Self-management Capacity Research Articles

Más allá de la toma de decisiones: Una visión contextual y multidimensional de la autonomía del paciente

There has been a trend in the clinical literature to reduce patient autonomy to decision-making, perhaps due to the influence of the philosophical-legal tradition and because of its initial hospital and emergency medicine focus. This paper presents a broader model of autonomy, which, in addition to strict medical issues and respect for freedom of choice, pays more attention to the specificities that characterise people in need of health care, i.e., the biological, psychological, and social aspects that allow or impede them a greater degree of autonomy. To that end we identify and describe all the stages or points at which the question arises of the patient's (in)capacity for self-management throughout the care process. This generates a more complex and multidimensional notion of patient autonomy which, in addition to the ability to make free and therapeutically informed decisions —decisional autonomy—, also includes the ability to carry out basic vital functions and tasks that can be performed by a statistical majority of people (such as eating, seeing, walking, understanding complex situations, etc.) —functional autonomy—, the patient's capacity to plan, sequence, and perform tasks related to the management of their chronic diseases, i.e., the capacity to implement the chosen therapeutic plan and maintain it over time—executive autonomy—, the patient's capacity to retain, understand and communicate coherently and understandably for others the principle identifying aspects that have characterised them during their lives—narrative autonomy—, and the ability of patients to access and control information relative to their situation for themselves—informative autonomy—.

Promoting psychological well-being in preschool children: study protocol for a randomized controlled trial of a mindfulness- and yoga-based socio-emotional learning intervention

BackgroundMental health issues in youths have cascading negative effects on school outcomes, professional life, and physical health. Psychological well-being (P-WB) is an important protective factor against mental illness. Preliminary research suggests that mindfulness- and yoga-based socio-emotional learning (SEL) interventions can each have a positive impact on preschoolers P-WB. The objective of this trial is to rigorously evaluate the effect of a 24-week combined mindfulness- and yoga- based SEL intervention in preschool children from a French socio-economically disadvantaged area.MethodsThe P-WB promotion intervention is compared to a wait-list control condition in a cluster randomized controlled trial (RCT). Sixty-four pre-Kindergarten classrooms are randomized to the intervention or control group. Primary outcomes measure self-management capacity and core P-WB components: connection, insight, engagement, and positive relationship. Secondary outcomes include measures of mental health, executive functioning, and school performance. Primary and secondary outcomes are assessed through teacher questionnaires, standardized observations of children in school context, and experimental tasks and by collecting results of the national evaluation at first grade. All children-level outcomes are evaluated at pre-intervention, at the end of the intervention, and 1 year later (follow-up analysis), to the exception of school performance which is evaluated at follow-up only. Intention-to-treat analyses, accounting for clustering within classes, will adopt a random effects linear regression model to examine outcomes for the intervention versus control children.DiscussionThis is the first trial to rigorously evaluate a combined mindfulness- and yoga-based P-WB promotion intervention, and the first RCT evaluating a SEL curriculum in French schools. Results may have key implications for P-WB promotion in preschool children.Trial registrationhttps://www.drks.de/ DRKS00028623. Retrospectively registered on 30 May 2022

SIOG2022-0068 - A survey of older adults’ cancer self-management capacity and experiences

SIOG2022-0068 - A survey of older adults’ cancer self-management capacity and experiences

Observation on the Effect of High-Quality Nursing Intervention plus Health Education in Chemotherapy for Non-Small Cell Lung Cancer and Its Influence on the Physical and Mental Health of Patients.

Objective The objective is to analyze the effect of high-quality nursing intervention combined with health education in the chemotherapy for non-small cell lung cancer and its impact on the physical and mental health of patients. Methods The study included 136 patients with non-small cell lung cancer treated at our hospital from March 2020 to December 2021, who were divided into the observation group and the routine/control group by randomization, with 68 patients in each. All patients received the GP (gemcitabine + cisplatin) chemotherapy. The control group received routine nursing care, whereas the observation group received high-quality nursing care mixed with health education. The effect of nursing intervention, patient self-management, and the influence on the physical and mental health of the patients was compared between the two groups. Results The total efficacy rate (89.71%) of the observation group was significantly higher than that of the routine group (57.35%) (P < 0.05). The self-management level of the patients in the observation group, indicated by the Exercise of Self-Care Agency (ESCA) score, was considerably higher than that of the regular group after nursing intervention. Similarly, the observation group's quality of life, which was evaluated in terms of physical function, role function, emotional function, cognitive function, social function, and overall health status, was much better than the routine group's. Furthermore, the SAS, SDS, and overall incidence of adverse events were lower in the observation group than in the regular group. (P < 0.05). Conclusion The application of high-quality nursing intervention combined with health education in chemotherapy for non-small cell lung cancer has favorable clinical benefits, enhances patient compliance and self-management capacity, and exerts a positive influence on the patient's physical and mental health. Adverse reactions can provide a more trustworthy scientific basis for therapeutic therapy. The method should be widely used.

Incorporating social determinants of health into individual care-a multidisciplinary perspective of health professionals who work with people who have type 2 diabetes.

Social determinants of health (SDoH) and type 2 diabetes mellitus (T2DM) are interrelated. The prevalence of T2DM is increased amongst those with suboptimal SDoH. Poor SDoH can also negatively impact T2DM self-management. Social determinants of health are mostly considered at population and community levels, rather than individually or clinically. This qualitative study combines the perspectives of a multidisciplinary cohort of health professionals to identify and explore the impact of social determinants on self-management, and ways they could be incorporated into individual clinical care. Purposively selected participants chose to partake in an in-depth, semi-structured, one-on-one interview or focus group. Data were analysed, and themes identified using a combination of deductive and inductive thematic analysis. Fifty-one health professionals volunteered for the study. Two small focus groups (n = 3 and n = 4) and 44 one-on-one interviews were conducted. The identified themes were: 1) Support for incorporating SDoH into T2DM care, 2) Effect of SDoH on T2DM self-management, 3) Identifying and addressing social need, 4) Requirements for incorporating SDoH into T2DM individual clinical care. Health professionals reported that poor social determinants negatively affect an individual’s ability to self manage their T2DM. Person-centred care could be enhanced, and people with T2DM may be more likely to achieve self-management goals if SDoH were included in individual clinical care. To achieve successful and sustained self-management for people with T2DM, health professionals require a thorough understanding of T2DM and the effect of social determinants, respect for client privacy, client trust and rapport, effective communication skills, validated tools for assessing SDoH, team champions, teamwork, ongoing education and training, adequate resources, guiding policies and procedures, and management support. Incorporating SDoH into individual, clinical care for people with T2DM was strongly supported by health professionals. If embraced, this addition to care for individuals with T2DM could improve self-management capacity and enhance person-centred care.

Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings.

Background and AimsMultimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self‐management in everyday life, the effects of patient activation – a patient's knowledge, skills, and confidence in managing own health – on the capacity for self‐management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self‐management behavior, related perceptions, and health‐related quality of life (HRQoL).MethodsA cross‐sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM‐13®. Responses from 122 patients were analyzed using descriptive statistics, t‐tests, analysis of variance, linear modeling, the χ 2 test, and binary regression analysis.ResultsThe mean score of patient activation was 56.12 (SD 12.82) on a scale 0–100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self‐management including motivation and energy, sense of normality, and support from physicians, nurses, and close people.ConclusionPatient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.

A contribution towards health.

A contribution towards health.

Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial

BackgroundOlder people with multimorbidity are usually required to manage multiple medications and complex medication regimens. However, clinical guidelines for medication management almost entirely focus on a single disease. Further research is needed to assess the efficacy of medication self-management interventions for older people with multimorbidity. ObjectiveThis study aimed to evaluate the effectiveness of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity. DesignA single-blind, two-arm randomised controlled trial. SettingsThree community health centres in Changsha, China. ParticipantsOlder people with multimorbidity. MethodsA total of 136 participants were recruited and randomly allocated into either a 6-week nurse-led medication self-management intervention group (n = 67) or usual care group (n = 69). The intervention consisted of three one-on-one educational sessions on medication-related information, motivation and self-management skills and two follow-up phone calls. The primary outcome was medication adherence. Secondary outcomes included medication self-management capacity, treatment experiences, quality of life and utilisation of health care services. Outcomes were measured at baseline, post-intervention and 3-month follow-up. The intervention effects were assessed using generalised estimating equation models. ResultsStatistically significant improvements were found in medication adherence (β = 1.63, p = 0.034), medication knowledge (β = 2.61, p < 0.001), beliefs about harm of medication (β = −1.83, p < 0.001), medication self-efficacy (β = 3.22, p < 0.001) and satisfaction with convenience of medication use (β = 5.02, p = 0.005) for the intervention group compared with the control group immediately post-intervention. Compared with the control group at 3 months follow-up, the intervention group demonstrated significantly greater improvements in medication knowledge (β = 2.26, p < 0.001), beliefs about necessity of medication (β = 2.68, p = 0.002) and concerns about medication (β = −2.44, p = 0.002), medication self-efficacy (β = 1.87, p = 0.015) and medication burden (β = −3.96, p = 0.004). Improved medication adherence was observed in the intervention group at 3 months follow-up compared with baseline, although the differences between the groups were not significant. No statistically significant effects were found on quality of life and utilisation of health care services at either time point. ConclusionsA 6-week medication self-management intervention significantly improved medication adherence immediately post-intervention, suggesting a short-term intervention effect. A longer intervention period and continuous follow-up support may be required to achieve sustained improvements in medication adherence and health outcomes in older people with multimorbidity. RegistrationChiCTR.org.cn (ChiCTR2000030011); Start of recruitment: June 2020.

CroniCare: Platform for the Design and Implementation of Follow-Up, Control and Self-Management Interventions for Chronic and Multimorbidity Patients Based on Mobile Technologies.

The project proposes to facilitate the design and evaluation of interventions based on mobile technologies and information systems in order to improve the capacity for self-management, empowerment and control of chronic and multimorbidity patients. The system allows to create customizable apps according to the needs of primary care and specialized care. The project includes an evaluation of the impact of the care model, as well as the effectiveness and efficiency of the intervention through a study with 124 multimorbidity patients.

Neurological patient and informal caregiver quality of life, and caregiver burden: A cross-sectional study of postdischarge community neurological nursing recipients

Background Neurological conditions produce considerable disease burden. Aims To describe quality of life in patients with neurological conditions and informal caregivers receiving postdischarge generic community neurological nursing services, and caregiver burden. Method A descriptive cross-sectional design was used with researchers administering the WHOQOL-BREF Australian Version questionnaire and Zarit Burden Interview. Results Most patients and caregivers rated quality of life as ‘Good’. The patients’ physical, psychological and environment domain scores, and caregivers’ physical domain scores, were below norms. Half of the caregivers experienced burden and 42% had risk for depression. Conclusion A heterogeneous group of patients with neurological conditions had considerable care and support needs for fundamental functioning postdischarge. Quality of life and caregiver burden measures highlight the impact of their circumstances on their health and wellbeing. Research is warranted to determine a comprehensive set of generic needs to guide integrated community nursing services for building patient and caregiver self-management capacity.

Identification of core components and implementation strategies for a Conservative Kidney Management Pathway across a complex, multisector healthcare system in Canada using World Cafés and the Theoretical Domains Framework

ObjectiveDevelop a Conservative Kidney Management (CKM) Pathway for patients unlikely to benefit from dialysis. We sought to determine (1) core components of care and (2) implementation strategies across a multisector...

A holistic view of the stoma care pathway in Italy: a nationwide learning survey

Background: The therapeutic care pathway for a patient with a stoma starts with a preoperative diagnosis and the decision to form an ostomy, followed by postoperative education, and it continues for as long as the stoma is in place. Clinical studies in this area are often limited to analysing a specific stage in this process, and less attention has been given to how each stage influences the rest of the pathway. Aim: This study aimed to provide a holistic assessment of the entire stoma care pathway, encompassing professional management of emerging complications, as well as the patient's perceptions of care and capacity for self-management, to determine how one management stage might affect another. Method: The study consisted of an anonymous questionnaire with 96 items divided into nine sections. It enrolled people with one or more urinary and/or intestinal stoma/s and lasted from September 2017 to December 2019. Findings: In the sample of 403 ostomates, 52% were female and 48% male, while 74% had an intestinal stoma, 19% a urinary stoma and 7% both. Of all respondents, 52% presented with peristomal lesions. Pre-operatively, a lack of training (76%), stoma siting (70%) and psychological support (92%) were observed. After discharge, 75% had peristomal lesions, 47% had professional care. At the time of the study, 60% were self-sufficient in ostomy care, 52% had lesions, while 38% were unsatisfied with the device used. Conclusion: Detailed discussion is given to peristomal skin care, self-sufficiency, ongoing support and the needs of people with both a urinary and an intestinal stoma. Patient education, psychological support and access to a stoma care specialist all likely affect acceptance and quality of life.

Improving glycemic control in patients with type 2 diabetes mellitus through a peer support instant messaging service intervention (DiabPeerS): study protocol for a randomized controlled trial

BackgroundDiabetes mellitus is one of the four priority non-communicable diseases worldwide. It can lead to serious long-term complications and produces significant costs. Due to the chronicle character of the disease, it requires continuous medical treatment and good therapy adherence of those suffering. Therefore, diabetes self-management education (DSME) (and support DSMES) plays a significant role to increase patient’s self-management capacity and improve diabetes therapy. Research indicates that these outcomes might be difficult to maintain. Consequently, effective strategies to preserve the positive effects of DSMES are needed. Preliminary results show that peer support, which means support from a person who has experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, is associated with better outcomes in terms of HbA1c, cardiovascular disease risk factors or self-efficacy at a lower cost compared to standard therapy. Peer-supported instant messaging services (IMS) approaches have significant potential for diabetes management because support can be provided easily and prompt, is inexpensive, and needs less effort to attend compared to standard therapy. The major objective of the study is to analyze the impact of a peer-supported IMS intervention in addition to a standard diabetes therapy on the glycemic control of type 2 diabetic patients.MethodsA total of 205 participants with type 2 diabetes mellitus will be included and randomly assigned to an intervention or control group. Both groups will receive standard therapy, but the intervention group will participate in the peer-supported IMS intervention, additionally. The duration of the intervention will last for 7 months, followed by a follow-up of 7 months. Biochemical, behavioral, and psychosocial parameters will be measured before, in the middle, and after the intervention as well as after the follow-up.DiscussionType 2 diabetes mellitus and other non-communicable diseases put healthcare systems worldwide to the test. Peer-supported IMS interventions in addition to standard therapy might be part of new and cost-effective approaches to support patients independent from time and place.Trial registrationClinicalTrials.govNCT04797429. Registered on 15 March 2021.

What Injured Workers With Complex Claims Look For in Online Communities: Netnographic Analysis.

BackgroundImproved understanding of social constructs around injury may help insurance case managers to understand how best to support people after injury.ObjectiveThis study sought to explore what people who sustain work-related injuries may seek from online communities. The study highlights potential opportunities for improved engagement with insurance case management practice.MethodsAn observational netnographic analysis was undertaken on anonymous, publicly available messages posted on Australian message boards. All research data were drawn from anonymous, online communities. A person (author SM) with experience of making a claim through an Australian workers’ compensation system and online engagement was involved in study conception, design, and analysis. Data were analyzed using NVivo12 in an iterative, multistage process including coding, journaling, and member checking. A total of 141 people were engaged in discussion across 47 threads housed on 4 Australian forums.ResultsIn this qualitative study, themes emerged from the data, describing how injured workers use online communities to help make decisions, get support, and solve problems. The key motivators for action and engagement were seeking information, connection, or justice. Establishment of relationships was a key mediator of each of these parameters.ConclusionsSome work-related injuries may involve medical and medicolegal complexity as well as changed lifestyle and routine during convalescence and recovery. The mechanism used by some injured workers to seek information and problem solve suggests a capacity for self-management and self-care after work-related injury. Netnography provides information on a community that may not regularly engage with research because of the complexity of their situation and their vulnerability.

IDF21-0117 Psychological intervention in comprehensive care for people with diabetes

Background: Diabetes is one of the most relevant global health problems, due to its prevalence, multidimensional biopsychosocial consequences and economic impact on society. This holistic approach favours management, planning and lifestyle changes, which are the main objectives of diabetes intervention. There is increasing recognition that diabetes has psychological consequences that directly affect behavioural management and quality of life and that these aspects need to be addressed as part of diabetes management. People with diabetes require psychological care from the moment the disease is diagnosed. However, in intervention settings, either due to lack of time or absence of professionals, this type of treatment is not offered. Psychological problems are sometimes thought to be less important than physical problems in improving health and people with diabetes are not aware of the importance of psychological well-being in diabetes management. Aim: The aim of this review is to search for references on different randomised studies investigating the efficacy of psychological interventions aimed at treating people with diabetes. Method: A systematic search was carried out in several databases: PsycINFO, Dialnet, Scopus and Web of Science and 1,360 articles were obtained. The PRISMA system was applied, and after eliminating duplicates and theoretical articles, 311 potential articles of interest were left, published between 2017-2021. Subsequently, a critical reading of the clinical evidence found was carried out by applying CASPe to check the efficiency of the search. Results: Eleven articles are randomised controlled trials of which the characteristics of the subjects (sex, age, diabetes, methodological characteristics (sample size, type of design, quality of the study) and the characteristics of the intervention are analysed according to a) the purpose (adherence to treatment, self-management, anxiety, depression), b) the type (cognitive behavioural, problem solving, acceptance and commitment), the mode (group, individual, both) and the style (face-to-face, blended, online). After contrasting the analyses, it has been possible to demonstrate that psychological interventions adapted to diabetes reduce HbA1c and have a positive effect on Mental Health, especially anxiety, stress and depression, improving the capacity for self-management of the disease. Discussion: This review suggests that the identification and management of psychological aspects in people with diabetes is an integral and critical component of their treatment. Psychological well-being has become an important indicator of diabetes control. Further studies should be conducted to thoroughly evaluate the effect of early identification of problems and early referral to appropriate psychological care services. It is also suggested that a simple and effective protocol for providing psychological care in clinical use be developed and the effectiveness of such a protocol examined.

Technologizing youth training for entrepreneurship to fulfil sustainable development goals

The relevance of the article can be justified by the requirements for youth entrepreneurship training defined by sustainable development goals. In particular, these requirements are expected to promote the continuous, comprehensive and sustainable economic growth of the country, as well as full and decent employment for all. The object of the research is the technologization of youth training for entrepreneurship. The aim of the research lies in justifying and experimentally verifying the author’s method of introducing pedagogical technologies in youth training for entrepreneurship in vocational education institutions. Results: the author’s method of introducing pedagogical technologies is defined as a system of dependent variables, pedagogical factors and algorithms of their application. The article also presents a modelled algorithm of the simultaneous introduction of the author’s technologies (motivating future specialists towards business activity, improving their financial literacy and capacity for project activity and effective self-management) in educational institutions. The effectiveness of this method has been verified during a pedagogical experiment. This experiment aimed to prove the positive dynamics in the levels of future specialists’ entrepreneurship competence. Conclusions: In the short run, the author’s method of introducing pedagogical technologies in youth training for entrepreneurship allows one to optimize teachers’ activities (by simplifying the choice of pedagogical influence factors and isolating dependent variables), strengthen the systematicity, controllability, reproducibility and effectiveness of the author’s technologies. In the medium run, it will promote the technologicalization of vocational education and help achieve sustainable development goals. Experimental verification of the author’s method has shown a significant increase in students’ levels of entrepreneurship competence. Furthermore, it has proved the synergistic effect of the systematic use of innovative forms and methods of pedagogical influence on personality.

Self-Management Capacity in Adults with Type 2 Diabetes Using Educational Interventions: A Pilot Study.

Type 2 Diabetes (T2D) has been increasing in prevalence over the last decade in Mexico. The glycemic control actions can help to prevent complications. The aimed is to pilot an educational intervention in self- management of adults with T2D through using text messages. Findings show the respondents reported a low level of self-care skills of T2D and there was an increase in the self-care skills after it.

Development of an instrument to assess self-management capacity of patients receiving peritoneal dialysis: CAPABLE.

Treatment of kidney failure with peritoneal dialysis (PD) at home implies that the patient and/or their caregiver develop a series of skills and basic knowledge about this therapy. There is not a specific inventory of the patient's abilities to safely perform the PD procedure at home. The objective of this study was to describe the development of an instrument that allows measuring the self-management capacity of patients receiving PD, locating the performance areas that justify the need for intervention by a caregiver. This is a qualitative study developed in three phases: The first phase was the identification of performance areas through bibliographic search and validation of the results with focus groups of experts in PD. The second phase was the design of a system to measure self-management capacities. The third phase was a pilot test of the preliminary version of the instrument applied in 20 incident PD patients. Three domains were identified to evaluate the fundamental components of self-management capacity: cognitive and sensory, each one evaluated with four items and motor domain evaluated with eight items. After applying the instrument, we found that 15 patients (75%) did not require support from the caregiver in any of the items. PD patients and nurses found the tool valuable, easy to understand and applicable in the early evaluation of a PD patient. We developed an easy-to-administer instrument to measure the self-management capacity of patients receiving PD. This inventory could locate areas that require specific support from a caregiver. Planning an individualised and focused education and training process could result in better health outcomes.

An examination of the help-seeking behaviors of HBCU students by gender, classification, referral source, and mental health concerns

ABSTRACT This study examined the actual help-seeking behaviors of 428 Black students at an urban HBCU to identify factors propelling students to seek mental health services at a university counseling center. In contrast to Black students’ reported reluctance to seek professional mental health services, self-referrals accounted for 39.7% of students seeking services. Despite the stigma associated with experiencing a mental health concern, students’ social and familial capital also factored heavily in the referral for services. Family problems, couples problems, peer interpersonal relationship problems, depression, anxiety and stress were major concerns influencing help-seeking. To facilitate student growth and development, counseling centers should provide transformative services that enhance students’ capacity for self-awareness, self-management, and academic success.

Management Community of Communal Lands in the Andean Rural Community of San Roque de Huarmitá, Concepción, Junín, Peru

In this research, the influence of community management of the rural Andean community of San Roque de Huarmitá on the condition of communal lands was analyzed: usufructuated lands (family management) and communal farm (collective management), through an evaluation of the institutional level (design principles) as an indicator of community self-management capacity and analysis of physical-chemical characteristics of soils. Research methods such as: ethnoknowledge and similarity analysis were also used. The results showed that the design principles were well implemented in relation to land use and that the physical-chemical properties differ significantly between the two types of communal lands, showing better fertility results in the usufruct lands. It was concluded that the Andean rural community has a robust level of self-management, that is, it has sustainable community management. Since the usufruct lands provide direct benefits to the families (good soil fertility and pasture production), while the communal farmlands, having extensive management, do not generate direct benefits. In other words, there is a prioritization for the care of the family resources before the community resources.