Self-management Education Program Research Articles

Digital Interventions in Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes mellitus (T2DM) is a highly prevalent chronic disease with an increasing mortality rate over the last decade. Diabetes self-management education (DSME) programs have been reported as essential to improve survival; however, patient adherence rates are very low. Therefore, digital devices have been created to deliver DSME at a distance and enhance program attendance. This study aims to assess the effects of digitally delivered DSME programs on the glycosylated hemoglobin (HbA1C) of patients with prediabetes and T2DM. Methods: We researched PUBMED databases for randomized controlled trials (RCT) and observational studies (OS) published between 2012-2022 in English, Portuguese, or Spanish. The selected articles tested digital DSME interventions against treatment as usual (TAU) on adults (>18 years) previously diagnosed with T2DM or prediabetes. The result was measured by determining the HbA1c levels. Results: Out of 261 articles, 14 RCTs were selected based on eligibility criteria. Digital DSME technologies have different objectives, including monitoring glycemic fluctuation, insulin titration, nutritional guidance, sleeping assessment, enhancement of physical activity, control of comorbidities, relevant task notifications, personalized treatment recommendations, educational content, and patient/medical staff remote interaction. Some of the technologies combined machine learning techniques for different functions, including detecting adverse glycemic events, physical activity, and blood pressure, among others. Although the level of adherence varied among the various trials, 4 of the 14 RCTs analyzed reported a significant reduction of HbA1c levels using these digital devices compared to TAU. Discussion: Programs providing digital DSME education is a potentially cost-effective tool to improve diabetes care worldwide by overcoming distance barriers, facilitating physician-patient communication, and reducing HbA1c levels. Future improvements in implementing these technologies could enhance user compliance and contribute effectively to diabetes management.

Evaluating a pilot community-based self-management program for adults with spinal cord injury

Objective To evaluate outcomes and perceptions of participating in a pilot spinal cord injury (SCI) specific community-based self-management program. Design A program evaluation conducted through the review of retrospective data. Setting An outpatient vocational rehabilitation service in Singapore. Participants Adults with SCI who completed a self-management intervention. Intervention A self-management educational program was delivered by healthcare professionals with involvement of peer mentors. Up to six self-selected topics were covered using a multi-modal teaching approach. Outcome Measures Retrospective data collected at baseline, post-intervention, and three-month follow-up were analyzed. Outcome measures included the University of Washington Self-Efficacy scale (UW-SES), SCI Secondary Conditions Scale (SCI-SCS), Community Integration Questionnaire (CIQ), and employment. Post-program survey findings were also reviewed. Results Data from fifteen participants revealed positive changes over time for the UW-SES (η² = .27), SCI-SCS (η² = .21), and CIQ (η² = .23). Self-efficacy scores increased from baseline to post-intervention with a large effect size (Hedge’s g = 0.89), and from baseline to follow-up with a medium effect size (Hedge’s g = 0.50). Participants reported overall perceived benefit and satisfaction with the program’s design and relevance. They valued access to useful information, effective instructional methods, program customization, and participant empowerment and affirmation. Suggestions for program refinement included: more peer support, psycho-emotional support, and continued program adaptability and accessibility. Conclusion A SCI-specific community-based self-management program was associated with short-term improvements in self-efficacy and was well-received. Further research is required to determine its effectiveness, essential program features that promote successful outcomes, and cost-effectiveness of program implementation.

A qualitative-based evaluation of the impact of participating in a social media-based foot self-management program among people with diabetes

BackgroundThe rising prevalence of diabetes, along with continued challenges associated with diabetes self-management, including foot self-care activities critical to reducing the incidence of diabetic foot ulcers among people with diabetes (PWD), calls for an alternative approach to diabetes self-management education and support (SMES) programs. AimThis study aimed to explore PWD’s experience of participating in a social media-based foot SMES program tagged Diabetic Foot Care Group (DFCG) and their perspective on how the program changed their foot self-care practices. MethodsThis qualitative-based summative evaluation study involved content analysis of transcripts from telephone interviews about PWD’s current foot self-care practices, change process, likes/dislikes, preferences, and recommendations three months after participating in DFCG. FindingsThe participants had a positive experience in DFCG and reported improved foot self-care practices. Five themes emerged to describe how DFCG helped participants change their foot self-care practice — in-depth knowledge, perceived susceptibility, sense-making, informed decision, and self-motivation. Most participants preferred an online program like DFCG to an in-person program. Participants’ recommendations include increasing individual access to DFCG, integrating virtual group meetings, increasing participants’ engagement, framing posts more positively, and ensuring program continuity. DiscussionDFCG content and structure facilitated cognitive processes that activated PWD to discern the reality of their diabetic foot risks, take ownership of their health, and become committed to practicing the required foot self-care activities. ConclusionThe findings of this study indicate the potential of a social media-based SMES program in promoting healthy foot self-care practices among PWD.

A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing.

Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed "chapters"), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial.

Effect of Self-management Education Program for First Line Nurse Managers on Their Critical Thinking Dispositions

Effect of Self-management Education Program for First Line Nurse Managers on Their Critical Thinking Dispositions

Evaluation of a pilot intervention for online delivery of arthritis-appropriate evidence-based interventions to older adults via parks and recreation agencies

ABSTRACT The objective of this research was to examine the implementation, successes, and challenges to online delivery of existing arthritis-appropriate evidence-based interventions (AAEBIs) to older adults (55+) with arthritis through park and recreation (P&R) agencies, using the Consolidated Framework for Implementation Research (CFIR). Prior to the COVID-19 pandemic, AAEBIs were offered in-person, thus the purpose of the pilot intervention was to assess online delivery through semi-structured interviews with nine P&R agencies. Benefits to participants included protection during a time of heightened risk of serious illness; ease of access and elimination of transportation barriers; flexibility; engagement of community members previously not engaged in physical activity programs; and increased opportunities for socialization, chronic condition management and physical activity, and acquisition of new skills that can support overall well-being. Benefits to organizations offering online AAEBIs included overcoming space constraints or equipment requirements; offering flexible scheduling; engaging community members previously not engaged in physical activity programs; and helping advance social participation, learning opportunities and meaningful community engagement among older adults. The most common challenge was transitioning to an online platform, which can be time-consuming, burdensome, and discouraging for both participants and organizations implementing online AAEBIs. This study demonstrated how the online delivery of AAEBIs can positively influence rates of participation in both virtual programming and chronic disease self-management education programs, as well as combat the adverse effects of social isolation and loneliness among older adults.

Diabetes self-management education for older adults in Western countries: a scoping review protocol.

This scoping review will map the available evidence on diabetes self-management education programs for older adults in Western countries. Self-management and education are crucial for controlling diabetes and its associated complications. The successful uptake of diabetes self-management education programs is not straightforward, and little is known about diabetes programs for older adults. Within this context, a broad overview of diabetes self-management education for older adults, considering all types of related evidence, is needed. All studies in English concerning diabetes self-management education for older adults (aged 65 years and older) living with type 1 or 2 diabetes will be included. This review will not be specific to gender, sex, ethnicity, frailty, or other demographic variables. The review will be restricted to Western countries (North America, Western and Northern Europe, and Australasia), where approaches to diabetes self-management education will be similar. Studies including older adults with or without diabetes will not be considered unless they provide separate analyses for the 2 cohorts. This scoping review will follow the JBI methodology for scoping reviews. We will conduct searches of electronic databases, including CINAHL, MEDLINE, and PubMed, from January 1, 2000, to the present to capture eligible articles. The review will consider all study designs, including quantitative, qualitative, mixed methods designs, as well as text and opinion papers, and systematic reviews that meet the inclusion criteria. After duplicates are removed, titles and abstracts will be screened independently by 2 reviewers, and the full texts will be reviewed. The screening criteria and data extraction protocol will be pilot-tested by the research team. The results will be summarized in tables accompanied by narrative text.

Assessment of the level of knowledge about diabetes mellitus among diabetic patients: A cross-sectional study from Nepal

Background Diabetes mellitus is a chronic non-communicable disease (NCD) often associated with poor psychosocial and health outcomes. Available evidence suggests that patients’ knowledge about the disease is fundamental to its treatment and prevention or delaying of complications. Therefore, this study assessed the level of knowledge of diabetes patients on diabetes mellitus and its associated factors. Methods A descriptive cross-sectional study using a translated Nepalese version of the revised Michigan Diabetes Knowledge Scale was conducted among randomly selected patients with diabetes mellitus presenting to the outpatient department (OPD) of Madhyabindu Hospital, Nepal. Data were collected via an interviewer administered questionnaire and analyzed with MS Excel 2016 and IBM SPSS version 25 software. Results Among the 360 participants, 27.2% had good knowledge of diabetes and 72.8% had poor knowledge. Age, level of education, occupation, family history of diabetes, duration of the disease, presence of comorbidity, complications and body mass index (BMI) were significantly associated with knowledge of diabetes mellitus (p-value ≤ 0.05). Conclusions Based on the study findings, it is important that diabetes self-management education and support (DSMES) programs should be implemented and/or strengthened at the Madhyabindu Hospital and targeted communities to improve diabetes patient’s knowledge on their disease condition and self-care practices.

Effects of a culturally tailored, family-support, community-based self-management education and support programme on clinical outcomes amongst adults with type 2 diabetes in Western Ethiopia: A pilot randomised controlled trial.

To examine the preliminary effects of a culturally tailored, family-supported, community-based diabetes self-management education and support (DSMES) programme for Ethiopian people with type 2 diabetes on glycosylated haemoglobulin (HbA1c), blood pressure, body mass index and lipid profiles. A two-arm pilot randomised controlled trial (RCT) was conducted involving 76 patient-caregiver dyads from Western Ethiopia, which were randomly allocated to the intervention arm to receive 12 hours of DSMES intervention guided by social cognitive theory on top of usual care, or to the control group, which received usual care. Whilst HbA1c was a primary outcome, the blood pressure, body mass index and lipid profiles were secondary outcomes. Primary outcome was the change in HbA1c between baseline and 2-month follow-up between the groups. Generalised estimating equations was used to test the preliminary effect of the DSMES programme on the outcomes at baseline, post-intervention and at 2-month follow-up for secondary outcomes. Cohen's d was used to estimate the between-group effect sizes of the intervention. The DSMES produced significant improvement in HbA1c with large effect size (β = -1.667, p < 0.001, d = -0.81) and triglycerides with medium effect size (d = -0.50). HbA1c in the intervention group was decreased by 12 mmol/mol (1.1%). Although non-significant, the DSMES also had small to moderate effects (d = -0.123 to 0.34) on blood pressure, body mass index, total cholesterol, low-density and high-density lipoproteins when compared with usual care. A culturally tailored, social-cognitive theory guided, family-supported, community based DSME programme could have a benefit on HbA1c and triglycerides. A full RCT is warranted to test the effectiveness of the DSMES programme.

Integrating the Consolidated Framework for Implementation Research (CFIR) into a Culturally Responsive Evaluation (CRE) Approach to Conduct Mixed-Method Evaluations of Diabetes Prevention and Management Programs Reaching Underresourced Populations and Communities.

Diabetes is a significant population health threat. Evidence-based interventions, such as the Centers for Disease Control and Prevention's National Diabetes Prevention Program and diabetes self-management education and support programs, can help prevent, delay, or manage the disease. However, participation is suboptimal, especially among populations who are at an increased risk of developing diabetes. Evaluations of programs reaching populations who are medically underserved or people with lower incomes can help elucidate how best to tailor evidence-based interventions, but it is also important for evaluations to account for cultural and contextual factors. Culturally responsive evaluation (CRE) is a framework for centering an evaluation in the culture of the programs being evaluated. We integrated CRE with implementation and outcome constructs from the Adapted Consolidated Framework for Implementation Research (CFIR) to ensure that the evaluation produced useful evidence for putting evidence-based diabetes interventions to use in real-world settings, reaching populations who are at an increased risk of developing diabetes. The paper provides an overview of how we integrated CRE and CFIR approaches to conduct mixed-methods evaluations of evidence-based diabetes interventions.

Self-Management and Glycemic Targets in Adult Haitian Immigrants With Type 2 Diabetes: Research Protocol.

Type 2 diabetes (T2D) is a chronic condition affecting more than 34.2 million U.S. adults, and people of African descent have a disproportionate burden. Haitian immigrants' unique cultural and biological factors put them at elevated risk for T2D-related complications. Despite prior research highlighting the success of multimethod approaches to T2D self-management behaviors on glycemic targets, a dearth of studies have used these methods to improve diabetes self-management in this marginalized population. This article describes a repeated-measures design protocol of a going study about self-management behaviors among adult Haitian immigrants with T2D and characterizing their barriers to T2D self-management. We will enroll 100 Haitian immigrants aged 18-64 years who have lived with T2D for at least 1 year. Using multiple recruitment methods and Research Electronic Data Capture, subjective and objective data on T2D self-management practices, glucose variability via continuous glucose monitor, and a comprehensive view of physical activity via actigraphy are collected. Data analysis will follow a two-part approach mirroring the two primary study objectives. Findings from the study will guide the development and testing of a culturally tailored diabetes self-management education program that will contribute essential information about best practices for this population and break barriers that may impede research on unique individuals and subsequent effective self-management.

Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness

BackgroundIn high-resource settings, structured diabetes self-management education is associated with improved outcomes but the evidence from low-resource settings is limited and inconclusive.AimTo compare, structured diabetes self-management education to usual care, in adults with type 2 diabetes, in low-resource settings.Research design and methods.DesignSingle-blind randomised parallel comparator controlled multi-centre trial.Adults (> 18 years) with type 2 diabetes from two hospitals in urban Ghana were randomised 1:1 to usual care only, or usual care plus a structured diabetes self-management education program. Randomisation codes were computer-generated, and allotment concealed in opaque numbered envelopes. The intervention effect was assessed with linear mixed models.Main outcome: Change in HbA1c after 3-month follow-up.Primary analysis involved all participants.Clinicaltrial.gov identifier:NCT04780425, retrospectively registered on 03/03/2021.ResultsRecruitment: 22nd until 29th January 2021.We randomised 206 participants (69% female, median age 58 years [IQR: 49–64], baseline HbA1c median 64 mmol/mol [IQR: 45–88 mmol/mol],7.9%[IQR: 6.4–10.2]). Primary outcome data was available for 79 and 80 participants in the intervention and control groups, respectively. Reasons for loss to follow-up were death (n = 1), stroke(n = 1) and unreachable or unavailable (n = 47). A reduction in HbA1c was found in both groups; -9 mmol/mol [95% CI: -13 to -5 mmol/mol], -0·9% [95% CI: -1·2% to -0·51%] in the intervention group and -3 mmol/mol [95% CI -6 to 1 mmol/mol], -0·3% [95% CI: -0·6% to 0.0%] in the control group. The intervention effect was 1 mmol/mol [95%CI:-5 TO 8 p = 0.726]; 0.1% [95% CI: -0.5, 0.7], p = 0·724], adjusted for site, age, and duration of diabetes.No significant harms were observed.ConclusionIn low-resource settings, diabetes self-management education might not be associated with glycaemic control. Clinician’s expectations from diabetes self-management education must therefore be guarded.

Cognitive Behavioral Sleep Self-Management Intervention for Young Adults With Type 1 Diabetes (NCT04975230).

The purpose of this study was to explore perceptions of the first dose of a cognitive behavioral sleep self-management intervention (CB-sleep) among young adults aged 18 to 25 years with type 1 diabetes (T1D). We used a qualitative descriptive approach to conduct in-depth semi-structured focused interviews with a purposive sample of 16 young adults with T1D, transitioning from adolescence to early adulthood. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Participants described their sleep knowledge (previous, new, and additional), sleep health goals, along with barriers and facilitators of the CB-sleep intervention. Based on these results, we suggest CB-sleep is a useful modality with the potential to support sleep self-management in young adults with T1D during this complex life transition. Furthermore, CB-sleep could be incorporated into an existing diabetes self-management education and support program after pilot testing and determining efficacy to improve sleep and glycemic health.

Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study.

To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program. We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes. We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA1c) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively. A total of 10 adults living with T2D were recruited (female 60%; age 49.9, SD 14.3 years; estimated HbA1c 6.2%, SD 0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3.2 (SD 2.6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were "satisfied" with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA1c are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA1c was 6.2% (SD 0.5%) and 6.2% (SD 0.6%) at baseline and week 6, respectively. This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA1c >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted. ClinicalTrials.gov NCT04498819; https://clinicaltrials.gov/study/NCT04498819.

Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models.

Improving Self-management of Type 2 Diabetes in Latinx Patients: Protocol for a Sequential Multiple Assignment Randomized Trial Involving Community Health Workers, Registered Nurses, and Family Members

The rate of Type 2 diabetes mellitus (T2DM) among Mexican American individuals is 16.3%, about twice that of non-Hispanic White individuals. While a number of education approaches have been developed and shown to improve diabetes self-management behaviors and glycemic control for Spanish-speaking Latinx patients with T2DM, there is little research to guide health practitioners regarding which interventions to apply and when so that resources are used efficiently, and treatment outcomes are maximized. This study aimed to describe an adaptive intervention that integrates community mental health workers, diabetes nurse educators, family members, and patients as partners in care while promoting diabetes self-management for Mexican American individuals with T2DM. The project incorporates four evidence-based, culturally tailored treatments to determine what sequence of intervention strategies work most efficiently and for whom. Given the increasing prevalence of T2DM, achieving better control of diabetes and lowering the associated medical complications experienced disproportionally by Mexican American individuals is a public health priority. Funded by the National Institute of Nursing Research (National Institutes of Health grant R01 NR015809), this project used a sequential multiple assignment randomized trial and included 330 Spanish-speaking Latinx patients with T2DM. In the first phase of the study, subjects were randomly assigned to an evidence-based diabetes self-management educational program called Tomando Control delivered in a group format for 6, biweekly 1.5-hour sessions, led either by a community health worker or a diabetes nurse educator. In the second phase of the study, those subjects who did not improve their diabetes self-management behaviors were rerandomized to receive either an augmented version of Tomando Control or a multifamily group treatment focused on problem-solving. The primary outcome measure was the "Summary of Diabetes Self-Care Activities." Evaluations were made at baseline and at 3, 6, and 12 months. This study was funded in June 2016 for a period of 5 years. Institutional review board approval was obtained in November 2016. Between March 2017 and September 2020, a total of 330 patients were recruited from the outpatient primary care clinics of Olive View-UCLA Medical Center, with a brief hiatus between May 2020 and July 2020 due to COVID-19 restrictions. The study interventions were completed in December 2020. Data collection began in March 2017 and was completed in December 2021. Data analysis is expected to be completed in Spring 2023, and results will be published in Fall 2023. The results of this trial should help practitioners in selecting the optimal approach for improving diabetes self-management in Spanish-speaking, Latinx patients with T2DM. ClinicalTrials.gov NCT03092063; https://clinicaltrials.gov/ct2/show/NCT03092063. DERR1-10.2196/44793.

Interventions for supporting self-management in people with musculoskeletal pain, including focus on varying levels of health literacy: A systematic overview of reviews

Background: Musculoskeletal (MSK) pain is a major cause of disability globally, affecting one in three adults. Self-management is a core recommendation for managing MSK pain; however, most self-management programmes require a high level of patient engagement, which may be partly influenced by health literacy levels. This overview aims to summarise current evidence on supported self-management and the influence of varying levels of health literacy in people with MSK pain. Methods: A systematic search was conducted for relevant systematic reviews in databases (Cochrane Library, Medline, EMBASE, CINAHLPlus, AMED, and PsycInfo). Data on study populations (including markers of health literacy), characteristics, and outcomes of supported self-management such as self-efficacy in pain management were extracted. Quality of systematic reviews was assessed using AMSTAR 2, and strength of evidence rated using a modified GRADE approach. Results: In total, 40 systematic reviews contributed evidence to this overview. Based on intervention components and mode of delivery, three main self-management intervention approaches were indicated: structured self-management education programmes (10 reviews), self-directed self-management (four reviews), and combined self-management activity and education programmes (26 reviews). MSK patients with low health literacy levels were found to have poorer outcomes with current self-management interventions. The strength of evidence for self-efficacy in pain management was assessed as low (across the three approaches). Only one review systematically extracted data on measures or markers of health literacy, highlighting an important gap in evidence. Conclusions: A comprehensive summary and critical assessment of current evidence on supported self-management and the influence of health literacy levels among patients with MSK pain was presented. There is a gap in evidence regarding potential mediators of the effects of supported self-management among people with musculoskeletal conditions and low levels of health literacy, thereby limiting the opportunity to positively influence outcomes.

Cost-Effectiveness Analysis of the Culturally Developed Diabetes Self-Management Education and Support Program among Type 2 Diabetes Mellitus Patients in Iraq.

Diabetes mellitus (DM) is a chronic disease associated with a major economic burden on persons, health care systems, and countries. Diabetes self-management education and support (DSME(S)) programs are highly effective method in the management of T2DM patients. Therefore, this study aimed to determine the cost-effectiveness of the developed culturally-specific DSME(S) program regarding glycemic control, lipid profile, and body weight for Iraqi type 2 DM patients. A randomized controlled clinical trial design was used to assess the cost-effectiveness of the culturally-specific DSME(S) program from the perspective of health care providers. In the cost-effectiveness analysis (CEA), cost per patient and clinical outcomes over 6 months were compared between the intervention and control group. Incremental cost-effectiveness ratios (ICERs) were expressed as cost per unit improvement in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high density lipoprotein- cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body weight. The effectiveness of most outcomes was better in the intervention group compared with the control group. The ICER per unit improvement in HbA1c, SBP, DBP, serum TC, and TG levels was <1 of the minimum CET compared with the control group, thus meeting the definition of being highly cost-effective. The currently developed DSME(S) was cost effective method to improve glycemic control, blood pressure, TC, and TG for T2DM patients in Iraq.

Rural/Urban Variations in Diabetes Self-Care in a Sample of Ghanaian Adults with Type II Diabetes: a Study in the East Gonja Municipality

More recently, there has been a greater focus on nutrition and physical activity as key determinants of health. Available evidence suggests that community of residence drive unhealthy diets and sedentary behaviour (e.g. increased physical inactivity); unhealthy diet and sedentary behaviour are major risk factors for non-communicable diseases (NCDs). This single-site hospital-based study assessed rural/urban variations in diabetes self-care practices in a sample of Ghanaian adults with type II diabetes. The study employed a descriptive cross-sectional design. Respondents were recruited from the Diabetes/Hypertension clinic of the East Gonja Municipal Hospital in Salaga, Ghana, through systematic sampling. Structured, interviewer-administered questionnaires were used to collect data for the study. The primary data were analyzed using Statistical Package for Social Sciences (SPSS) version 25. One hundred and sixty-eight (168) type II diabetes patients participated in the study. More than half of them were residents of rural communities (50.6%). Overall, adherence to medication, diet, and physical activity were 51.8%, 41.8%, and 56.0%, respectively. Controlling for age, occupation, and monthly income, residents of urban communities were more likely to adhere to prescribed anti-diabetic medications compared to those in rural communities (AOR 3.70; 95% CI 1.02, 8.11). On the contrary, residence in a rural community was positively associated with adherence to dietary recommendations (AOR 4.21; 95% CI 1.73, 9.54). The current findings highlight the need for diabetes self-management education and support (DSMES) programmes in the East Gonja Municipality to facilitate the knowledge sharing, decision-making, and skills mastery for diabetes self-care.

The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring.

Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1-5 years, ages 21-75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70-180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% (Ps = 0.01). Overall well-being rose significantly (P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven "discovery learning" approach to education.