themselves as individuals, control and manage their behaviour, and eliminate the sources of existing negative stereotypes in their behaviour and behaviour. aimed at developing reflection aimed at identifying and taking measures to increase the types of positive emotional reactions. Pedagogical correction methods are based on reflection on the organization of the self-management process by assessing the situation and identifying the source of negative emotions using algorithms for working with negative emotions in emotogenic situations. Conclusion. Orientation of correctional activities to the development of reflection, which helps to identify the sources of negative stereotypes in the student's behaviour and to take measures to increase the types of positive emotional reactions, the formation of the qualities of activity, enthusiasm and curiosity, and the development of the ability to analyze and evaluate one's behaviour and compare it with the planned goal will help.

Exploring medication self-management in polypharmacy: a qualitative systematic review of patients and healthcare providers perspectives.

Purpose: Polypharmacy presents many challenges to patient medication self-management. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024524742.

Associations Between Components of Self-Management Theory and Falls Among Older Adults.

To examine the relationship of key individual and family self-management theory (IFSMT) components, including self-management process variables on proximal (self-management behaviors) and distal (falls) outcomes in older adults. A secondary data analysis was conducted using data of 99 older adults living in continuing care retirement communities in the U.S. Midwest. Descriptive statistics, multiple regression, and logistic regression were performed to analyze the data. The multiple regression model demonstrated a positive association between self-efficacy for physical activity and steps per day. The logistic regression model showed that high expectations regarding aging are associated with reduced likelihood of meeting daily protein intake. Key components of the IFSMT, such as self-efficacy, steps per day, and expectations regarding aging, are important when designing self-management interventions to prevent falls. [Journal of Gerontological Nursing, 50(8), 19-28.].

Diabetes Tween Day Camp: A Case Study

Approximately 1.6 million Americans have type 1 diabetes, and 200,000 of them are under the age of 20. Self-management processes for these youth, such as peer-based support, are essential for quality of life. This pilot study partnered with university students and Lions Club International Foundation to pilot test a new diabetes camp model and evaluations. Data were collected from 10 youth who participated in the diabetes camp held on a college campus. Data revealed they learned about fellow campers, and their experience living with and manag-ing diabetes. This pilot program provides an innovative approach to combining community resources to serve youth with diabetes through a campus camp.

Facilitators and barriers to self-management in Iranian men with chronic obstructive pulmonary disease: a qualitative study

IntroductionSelf-management, as the most common method of chronic obstructive pulmonary disease (COPD) management, is not an isolated behaviour, but a set of physical, social, cultural, psychological and existential factors affecting...

Metacognitive Self-management in Developing Students' Rigorous Mathematical Thinking Skills

This study aims to describe the metacognitive self-management of students in developing rigorous mathematical thinking. This study uses a qualitative method with a case study approach. The participants were three students from the thirdlevel mathematics education department, who were selected and made a contract with for real analysis lectures. The first student experienced a significant change from the beginning of the meeting, resulting in the metacognitive self-management process being well-conditioned. He completed the task more confidently than the initial presentation, used several references and sources of information to complete the job, and represented each answer in the form of mathematical symbols. This studentscognitive function appears to be of level-1, with qualitative thinking. For the 2nd student, a change was observed in the learning process and the teacher’s motivation and guidance. The results of the interviews showed that the student applied strategies in completing assignments. He answered them systematically, based on experience, and mastered the prerequisite material. This student showed improved thinking skills related to mastery of concepts from new material, analyzing the problems given, being critical and focused when answering, and looking hard to get maximum evaluation results. This 2nd student entered the level of quantitative thinking with precision. Lastly, in the 3rd student, self-management seems stable, but was still lacking in adjusting the understanding of prerequisites with understanding concepts from new material. The development during the learning process shows that he can activate his mathematical knowledge, compose logical proofs of Real Analysis material problems, and build relationships between prerequisite concepts and new material. This type of student enters the level of abstract relational. The results of the study can be a reference for teachers to determine the learning model and the related instruments, so that they can grow the level of mathematical thinking before, during, and after the learning process. Keywords: Metacognitive, self-management, Mathematical thinking skill

Effects of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers.

This study aims to evaluated the effectiveness of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers. This quasi-experimental study applied concept and process of participatory actionoriented training and self-management to guide the development of the intervention addressing improvement in hypertension management behaviors. A total of 104 intercity van drivers with uncontrolled hypertension in Thailand were recruited to participate in this program. The intervention group (N = 52) received PAOT program, while the control group (N = 52) received conventional program. Data on hypertension management behaviors, and blood pressure were measured at baseline, 1 month and 3 months after intervention. At 3 months after intervention, hypertension management behavior, and systolic blood pressure were significantly different between 2 groups (p < 0.05). This PAOT was found to be feasible and could potentially improve hypertension management, and blood pressure level of intercity van drivers. The program should be applied in further studies with other workplaces in both formal and informal sectors with different characteristics and other health issues. Int J Occup Med Environ Health. 2024;37(2):194-204.

Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review

ObjectivesChronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. MethodsWe searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. ResultsOur review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. ConclusionsPromoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.

Development and Preliminary Validation of Self-management Scale for Breast Cancer Patients in a tertiary hospital in southeastern Nigeria

Background: Self-management process of diseases aims to equip patients with specific information that will improve adherence with prescribed medication and develop strategies that will help to maintain good quality of life. This study developed and validated a self-management scale for breast cancer patients in two tertiary hospitals in southeastern, Nigeria.&#x0D; Methods: A set of 35-potential self-management model was developed for the breast cancer patients in 2 domains from extensive literature search. The Instrument was validated using Delphi technique, item-total correlation analysis, factor analysis, construct validity and reliability analysis. Consensus was reached on the content validation of the self-management scale with mean score &gt; 3.5, median &gt; 3.5, absolute value between the median and mode &lt; 1.00.&#x0D; Results: Forty-three items emerged after content validation in 2 domains: demographic characteristics of patients, and self-management content. Construct validity for selected items of the instrument showed values above 0.5. Item-total correlation analysis resulted in 31-items of the instrument. Factor analysis revealed a multi-dimensional instrument. The internal consistency of the instrument was determined with values between 0.5 - 0.8. The Cronbach’s alpha for the reliability of the items of the instrument were : Items 1 to 11: 0.60; Items 12 to 17: 0.60; Items 18 and 19: 0.80; Items 20 to 30: 0.50; and Items 31 to 33: 0.60.&#x0D; Conclusion: Preliminary validation of the instrument showed the instrument is valid but the internal consistency needs to be evaluated further with larger population size. The self-management scale revealed level of self-management among the breast cancer patients. This instrument should form a reliable tool for evaluating self-management in breast cancer patients in Nigeria.

Silent struggles to self-manage high blood pressure among deaf sign language users: a qualitative study.

Tailored self-management support of hypertension, considering language and communication, is important for minorities, specifically in the deaf community. However, little is known about the experiences of hypertension self-management in deaf individuals who use sign language. This study aimed to explore the factors and processes of self-management in deaf sign language users with hypertension. Ten men and women who used sign language participated in this study. Data were collected using in-depth personal interviews conducted in the presence of a sign language interpreter between November 2022 and February 2023. All interviews were recorded and transcribed for conventional content analysis. Qualitative analyses identified four categories related to the self-management of hypertension among participants: personal factors (chronic hand pain, unique language and communication, and efforts to turn crisis into opportunities), family and socioeconomic factors (family support and financial burden of living), challenges (limited health literacy and alienation from health education), and desire for health education considering the deaf community. The results of this study suggest that family support, socioeconomic status, hand pain, and health literacy should be considered for the planning and development of health education on self-management of hypertension in deaf individuals. In addition, this health education requires cooperation with qualified sign language interpreters in healthcare settings.

Self-Management and Its Associated Factors Among People Living With HIV at University of Gondar Comprehensive Specialized Hospital: A Cross-Sectional Study.

Background: Self-management (SM) is the gold standard of care and is the direct active participation of patients in their disease management. Condition-specific factors, physical and social environment, individual and family, and the process of SM are factors that influence SM in people living with human immunodeficiency virus (PLHIV). Poor SM leads to high retroviral infection transmission, mortality, and morbidity. Objective: This study was aimed at assessing SM and its associated factors among PLHIV at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Northwest Ethiopia. Methods: A cross-sectional study was conducted using a systematic random sampling technique at the UOGCSH from May 20 to July 30, 2022. The data were collected using a previously validated tool and were entered and analyzed using Statistical Package for Social Sciences Version 25. A binary logistic regression analysis was used to identify factors associated with poor SM. The statistical significance was considered at a p value < 0.05. Result: Of 419 PLHIV, the median (IQR) SM score was 39 (9), and above half (52.6%, 95% CI: 48%-57%) of them had poor SM. Being unemployed (AOR = 2.49, 95%CI = 1.19, 5.19), living alone (AOR = 2.16, 95%CI = 1.12, 4.17), unfamiliar with the management of HIV-related symptoms (AOR = 3.59, 95%CI = 2.08, 6.20), poor social support (AOR = 3.02, 95%CI = 1.54, 5.93), poor self-efficacy (AOR = 3.04, 95%CI = 1.83, 5.06), and unsupported by the adherence support group (AOR = 17.17, 95%CI = 8.37, 35.22) were significantly associated with poor SM. Conclusion: The majority of PLHIV had poor SM. This study supports the findings of individual family SM theory and previously published studies regarding factors affecting SM. The government, hospital, adherence support groups, and PLHIV should work on modifiable sociodemographic, condition-specific, and process of SM to improve SM of PLHIV.

A gestão orgânica de conflitos desenvolvida em empreendimentos formados por mulheres da economia solidária: uma análise pós-colonialista sobre uma prática feminista de autogestão

Abstract This research arises from Martin’s (1993) studies of women’s management practices.However, it is articulated from the place of self-management within the scope of the Solidarity and Feminist Economy Network (SFEN). Therefore, a new construct to identify some practices that are performed in the Solidarity Economy (SE) was developed:feminist practices of self-management (Bauhardt, 2014; Faria, 2017; Vieta, 2015). The objective is to analyze one of the practices observed in the field: the organic management of conflicts. The main theoretical contributions used to mediate the discussion depart from Martin’s approach (1993), from the perspective of substantive rationality in Ramos (1989), from studies on conflicts in organizations in Guerardi (2009) and Putnam (2010), as well as the postcolonialistview that adheres to the context of women in higher education (Lugones, 2008; Mohanty, 2006). Data collection is based on semi-structured interviews with women from the SFEN and direct and indirect observation in the field between 2018 and 2021. The perspective adopted for data analysis is an oral history based on critical discourse analysis (Meihy, 2002; Wodak, 2004). The results point to the following findings: non-concealment of conflict in self-management processes, organically managed conflict based on intense communication, and conflict management as a learning process that prioritizes experiences and differences. For women, conflict is not a demerit. On the contrary, it is managed in such a way as to strengthen reciprocal ties between members of solidarity enterprises.

An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study.

Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data-connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation.

Technology-based self-management interventions for women with breast cancer: a systematic review.

Since technology-based interventions can facilitate convenient access to healthcare for women with breast cancer, it is crucial to understand innovative approaches to maintaining the effectiveness of these interventions. Therefore, we conducted a systematic review of technology-based self-management interventions for women with breast cancer in six countries. We analyzed the characteristics of these interventions and examined their diverse health outcomes. Six databases were systematically searched to extract research articles using the keywords "breast cancer," "technology," and "self-management." The search was carried out up until June 12, 2023. From the 1,288 studies retrieved from the database search, 10 eligible papers were identified based on inclusion/exclusion criteria. Two authors independently extracted and compared the data from these articles, resolving any discrepancies through discussion. Most of the 10 studies utilized web- or mobile-based technology, and one used artificial intelligence-based technology. Among the 12 health-related outcome variables, quality of life and symptom distress were the most frequently mentioned, appearing in six articles. Furthermore, an analysis of the intervention programs revealed a variety of common constructs and the involvement of managers in the self-management intervention. Incorporating key components such as self-management planning, diary keeping, and communication support in technology-based interventions could significantly improve the self-management process for breast cancer survivors. The practical application of technology has the potential to empower women diagnosed with breast cancer and improve their overall quality of life, by providing timely and sustainable interventions, and by leveraging available resources and tools.

Grounded Theory Approach to Understand Self-Management of Opioid Recovery Through Pregnancy and Early Parenting

ObjectiveTo develop a theory to explain the processes women use to self-manage recovery from opioid use disorder during pregnancy, the postpartum period, and early parenting. DesignConstructivist grounded theory approach. ParticipantsWomen (N = 16) who gave birth during the past 12 months and used medication for opioid use disorder for recovery through pregnancy and the postpartum period. MethodsWe recruited participants through seven medication-assisted treatment clinics in a mid-size Midwestern city and the surrounding suburbs and through online parenting and recovery community groups with national-based memberships. We conducted semistructured, individual audio interviews from November 2020 to July 2021. Interviews continued until we reached theoretical and meaning saturation. We used constant comparative methods during initial and intermediate coding. ResultsParticipants described a central process, Growing as a Healthy Dyad, that included six processes they used to self-manage recovery: Maintaining Vigilance, Performing Self-Care, Putting in the Work of Recovery, Advocating, Navigating Social Support, and Acquiring Skills and Knowledge. These processes were affected by personal and social contextual factors. ConclusionsThe grounded theory, Self-Management of Opioid Recovery Through Pregnancy and Early Parenting, can be used to explain the unique processes of self-management by women in opioid recovery and highlights the need for a strengths-based approach to caring for the maternal–infant dyad.

Management mechanism for the formation of an inclusive model of the develop-ment of business structures of agribusiness

Agriculture is an integral part of inclusive development, as it is 2-4 times more effective in reducing poverty than other sectors based on the same level of investment. The study of realities and the search for drivers of the development of the agro-food system requires the adaptation of the research methodology of inclusive growth (in particular, concepts, criteria, indicators, evaluation methods, etc.) following the tasks of sustainable development of the agro-food system under modern economic conditions. Only inclusive growth will ensure the realization of the threefold task of food independence physical and economic availability of food for all sections of the population. The paper examines the main theoretical provisions of forming an inclusive model of the development of entrepreneurial structures of agribusiness and their role in the formation of management decisions. Systematic management of the specified process involves an expanded view of agribusiness and satisfying interests in developing business, society, and the state. It was emphasized that an essential component of the management mechanism for the formation of an inclusive model of agribusiness development is implementing an inclusive investment project by a business entity, that is, a project aimed at satisfying the interests of business, society, and the state. It is proven that the goal of management is the inclusive development of the business structure through specialization in economy, quality, creative differentiation, and, first, in the product offering. After satisfying the consumer's interests, business, society, and the state are involved in harmonious development. According to the type of inclusive investment project, the entrepreneurial structure of agribusiness chooses the type of inclusive development model in the market of products and services. The work considers an inclusive model of enterprise development that satisfies the interests of business in long-term profitability, society in clean air, and the state in environmentally friendly energy sources. The mechanism implements the conditions of a synergistic effect from the influence of the factors of increasing demand and stimulating it with the offer to implement the processes of self-regulation, self-management, and self-organization. Keywords: management mechanism, inclusive model, microeconomics, planning, agribusiness, increasing demand.

Executive Functioning and Self-Management Processes Mediate the Relationship Between Insomnia and Pain-Related Disability

Insomnia has been identified as a predictor of reduced benefit from cognitive-behavioral treatment (CBT) for adolescent chronic pain; however, it is not well understood how insomnia leads to reduced treatment response. The purpose of this study was to evaluate executive function and self-management processes as 2 potential mediators of the relationship between insomnia symptoms and pain-related disability outcomes from internet-delivered CBT using a single-arm clinical trial design. Eighty-five adolescents with chronic pain (77% female, ages 12–17 years) and their caregiver received an 8-week internet-delivered CBT intervention. Youth completed validated measures of insomnia symptoms, executive function, self-management processes, and pain-related disability at baseline, mid-treatment, immediate post-treatment, and 3-month follow-up. Results from multilevel structural equation modeling indicated that more severe insomnia symptoms were associated with greater problems with executive function, which, in turn, led to lower engagement in self-management processes and less improvement in pain-related disability. These findings identify 2 mediators by which higher insomnia symptoms may lead to reduced benefit from CBT intervention for chronic pain. Research is needed to understand whether psychological treatments for chronic pain may be optimized by strategies targeting insomnia, executive function, and/or engagement in self-management. This trial was registered at clinicaltrials.gov (NCT04043962). PerspectiveOur study suggests that executive functioning and self-management processes mediate the relationship between insomnia and treatment outcomes for pediatric chronic pain, highlighting the impact of insomnia on youth learning and implementation of self-management strategies and the critical need for targeted sleep interventions in this population.