Self-management Group Intervention Research Articles

Promoting Positive Self-Identity of Youths With Mental Disorders: Collaboration Between Academia and a Ministry of Education.

Inclusive schools reflect the dominant approach to education, yet many youths with mental disorders still attend special education schools. Although special education schools address educational, social, and developmental needs, they may increase students' self-stigma and hinder positive identity formation. Israel's Ministry of Education and an academic community mental health department partnered to address this challenge by developing a manual-based intervention for special education school settings. About 180 teachers were trained, and approximately 400 students participated in the self-management and positive identity group intervention. This partnership demonstrates the importance and potential of collaborations to address challenges that arise in real-world settings.

Occupational therapy-based self-management education in persons with post-COVID-19 condition related fatigue: a feasibility study with a pre-post design

Purpose Persons with post-COVID condition are a growing population requiring support returning to everyday life. Energy management education (EME) is a group self-management intervention based on energy conservation and management strategies delivered by occupational therapists. Data on the effectiveness of EME in persons with long COVID-related fatigue still need to be provided. This study aims to investigate procedural and methodological parameters to plan a future study analyzing the effectiveness of EME in individuals with post-COVID-19 conditions. Materials and Methods A pre-post design was used. The procedural data was collected regarding eligibility, reasons for participation decline, dropout, and follow-up rates. Changes in self-efficacy in using energy management strategies, fatigue impact, competency in daily activities, and quality of life were collected three times. Implemented behavior strategies at five months from EME were documented. Results During five months, 17 of 30 eligible participants were included in the study. No dropouts were registered during the intervention period. The follow-up response rate was 70%. The effect size was large in three out of four outcomes post-intervention, with a tendency to increase at follow-up. Conclusions This study demonstrated the feasibility of study procedures and reported promising effect sizes for EME that should be further researched.

Analysis of changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention

Objective: To analyze the changes in self-efficacy and its influencing factors in type 2 diabetic patients after community-based self-management group intervention. Methods: From August to November 2014, a 3-month community-based self-management intervention study of type 2 diabetes patients was implemented in Fangshan District, Beijing. 510 patients were recruited through posters, household inquiries and telephone notification and then were randomly divided into intervention group (260 patients) and control group (250 patients). Finally, 500 patients completed the study, including 259 in the intervention group and 241 in the control group. Self-efficacy score was measured through face-to-face interview at different time points, including pre-intervention, post-intervention, 2 years after the intervention and 5 years after the intervention, respectively. A two-level random coefficient model was fitted to analyze the long-term trend of self-efficacy and its relationship with group intervention. Results: Individual-level educational attainment, disease duration as well as their treatment plans had a positive correlation with self-efficacy of type 2 diabetic patients while gender and age did not affect their self-efficacy. Patients with junior middle school education, senior high school education and university and above education had 4.66 (P<0.05), 6.40 (P<0.05) and 11.02 (P<0.05) points higher than those with primary education, respectively. The self-efficacy of diabetic patients increased by 0.23 (P<0.05) for each additional course year. The effect of treatment plan on self-efficacy was mainly reflected in the self-efficacy of taking medication or insulin injection as prescribed and blood glucose monitoring. After controlling for the confounding factors, i.e., gender, age, disease duration, educational attainment, and treatment plan, self-efficacy scores at the post-intervention increased in both groups compared to those at the pre-intervention. The intervention group had 7.95 points higher than the control group (P<0.05). After the intervention, the self-efficacy scores of both groups decreased year by year while the intervention group declined faster, with 5.41 points (P<0.05) at 2 years after the intervention and 8.94 points (P<0.05) at 5 years after the intervention. Conclusion: Community-based self-management group intervention could improve the self-efficacy of type 2 diabetic patients while the self-efficacy decreases year by year in the absence of follow-up intervention.

Quality of life and its influencing factors among diabetic patients two years after a self-management intervention in six provinces and cities in China: a follow-up study

Objective To analyze the quality of life (QoL) and its influencing factors among diabetes mellitus patients two years after undergoing a community-based diabetes self-management and to provide references for improving medical service to diabetes. Methods From August to October of 2013, 1 653 diabetic patients were recruited in 84 communities in three cities (Beijing, Shanghai and Chongqing) and three provinces (Jiangsu, Guangdong and Zhejiang) to carry out a 2-month diabetes self-management group intervention. A follow-up survey was conducted during September – December 2015 to analyze changes in QoL and its influencing factors before and after the self-management intervention. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was used in QoL evaluation. Results Among the 1 653 diabetic patients recruited in 2013, 1 603 (96.98%) completed a baseline survey, of which, 1 299 patients were followed up and 304 (18.96%) were lost to follow-up in 2015. Compared to those before the intervention, the patients′ median (quartile range, QR) of SF-36 physical health score increased significantly two years after the self-management intervention (76.50 [23.75] vs. 75.00 [25.00], Z = – 2.53; P = 0.011), but the patients′ median (QR) of SF-36 mental health score was not significantly different (78.44 [25.03] vs. 78.44 [23.31], P > 0.05). The results of unconditional multivariate logistic regression analysis demonstrated that two years after receiving the diabetes self-management intervention, the patients suffering from diabetes 5 years or more and smoking were less likely to have an increased physical health score, while those with an improved self-efficacy were more likely to have an increased physical health score; the patients with following characteristics were less likely to have an increased mental health score: female, with medication reimbursement by medical insurance for urban workers, having complication of other chronic disease, smoking, and being capable of self-injection of insulin or not needing insulin injection. Conclusion The quality of life was improved to a certain extent among a group of community diabetic patients in China two years after a self-management intervention and the improvement was influenced by the patients′ gender, major payer of the medication cost, disease course, comorbidity of other chronic diseases, self-efficacy, smoking, and self-injection of insulin.

Perceptions of a self-management intervention for adolescents with sickle cell disease.

Objective: Individuals with sickle cell disease (SCD) are at increased risk for complications from their disease during their adolescent and young adult (AYA) years. The risk of morbidity in AYAs with SCD can be decreased with improved self-management. Existing self-management interventions typically focus on one aspect of self-management (e.g., adherence) and do not address factors that activate patients (knowledge, motivation, self-efficacy, and social support) to self-manage. Sickle Cell Thrive (SCThrive) is a mixed in-person/online, technology-enhanced (use of a mobile app), group self-management intervention that targets patient activation. To determine the most clinically significant intervention components, a qualitative study was conducted. Method: Participants were 19 AYAs (Mage = 17.05) with SCD who participated in individual semistructured phone interviews after completing SCThrive. Interview content was coded using a grounded-theory approach to generate themes related to SCThrive’s feasibility, acceptability, and motivation for and impact on self-management. Results: SCThrive was reported to be highly feasible due to the mixed in-person/online format and acceptable because they learned skills to manage SCD in a group of AYAs with SCD. Action planning and pain/mood tracking appeared to be key factors in motivating AYAs for self-management. Participants reported continuing to use self-management skills post-SCThrive (self-efficacy) including applying them to other domains of their lives (e.g., educational/vocational). Conclusions: Study results provide data that can be leveraged to enhance the feasibility, acceptability, and impact of SCThrive and other self-management interventions. Findings can also inform clinical and mobile health interventions to increase self-management in this population.

Lasting Effects of a Community-Based Self-Management Intervention for Patients With Type 2 Diabetes in China: Outcomes at 2-Year Follow-up of a Randomized Trial.

This research is to evaluate the lasting effects of a community-based self-management intervention for patients with type 2 diabetes at 2-year follow-up in China. Five hundred patients with diabetes were recruited and randomly divided into intervention group and control group. Eight times standardized self-management intervention group activities were conducted. The results of physical examination, biochemical laboratory examination, health behavior, and self-efficacy information were collected before intervention, 3 months after intervention, and 2 years after intervention. The total score for self-efficacy in the intervention group increased from 96.12 ± 17.48 to 112.90 ± 14.58 after intervention and decreased after 2 years (106.98 ± 18.03; F = 6.64, P = .0014). The number of days of self-blood glucose monitoring in the intervention group was increased from 1 day per week to 2 days per week after intervention, and 2 days per week at 2-year follow-up (F = 8.02, P = .0003). The frequency of average number of aerobic exercises in the intervention group increased from 6 days per week to 7 days per week after intervention and was 7 days per week at 2-year follow-up (F = 3.63, P = .0269). Community-based self-management group intervention for patients with diabetes has long-term effects.

Effectiveness of peer-supported self-management group intervention in patients with type 2 diabetes

Objective: To assess the effectiveness of peer-supported diabetes self-management group intervention and explore a community-based diabetes health management model. Methods: From September to December in 2016, patients with type 2 diabetes were recruited from 6 streets (townships) in Binhu and Xishan district of Wuxi, Jiangsu Province. According to a structured diabetes self-management course, guidance was provided by community health workers and peer volunteers. Self-management group intervention was led by type 2 diabetes patients. A self-control design was used to collect information on self-management behavior, fasting blood glucose, and health care utilization at baseline and after 4-month intervention, and compare the difference of these indicators before and after the intervention. Results: Compared with the baseline, 147 participants aged from 30 to 80 years old had more increases in proportions of salt control (78.2% vs 60.5%, P<0.001) and oil control (79.6% vs 58.5%, P<0.001) in daily diet. The P(50) (P(25), P(75)) of scores of symptom management and consultation list increased from 6 (0, 11) and 0 (0, 2) to 9 (4, 13) and 1 (0, 2) (P<0.05) after 4-month intervention. Fasting blood glucose significantly decreased from (8.8±2.9) mmol/L at baseline to (7.6±1.9) mmol/L and the control rate of blood glucose significantly increased from 29.3% to 44.2% (P<0.05) after 4-month intervention. The proportion of outpatient visited decreased from 42.2% to 12.9% and the proportion of hospitalized decreased from 10.2% to 4.1% (P<0.05) after 4-month intervention. Conclusion: Peer-supported diabetes self-management group intervention could effectively improve behavior and blood glucose control of patients with type 2 diabetes.

SAT-474 “IN OUR OWN TERMS”: DYADS EXPECTATIONS ABOUT A FAMILY-BASED SELF-MANAGEMENT INTERVENTION IN END-STAGE RENAL DISEASE

End stage renal disease (ESRD) is a complex condition that requires patients to follow strict life-changing treatment regimens and health care recommendations. Family caregivers can play a protective role in treatment adherence and help the patient cope with the challenges that this disease may pose. Self-management interventions seek to increase an individual's ability to deal with the implications of the condition throughout its course. Although theoretically oriented, the design of such interventions can benefit from the patients and their family caregivers’ input to ensure that their preferences and needs are met. This study aimed to explore the expectations and concerns of patients and their family caregivers regarding participation in a family-based self-management group intervention for ESRD. The study received full approval from the Institutional Ethics Committee. A qualitative exploratory study was conducted with a purposive sample recruited from two dialysis units. Semi-structured face-to-face dyad interviews were conducted with 17 patients (9 males; 66.6±12.3 years) undergoing hemodialysis for 17.4±11.9 months and their respective family caregivers (11 females; 57.2±13.6 years; 12 spouses). The interviews were digitally audio-recorded, transcribed verbatim, and submitted to content analysis by two independent researchers. Most dyads (n = 12; 71%) were interested in participating in a family-based self-management group intervention. By participating, dyads expect to i) acquire better knowledge and clarification about disease etiology, hemodialysis and related complications, and health care recommendations (9 patients, 53%; 12 caregivers, 71%); ii) give and receive emotional support by sharing experiences (10 patients, 59%; 7 caregivers, 41%); iii) improve disease-related coping skills (3 patients, 18%; 3 caregivers, 18%); iv) improve communication with health professionals (2 patients, 12%); v) and strengthen family involvement in the disease (3 caregivers, 18%). Some participants also expressed concerns of being misunderstood and/or judged by others (3 patients, 18%; 2 caregivers, 12%); and of being contaminated by others’ negative experiences and feelings (1 patient, 6%; 3 caregivers, 18%). Findings suggest that patients and their respective family caregivers expect to benefit from a self-management intervention for ESRD, supporting the need for the development of approaches involving both parties. In accordance with their expectations, future family-based self-management programs for ESRD should be tailored to provide educational and psychological support and promote coping skills training.

Evaluation of a Peer-led Asthma Self-management Group Intervention for Urban Adolescents

PurposeThis paper describes the acceptability and generalizability of an evidenced-based peer-led asthma self-management program. Design and methodsAdolescents with persistent asthma (n = 259, ages 12–17 years) from three urban cities participated in a one day camp led by either trained peer leaders (n = 35, ages 16–20 years; intervention group) or healthcare professionals (control group). Participants completed a camp evaluation form, and the peer leader quality survey. ResultsOverall program evaluation showed high acceptability with average score of 4.5 (±0.87) out of 5 and no treatment group differences were found. Campers highly rated peer leaders' qualification, particularly trustworthiness (98%), knowledge (97%), and sense of humor (95%). Participants from low income families (annual income < $30,000) reported higher satisfaction with their camp experience being enjoyable compared to their counterparts from higher income families (X2 = 4.23, p ≤ .04). ConclusionsThis study supports the acceptability and generalizability of a peer-led asthma self-management program across different urban community locations, seasons and venues. Practice ImplicationsTrained peers can be as effective as adult educators in teaching adolescents asthma self-management.

Focusing on the Future of Mobile Mental Health and Smartphone Interventions.

Focusing on the Future of Mobile Mental Health and Smartphone Interventions.

Research protocol: investigating the feasibility of a group self-management intervention for stroke (the GUSTO study)

BackgroundLife after stroke can be an ongoing struggle with over half of all survivors reporting unmet emotional and social needs. In the United Kingdom’s (UK) national clinical guidelines for stroke, self-management is suggested as one approach which can support long-term needs. In the UK NHS, self-management interventions are delivered in various ways. Regardless of the delivery mechanism, a tailored approach and ways to integrate peer support are advocated. Group delivery offers a platform for peer support and has the potential to remain individualised. However, before the efficacy of a group self-management intervention can be tested, the feasibility must be explored. This research investigates the feasibility of a GroUp Self-management intervention for sTrOke (GUSTO).MethodsA randomised waitlist control design will be used to investigate the feasibility of a group self-management intervention adapted from an existing one-to-one intervention called Bridges. A mixed methods approach will be used. Qualitative work will capture participant experience, while quantitative work will allow preliminary comparison between the intervention and waitlist groups (between subjects) and pre-post intervention measures (within subjects). Interviews will be conducted with stroke survivors and focus groups with family and friends to assess acceptability of the intervention.DiscussionThere is a growing interest in group-based self-management interventions for stroke as a method of supporting stroke survivors’ ongoing unmet needs. This is an area with limited research to date. This study will inform design of a fully powered trial which would assess the efficacy of a group self-management intervention following stroke.Trial registrationISRCTN19867168

Effectiveness of sleep self-management group intervention in Chinese patients with insomnia disorder.

The purpose of this study was to explore the effectiveness of sleep self-management group intervention for insomnia disorder. One hundred four patients with insomnia disorder were recruited from The Seventh Hospital of Hangzhou, from February to November 2015. After completing the Pittsburgh Sleep Quality Index (PSQI) and Sleep Diary and Beliefs and Attitudes about Sleep Scale (DBAS), they were randomly assigned into the intervention group (n = 52) and the control group (n = 52). The intervention group received the "sleep self-management group intervention," while the control group was trained with routine intervention in the same form combined with 5 to 10 mg Zolpidem nightly. Patients from both groups completed the PSQI, DBAS, and Sleep Diary after 8 weeks of treatment. The intervention group scored significantly lower on the PSQI total score, Objective Sleep Efficacy, and Sleep Disturbance but higher on the DBAS total score, misconceptions about the causes of insomnia, misattribution or amplification of the consequences of insomnia, faulty beliefs about sleep-promoting practices than the control group after intervention. The sleep self-management group intervention could enhance sleep efficacy, improve sleep disturbance, and sleep misbeliefs.

Self-Management Group Exercise Extends Healthy Life Expectancy in Frail Community-Dwelling Older Adults.

Preventing frailty and its adverse health outcomes is crucial in countries with a large elderly population, such as Japan. Since the long-term care insurance (LTCI) system was launched, the number of certified older adults with LTCI service requirement has continued to increase. This is a serious problem, because the LTCI service requirement certification is equivalent to disability. The aim of this study was to evaluate the effect of a self-management group intervention on new LTCI service requirement certifications in community-dwelling older adults in Japan. We analyzed the cohort data from a prospective study. In this study, we recruited community-dwelling adults aged 65 years and older who were independent in a city in Kyoto prefecture in 2012. The subjects in the participation group (n = 1620) attended 60-min group training sessions once or twice every two weeks from December 2012 to December 2016. The exercise sessions consisted of mild-intensity aerobic exercise, mild strength training, flexibility and balance exercises, and cool-down activities. These exercise classes were facilitated by well-trained volunteer staff. The outcome measure was the number of new LTCI requirement certifications during a four-year follow-up period. During the four-year follow-up period, 247 subjects (15.2%) in the participation group and 334 (20.6%) in the control group were newly certified for LTCI service requirements. The hazard ratio for new LTCI service requirements in the participation group compared with the control group was 0.73 (95% CI = 0.62–0.86) in the four-year follow-up period. These results indicate the usefulness of self-management group exercise to reduce the incidence of disability in older adults. Thus, increasing self-management group activities in each community should be encouraged.

A 9-year follow-up of a self-management group intervention for persistent neck pain in primary health care: a randomized controlled trial.

Background and objectiveIn previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and health care utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT.Materials and methodsOf 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and health care utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of “time by group”.ResultsNinety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and health care visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less disability (p = 0.006) and a trend toward better self-efficacy (p = 0.059) than the IAPT group.ConclusionThe favorable effects on pain-related disability of PASS were sustained 9 years after the intervention.

Pilot of the Chronic Disease Self-Management Program for Adolescents and Young Adults With Sickle Cell Disease

PurposeThis study evaluated the feasibility of a group self-management intervention, the well-established Stanford Chronic Disease Self-Management Program (CDSMP), for adolescents and young adults (AYA) with sickle cell disease (SCD). MethodsA total of 22 AYA participants with SCD, ages 16–24 years, completed self-efficacy and quality of life measures before the CDSMP, after, and 3 and 6 months later. ResultsThis AYA cohort showed significant improvements in self-efficacy (primary outcome) after the intervention. Analyses of follow-up data revealed a medium effect of the CDSMP on patient activation 3 months post although this was not sustained. Participants were highly satisfied, but only 64% completed the program. ConclusionsThis study demonstrates that the CDSMP is acceptable and has the ability to improve self-efficacy. Additional research is needed to determine feasibility and evaluate health outcomes for AYA with SCD.

Development of a complex group self-management intervention and feasibility trial for osteoarthritis and chronic low back pain

Development of a complex group self-management intervention and feasibility trial for osteoarthritis and chronic low back pain

Effects of a nurse-led medication self-management programme in cancer patients: protocol for a mixed-method randomised controlled trial.

BackgroundWith the widespread use of orally administered anticancer agents, self-management by cancer patients is inevitable, and adherence to medication is becoming the centre of interest in oncology.Methods/DesignThis mixed-method study is a two-phased approach with a combined quantitative and qualitative design. In the first phase, we will conduct a prospective randomised controlled study to assess the effects of a nurse-led medication self-management programme for patients receiving oral anticancer treatment. Patients with metastatic breast cancer, who have been newly prescribed an oral chemotherapy or a targeted therapy agent will be enrolled in the study. The participants will be randomly assigned to either the medication self-management support programme group (intervention group) or the conventional care group (control group). This will be an open-label study; therefore, neither the patients nor the nurses will be blinded. Nurses will provide patients in the intervention group with information by using the teach-back method, help patients set a goal based on their preferences, and solve problems through follow-up counselling. The primary outcome measure is adherence to medication, to be measured on the basis of the medication possession ratio (MPR), which is the ratio of the number of days of medication supply to the total days at a specified time interval. We hypothesize that the intervention group will have an MPR of ≥90 % that is significantly higher than that of the control group. Secondary outcome measures include self-efficacy, quality of life, psychological distress, severity and interference of symptoms, patient satisfaction, emergency department visits, and hospital admissions. In the second phase, we will conduct focus-group interviews with intervention nurses, and perform a content analysis to understand their role and challenges these nurses will face in the programme while improving patients’ medication adherence.DiscussionThe present study will be the first Japanese study to evaluate the effects of medication self-management support provided by nurses to patients with metastatic breast cancer who are receiving oral anticancer treatment. The study is characterised by a unique patient-centred approach aiming to help patients manage their medication based on their needs and preferences, with both quantitative and qualitative evaluations. The findings will contribute to the facilitation of medication management in cancer patients.Trial registrationUMIN Clinical Trials Registry (UMIN-CTR), Japan, UMIN000016597. (27 February 2015).

A pilot randomized controlled trial of a self-management group intervention for people with early-stage dementia (The SMART study).

Self-management equips people to manage the symptoms and lifestyle changes that occur in long-term health conditions; however, there is limited evidence about its effectiveness for people with early-stage dementia. This pilot randomized controlled trial (RCT) explored the feasibility of a self-management intervention for people with early-stage dementia. The participants were people with early-stage dementia (n = 24) and for each participant a caregiver also took part. Participants were randomly allocated to either an eight-week self-management group intervention or treatment as usual (TAU). Assessments were conducted at baseline, three months and six months post-randomization by a researcher blind to group allocation. The primary outcome measure was self-efficacy score at three months. Thirteen people with dementia were randomized to the intervention and 11 to TAU. Two groups were run, the first consisting of six people with dementia and the second of seven people with dementia. There was a small positive effect on self-efficacy with the intervention group showing gains in self-efficacy compared to the TAU group at three months (d = 0.35), and this was maintained at six months (d = 0.23). In terms of intervention acceptability, attrition was minimal, adherence was good, and satisfaction ratings were high. Feedback from participants was analyzed with content analysis. The findings suggest the positive aspects of the intervention were that it fostered independence and reciprocity, promoted social support, offered information, and provided clinician support. This study has provided preliminary evidence that self-management may be beneficial for people with early-stage dementia.

Effectiveness of a self-management intervention with personalised genetic and lifestyle-related risk information on coronary heart disease and diabetes-related risk in type 2 diabetes (CoRDia): study protocol for a randomised controlled trial.

BackgroundMany patients with type 2 diabetes fail to achieve good glycaemic control. Poor control is associated with complications including coronary heart disease (CHD). Effective self-management and engagement in health behaviours can reduce risks of complications. However, patients often struggle to adopt and maintain these behaviours. Self-management interventions have been found to be effective in improving glycaemic control. Recent developments in the field of genetics mean that patients can be given personalised information about genetic- and lifestyle-associated risk of developing CHD. Such information may increase patients’ motivation to engage in self-management. The Coronary Risk in Diabetes (CoRDia) trial will compare the effectiveness of a self-management intervention, with and without provision of personalised genetic- and lifestyle-associated risk information, with usual care, on clinical and behavioural outcomes, the cognitive predictors of behaviour, and psychological wellbeing.Methods/DesignParticipants will be adults aged 25–74 years registered with general practices in the East of England, diagnosed with type 2 diabetes, with no history of heart disease, and with a glycated haemoglobin level of ≥6.45 % (47 mmol/mol). Consenting participants will be randomised to one of three arms: usual care control, group self-management only, group self-management plus personalised genetic- and lifestyle-associated risk information. The self-management groups will receive four weekly 2-hour group sessions, focusing on knowledge and information sharing, problem solving, goal setting and action planning to promote medication adherence, healthy eating, and physical activity. Primary outcomes are glycaemic control and CHD risk. Clinical data will be collected from GP records, including HbA1c, weight, body mass index, blood pressure, and HDL and total cholesterol. Self-reported health behaviours, including medication adherence, healthy eating and physical activity, and cognitive outcomes will be assessed by questionnaire. Measures will be taken at baseline, 3 months (questionnaire only), 6 months and 12 months post-baseline.DiscussionThis study will determine whether the addition of personalised genetic- and lifestyle-associated CHD risk information to a group self-management intervention improves diabetes control and CHD risk compared with group self-management and usual care. Effectiveness of the combined intervention on health behaviours cognitions theorised to predict them, and psychological outcomes will also be investigated.Trial registrationThis study has been registered at ClinicalTrials.gov; registration identifier NCT01891786, registered 28 June 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1073-7) contains supplementary material, which is available to authorized users.

Self-management for people with poorly controlled epilepsy: Participants' views of the UK Self-Management in epILEpsy (SMILE) program.

Epilepsy is a long-term condition that requires self-management, but currently, there is no well-evaluated epilepsy self-education or self-management intervention in the United Kingdom (UK). The aim of this study was to examine the views and experiences of the first participants of the Self-Management in epILEpsy UK (SMILE UK) program to assist the development of a full trial. In-depth semistructured interviews and group discussions were conducted with 10 people with poorly controlled epilepsy to explore their views and experiences of the self-management program. Interviews were audio-recorded, transcribed, and analyzed thematically. All participants viewed the program positively. Three themes emerged: i) peer support was experienced through knowledge sharing, disclosure of experiences, and exchange of contact details; ii) participants felt better equipped to enter discussions with doctors and other health-care professionals about their condition; and iii) participants reported an improvement in their personal life through increased confidence to live with epilepsy and acceptance of their diagnosis. A brief group self-management intervention increased knowledge and confidence in managing epilepsy.