Self-care Routines Research Articles

A User-Centered Approach: Understanding Client and Caregiver Needs and Preferences in the Development of mHealth Apps for Self-Management.

BackgroundMany adolescents and young adults with chronic illness or disability often fail to develop the self-management skills necessary to independently handle medical and self-management routines. In light of these needs, we are developing iMHere 2.0 (Interactive Mobile Health and Rehabilitation), a mobile health (mHealth) system to support a self-management program.ObjectiveOur objective was to gather data from persons with brain and spinal cord anomalies (BSA) and their caregivers to better understand how mHealth would be most helpful in supporting them to proactively manage daily self-care routines and to access medical care as needed. The specific purpose was not only to gather feedback and to gain increased insight into the design of the new version of iMHere, but also to gather perspectives of new groups, namely adolescents as young as 12 years and their parents and/or caregivers.MethodsOur project employed focus group sessions and surveys to collect data from participants with BSA, as well as their caregivers. A total of six focus group sessions were conducted on four separate occasions until the data gathered reached saturation. The objectives of our focus group sessions were to better understand ways to develop mHealth systems to support self-management, to promote independence, to motivate long-term system use, and to prevent medical problems that lead to hospitalizations and emergency room visits for youth and young adults with BSA.ResultsA total of 16 youth and young adults with BSA and 11 caregivers participated in the sessions. Within and among our groups, the following five overarching themes emerged from the data: (1) make it easy, (2) engage, (3) educate and prepare, (4) motivate and support, and (5) personalize. Participants shared their perspectives and detailed information about mHealth apps that would be important for independence in self-care and self-management.ConclusionsOur findings suggest that most individuals keep their mobile phones with them at all times and typically use a mobile phone for social media, music, photos, and texting. Our qualitative analysis indicates that youth and young adults with BSA, as well as their caregivers, acknowledge the importance of being actively engaged in developing and using mHealth apps that monitor and manage their health care needs. Information gleaned from these focus group sessions and surveys have provided data to refine the iMHere 2.0 mHealth prototype platform that we have developed.

Abstract 245: Demonstrating the Effectiveness of an Outpatient Occupational Therapy Program for Individuals with Heart Failure

Objective: To demonstrate the effectiveness of an outpatient occupational therapy program on improving self-care for individuals with heart failure. Background: Hospitalizations for heart failure (HF) are the largest Medicare expenditure, and 12% of these admissions are considered preventable. Effective self-management of the debilitating symptoms associated with HF (shortness of breath, fatigue, fluid retention, cognitive decline) helps keep patients out of the hospital. Individuals often experience difficulty incorporating self-care management activities into their daily lives. Occupational therapy (OT) is well suited to address the self-care needs of people with HF by increasing patient self-efficacy and facilitating lifestyle modification through the incorporation of new habits, roles, and routines. Methods: Participants with HF (n=11, ages 40-86) enrolled in an outpatient OT program focusing on self-care management. Participants received weekly, bi-weekly or monthly one-hour treatments over a six-month period. Sessions addressed the following topics: low sodium diet adherence, medication management, activity tolerance, symptom monitoring and psychosocial coping strategies. The Self-Care of Heart Failure Index (SCHFI) was administered at evaluation and upon completion of the program. The SCHFI is a reliable and valid assessment tool that measures self-care maintenance, management and confidence in people with HF. Results: All participants who received two or more treatments demonstrated 33.33% (16.67 of 49.99) to 190.01% (63.33 of 33.33) improvement in maintenance of self-care routines based on pre and post SCHFI scores. Additionally, half of these participants demonstrated 28.47% (22.16 of 77.84) to 85.33% (38.4 of 45) improvement in confidence with self-care management based on pre and post SCHFI scores. Conclusion: Participation in an outpatient OT program that focused on incorporating lifestyle modifications into daily routines was effective at improving self-care for people with HF, specifically maintenance of self-care routines and confidence with ability to self-manage their chronic condition.

Exploring Approaches to Facilitate Diabetes Therapy Intensification in Primary Care.

Several landmark studies have provided strong support for the position that vigorous treatment of diabetes in the majority of individuals has the potential to reduce the morbidity and mortality of the disease by decreasing its chronic complications (1,2). In response, many advances have been made that include the introduction of highly successful therapies and tools such as more effective medications, blood glucose meters, insulin delivery systems, and needle sizes. Yet, despite this progress, people with diabetes can still have challenges in meeting target goals (3,4) and experience distress related to their treatment plan (5–7). Intensive therapies that have been shown to prevent or slow the progression of complications require people with diabetes to learn and maintain demanding, complex self-care routines. These therapies and routines are often met with fear and reluctance, and adhering to them can be difficult (5,7,8). Furthermore, providers report challenges in introducing advanced therapies for people with diabetes. A survey of physicians’ attitudes found that primary care providers (PCPs) consider diabetes more difficult to treat than other chronic diseases because it requires more monitoring and medication adjustment to achieve treatment goals (9). Physicians also report that there is inadequate support for the increased time and effort required to treat diabetes patients and that neither clinics nor patients can afford what it takes for comprehensive care (9–11). Diabetes self-management education and support (DSME/S) have repeatedly been shown to improve clinical, behavioral, and psychosocial outcomes (12–14). In addition, DSME/S are reported to reduce the onset or advancement of diabetes complications (15), improve quality of life (16,17), enhance self-efficacy and empowerment (18,19), increase healthy coping (20), and decrease the presence of diabetes-related distress (21,22) and depression (23, …

Integrating Care in Complex Cardiac Care: the Tech Touch

Integrating Care in Complex Cardiac Care: the Tech Touch

Unmet needs and relationship challenges of head and neck cancer patients and their spouses

ABSTRACTIn head and neck cancer (HNC), couple-based interventions may be useful for facilitating treatment completion, patient rehabilitation, and improving both partners' quality of life. With the goal of identifying targets for future interventions, we conducted a qualitative study to understand patient and spouse unmet needs and relationship challenges during curative radiotherapy for HNC. Semistructured interviews were conducted with six HNC patients (83% male) and six spouses (83% female) within 6 months of completing treatment. Interviews were audiotaped and transcribed using grounded theory analysis. Patients and spouses identified several unmet needs including better preparation regarding the severity of physical side effects, a clearer timeline for recovery, and strategies for dealing with their own and each other's emotional reactions. Caregiver's unmet needs included balancing competing roles/responsibilities, making time for self-care, and finding effective strategies for encouraging patient's self-care. Eighty-three percent of spouses and all patients reported increased conflict during treatment. Other relationship challenges included changes in intimacy and social/leisure activities. Findings suggest that couple-based interventions that emphasize the importance of managing physical and psychological symptoms through the regular practice of self-care routines may be beneficial for both patients and spouses. Likewise, programs that teach spouses ways to effectively motivate and encourage patients' self-care may help minimize conflict and help couples navigate HNC treatment and recovery together as a team.

Development of mHealth system for supporting self-management and remote consultation of skincare.

BackgroundIndividuals with spina bifida (SB) are vulnerable to chronic skin complications such as wounds on the buttocks and lower extremities. Most of these complications can be prevented with adherence to self-care routines. We have developed a mobile health (mHealth) system for supporting self-care and management of skin problems called SkinCare as part of an mHealth suite called iMHere (interactive Mobile Health and Rehabilitation). The objective of this research is to develop an innovative mHealth system to support self-skincare tasks, skin condition monitoring, adherence to self-care regimens, skincare consultation, and secure two-way communications between patients and clinicians.MethodsIn order to support self-skincare tasks, the SkinCare app requires three main functions: (1) self-care task schedule and reminders, (2) skin condition monitoring and communications that include imaging, information about the skin problem, and consultation with clinician, and (3) secure two-way messaging between the patient and clinician (wellness coordinator). The SkinCare system we have developed consists of the SkinCare app, a clinician portal, and a two-way communication protocol connecting the two. The SkinCare system is one component of a more comprehensive system to support a wellness program for individuals with SB.ResultsThe SkinCare app has several features that include reminders to perform daily skin checks as well as the ability to report skin breakdown and injury, which uses a combination of skin images and descriptions. The SkinCare app provides reminders to visually inspect one’s skin as a preventative measure, often termed a “skin check.” The data is sent to the portal where clinicians can monitor patients’ conditions. Using the two-way communication, clinicians can receive pictures of the skin conditions, track progress in healing over time, and provide instructions for how to best care for the wound.ConclusionsThe system was capable of supporting self-care and adherence to regimen, monitoring adherence, and supporting clinician engagement with patients, as well as testing its feasibility in a long-term implementation. The study shows the feasibility of a long-term implementation of skincare mHealth systems to support self-care and two-way interactions between patients and clinicians.

Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults

ObjectivesHabit formation is a proposed mechanism for behaviour maintenance. Very few falls prevention studies have adopted this as an intervention framework and outcome. Therefore, we tested feasibility of a theory-based behaviour change intervention that encouraged women to embed balance and strength exercises into daily life routines (e.g., eating, self-care routines). DesignThe EASY LiFE study was a mixed-methods, 4-month feasibility intervention that included seven group-based sessions and two telephone calls. Main outcome measuresWe obtained performance-based (i.e., Short-Physical-Performance-Battery) and psychological self-report measures (i.e., intention, self-efficacy, planning, action control, habit strength, quality of life) from 13 women at baseline (T1) and 4-month follow-up (T2). We applied the Framework-Method to post-intervention, semi-structured interviews to evaluate program content and delivery. ResultsIn total, 10 of 13 women completed the program (Mage = 66.23, SD = 3.98) and showed changes in their level of action control [mean differenceT1−T2 = 1.7, 95% CI (−2.2 to −0.8)], action planning [mean differenceT1−T2 = 0.8, 95% CI (−1.1 to −0.2)], automaticity [mean differenceT1−T2 = 2.5, 95% CI (−3.7 to −1.2)], and exercise identity [mean differenceT1−T2 = 2.0, 95% CI (−3.2 to −0.8)]. Based on the Theoretical Domains Framework we identified knowledge, behavioural regulation, and social factors as important themes. For program delivery, dominant themes were engagement, session facilitators and group format. ConclusionThe theory-based framework showed feasibility for promoting lifestyle integrated balance and strength exercise habits. Using activity and object-based cues may be particularly effective in generating action and automaticity.

Psychosocial factors impacting on life transitions among young adults with type 2 diabetes: an Australian - Danish qualitative study.

Type 2 diabetes (T2DM) prevalence is increasing rapidly worldwide with a significant increase in young adults. There is limited information about psychosocial and service needs of this group. To explore similarities and differences in how psychosocial factors impact on Australian and Danish young adults with T2DM and to identify unmet support needs during life transitions. A qualitative approach was adopted using thematic content analysis of 26 in-depth semi-structured interviews. An inductive descriptive content analysis was undertaken using a comparative coding system. Eligible participants were from Australia (12) and Denmark (14), aged 19-42years who had T2DM for more than 10months. In general, they reported diabetes management was difficult during transitions and diabetes self-care routines had to change to accommodate life changes. The underpinning sense of 'uncertainty' initiated by life transitions caused guilt that often resulted in low self-worth, anxiety and depression, which in turn had a negative impact on social and professional relationships. The participants emphasised the importance of connectedness to social networks, particularly with T2DM peers, and the need for flexible access to health professionals, age-specific tailored support and lower costs for Australians. Australian participants were more concerned than Danish participants about the cost associated with diabetes care and their ability to stay employed; hence, they were reluctant to disclose diabetes at work. T2DM had a similar impact on life transitions of Australian and Danish young adults with T2DM, suggesting health care needs to encompass managing life transitions. Participants had to cope with uncertainty and the impact of people's responses to diabetes, particularly at work and in relationships. Health professionals are urged to integrate these factors in care plans and education, which must be individualised and focus on the psychosocial aspects that operate during life transitions.

Seeking social support on Facebook for children with Autism Spectrum Disorders (ASDs)

PurposeThis study examined the types of social support messages exchanged between parents and/or caregivers of children with Autism Spectrum Disorders (ASDs) who communicate via Facebook (FB); it studies two autism support groups: Autism Malaysia (AM) and Autism Children Club (ACA). MethodA total of 3637 messages including both postings (381) and comments (3256) were gathered from August to November 2013. The study employed a deductive content-analysis approach. The qualitative data were analyzed for social support themes adapted from the Social Support Behavior Code (SSBC). Before collecting the data, email was sent to the FB groups’ moderators to gain formal consent from the members. ResultThe finding indicated that the highest percentage of messages offered dealt with Informational support (30.7%) followed by Emotional support (27.8%). Network and Esteem support messages were responsible for 20.97% and 20.2%, respectively. Tangible Assistance was the least frequent category (0.4%). A majority of these messages discussed and addressed challenges and difficulties associated with caring and raising ASD children, as well as issues such as children's social lives and self-care routines. ConclusionUnderstandings of how FB is used to seek social support could impact supporting and maintaining effective communication among parents and/or caregivers of children with ASDs. This information could also improve approaches used by health professionals in developing, improving and evaluating social support systems for parents/caregivers.

An observational study of social control, mood, and self-efficacy in couples during treatment for head and neck cancer

Objective: Head and neck cancer (HNC) patients experience debilitating side effects, including abnormally reduced salivation and difficulty swallowing. Intensive self-care protocols are prescribed to control side effects and minimise discomfort, but non-adherence rates are high. Although spouses are in a prime position to encourage adherence, studies have yet to examine how spouse social control (i.e. attempts to influence patient behaviour to support adherence) affects HNC patient mood and self-efficacy for engaging in these self-care routines.Methods: One-hundred twenty-five HNC couples, where the patient (86% male) was undergoing radiotherapy, were recorded in the laboratory as they discussed a cancer-related issue that the patient identified as being a topic of concern.Results: Sixty-eight couples discussed side effects and spouses engaged in social control in 61 of these discussions. Although oral complications and pain were frequently identified by patients as being topics of concern, dental/oral care and pain management were some of the least likely self-care behaviours to be targeted by spouses, who focused primarily on encouraging patients to maintain their weight and hydration. Although spouses engaged in an almost equal number of positive and negative control attempts, only positive control was significantly (p < .05) associated with patient positive mood and self-efficacy.Conclusion: HNC couples may benefit from programmes that emphasise the regular practise of self-care routines to control oral side effects, pain and nutrition/hydration problems. Likewise, programmes that encourage spouses to maximise their use of positive social control may also boost patients’ mood during treatment and empower them to engage in recommended self-care behaviours.

Conceptions of diabetes and diabetes care in young people with minority backgrounds.

Adolescents with type 1 diabetes (T1DM) need stable self-care routines for good metabolic control to minimize future cardiovascular health complications. These routines are demanding, and might be particularly challenging in underprivileged groups. The aim of this study was to gain in-depth knowledge on the experience of adolescents with T1DM and a non-Swedish background regarding factors that might influence their ability to take care of themselves; in particular, factors that might influence diabetes management routines, their social situation, and the support they receive from caregivers. We interviewed 12 adolescents with T1DM and minority backgrounds. The results indicated resources and constraints in the adolescents' social context and in the health care organization. The adolescents developed conceptions that helped to explain and excuse their self-care failures, and their successes. These findings highlight the importance of integrating T1DM as part of the individual's personal prerequisites. We discuss implications for the organization of diabetes care for adolescents.

Risk, the prediabetes diagnosis and preventive strategies: critical insights from a qualitative study

Diagnosis constitutes a major categorisation tool in medicine. This paper adds to the paucity of knowledge about part of the work such a tool performs. It examines the ways in which diabetes epidemiology translates into attempts to prevent diabetes from occurring through screening and diagnosing, and then managing those categorised as ‘at high risk’. Using a qualitative design in the context of a small-scale Danish intervention study, the findings suggest that health professionals overinterpreted relative risk reductions and exaggerated treatment effects; simultaneously, prediabetics called into question the scientifically set thresholds. Nonetheless, arguments concerning changed behaviour’s benefits were sought to be incorporated into self-care routines. The data highlight how, by identifying a normatively set threshold, a diagnosis can determine health promotion messages’ impact in ‘high-risk’ prevention strategies.

Flying beyond Gray's Anatomy: A psychologist's experience in palliative care and psycho-oncology.

A clinical fellowship provides opportunities for health professionals to learn specialist skills from experienced mentors in "real-world" environments. In 2010-2011, I had the opportunity to complete a palliative care and psycho-oncology clinical fellowship in a public hospital. I found ways to integrate academic training into my practice and become a more independent psychologist. In this essay, I aim to share my experience with others and highlight key learnings and challenges I encountered. In providing psychosocial care, I learned to adapt my psychological practice to a general hospital setting, learning about the medical concerns, and life stories of my patients. I faced challenges navigating referral processes and had opportunities to strengthen my psychotherapy training. In the fellowship, I engaged in educational activities from the more familiar psychological skills to observing surgical teams at work. I also developed confidence facilitating groups and an interest in group psychological support for young adult offspring of people with cancer. I was able to engage participants with haematological cancer in qualitative research about their experiences of corticosteroid treatment. In this process, I came to understand the complexity of chemotherapy regimens. Overseeing my development were multiple supervisors, offering unique insights that I could take in and integrate with my personal practice and worldview. Throughout this process I became increasingly tuned into my own process, the impact of the work, and developed self-care routines to help disconnect from my day. I also reflected on my experiences of loss and grief and developed a deeper understanding of myself as a person. I use the metaphor of a parachuting journey to illustrate various aspects of my learning.

Errorless (re)learning of daily living routines by a woman with impaired memory and initiation: Transferrable to a new home?

Primary objective: To use errorless learning to train a memory- and initiation-impaired woman on two activities of daily living routines and then to transfer these routines to a new home.Research design: Single case quasi-experimental.Methods and procedures: Over 9 months, a young woman with an anterior cerebral haemorrhagic stroke (secondary to a ruptured arteriovenous malformation) was trained on routines of morning self-care and diabetes management, involving extensive practice on a structured series of steps with intervention as needed to prevent errors. Once routines were established, family members were trained in the supervision and rating of the routines at home. Following discharge, caregivers continued to monitor the routines daily for 3 months.Main outcomes: Errorless learning of self-care and diabetes routines was successful. The routines were transferred to a new home environment and maintained at a near perfect level over a 3-month follow-up period. The patient remained severely memory-impaired, indicating that her functional gains were not attributable to any recovery of her memory abilities over time.Conclusions: This case offers evidence that even people with severe memory and initiation impairments can be trained on new routines using errorless learning and that, once learned, these routines can be carried out in novel contexts.

IMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions.

BackgroundIndividuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh in which wellness coordinators supervise the care of individuals with chronic disease has produced remarkably improved outcomes. However, time constraints and travel costs have limited its scale. Mobile telehealth service delivery is a potential solution for improving access to care for a larger population.ObjectiveThe project’s goal was to develop and implement a novel mHealth system to support complex self-care tasks, continuous adherence to regimens, monitoring of adherence, and secure two-way communications between patients and clinicians.MethodsWe developed and implemented a novel architecture of mHealth system called iMHere (iMobile Health and Rehabilitation) consisting of smartphone apps, a clinician portal, and a two-way communication protocol connecting the two. The process of implementing iMHere consisted of: (1) requirement analysis to identify clinically important functions that need to be supported, (2) design and development of the apps and the clinician portal, (3) development of efficient real-time bi-directional data exchange between the apps and the clinician portal, (4) usability studies on patients, and (5) implementation of the mHealth system in a clinical service delivery.ResultsThere were 9 app features identified as relevant, and 5 apps were considered priority. There were 5 app features designed and developed to address the following issues: medication, skin care, bladder self-catheterization, bowel management, and mental health. The apps were designed to support a patient’s self-care tasks, send adherence data to the clinician portal, and receive personalized regimens from the portal. The Web-based portal was designed for clinicians to monitor patients’ conditions and to support self-care regimens. The two-way communication protocol was developed to facilitate secure and efficient data exchange between the apps and the portal. The 3 phases of usability study discovered usability issues in the areas of self-care workflow, navigation and interface, and communications between the apps and the portal. The system was used by 14 patients in the first 6 months of the clinical implementation, with 1 drop out due to having a poor wireless connection. The apps have been highly utilized consistently by patients, even those addressing complex issues such as medication and skincare. The patterns of utilization showed an increase in use in the first month, followed by a plateau.ConclusionsThe system was capable of supporting self-care and adherence to regimen, monitoring adherence, supporting clinician engagement with patients, and has been highly utilized.

Amount and Focus of Physical Therapy and Occupational Therapy for Young Children with Cerebral Palsy

ABSTRACTThe aims of this study were to describe physical therapy (PT) and occupational therapy (OT) services for a cohort of 399 children with cerebral palsy (CP), 2–6 years old, residing in the United States and Canada. Parents completed a services questionnaire by telephone interview. Therapists classified children's Gross Motor Function Classification System (GMFCS) level. Mean minutes per month of PT and OT were greater for children receiving services in both an educational and clinic setting. Mean minutes per month of PT and OT were greater for children in levels IV–V than children in level I and greater for children in the United States than children in Canada. Parents reported that interventions focused a moderate to great extent on primary impairments, secondary impairments, activity, and structured play activities, a moderate extent on environmental modifications and equipment; and a moderate to small extent on self-care routines. The results support the importance of coordination of PT and OT services.

Is the use of fluoride toothpaste optimal? Knowledge, attitudes and behaviour concerning fluoride toothpaste and toothbrushing in different age groups in Sweden

The most effective method to prevent caries is the regular use of fluoride toothpaste. The aim of this study was to evaluate self-care routines in a population by identifying knowledge, attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits. A questionnaire was sent to 3200 individuals in two municipalities in Sweden. Four age groups representing different life stages were chosen: 15-16, 31-35, 61-65 and 76-80 years of age. The participants were selected from the population register by random selection of birth dates. Totally 2023 (63%) individuals answered the questionnaire. The majority (84-94%) in all age groups brushed their teeth twice a day or more often. Good toothpaste behaviour identified as brushing at least twice a day, using at least 1 cm toothpaste, brushing 2 minutes or longer and using a small amount of water when rinsing was reported by only 10% of the respondents. The factors that increased the odds for having good caries-preventive behaviour were: (i) being female, (ii) being younger than 35 years, (iii) having knowledge about fluoride, (iv) finding use of fluoride toothpaste important and (v) rating own oral health as good. The population seems to have embraced regular toothbrushing with fluoride toothpaste to a large extent. However, regarding techniques for using fluoride toothpaste effectively, there was great potential for improvement, especially among the older respondents.

Healthcare routines of university students with Type 1 diabetes

Healthcare routines of university students with Type 1 diabetes. This paper is a report of a study examining the benefits that university students with Type 1 diabetes associate with diabetes self-care routines, and the barriers that they experience in enacting self-care routines in the university environment. Many young adults with Type 1 diabetes attend university, and it is thought that these students might experience difficulties with their self-care routines while they are there. A qualitative method was chosen to explore students' own perspectives. Seventeen students with diabetes were interviewed twice, and each kept a research diary for a 2-week period. Interviews and diaries were analyzed using standard qualitative techniques. The study was conducted in 2004-2005. Routines had a number of identity-producing benefits for students. However, students often experienced difficulties routinizing their self-care practices at university. These difficulties stemmed both from the irregular nature of university life and from students' desires not to let their diabetes interfere with their student lives. Most participants learned to adjust to university and enact self-care routines, although they could still experience routine difficulties during times of transition and stress. Healthcare professionals need to be aware of the difficulties that university students with Type 1 diabetes experience with their self-care routines. This awareness needs to encompass older students in the second, third and fourth years of their undergraduate degrees and postgraduate students as well as students in their first year at university.

Clinical guidelines about diabetes and the accuracy of peer information in an unmoderated online health forum for retired persons

The objective of this study was to determine whether peer recommendations made in response to user queries about non-insulin dependent type II diabetes in an online health forum for retired persons were in agreement with diabetes clinical practice guidelines. A content analysis was conducted on type II diabetes conversations occurring in an online health forum for Canadian retired persons from 1 January to 31 December 2006. Recommendations responding to posted questions about diabetes were compared with published Canadian diabetes clinical practice guidelines. Seven diabetes-related questions generated 17 responses and 35 recommendations. Comparison of recommendations with evidence-based sources indicated that 91% (32/35) were in agreement with the best practice clinical guidelines for type II diabetes. Discussion themes included diabetic signs and symptoms, glycemic control, neuropathy, retinopathy, diet and physical activity recommendations and interactions of prednisone with glucose control. Concerns about the accuracy of online peer recommendations about type II diabetes care and management have not supported these results. This forum presents information sharing among a group of knowledgeable older adults with high interactive health literacy skills. Future research is needed to determine whether deviations from ‘accurate’ online information are truly harmful or represent lay expert adaptations to self-care routines.

Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions

Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions