Self-management Interventions Research Articles

Abstract 4137716: Development and Content Validation of the Heart Failure Symptom Management Motivation Questionnaire

Introduction: Adequate heart failure (HF) self-management is crucial for alleviating distressing symptoms. While disease knowledge is important, it is insufficient for sustained self-care. Patient motivation plays a key role in successful self-management interventions. However, tools assessing motivation for HF symptom self-management are lacking. Aims: To develop the Heart Failure Symptom Management Motivation (HF-SMM) questionnaire and assess its content validity with nurse experts. Methods: A cross-sectional study occurred in three phases from November 2022 to April 2024. Initially, we conducted a systematic review to identify motivation assessment instruments for cardiovascular self-care and assess their psychometric properties. We then designed the HF-SMM items based on existing tools, guidelines, and clinical expertise, focusing on four HF symptoms: anxiety, depression, edema, and fatigue. The questionnaire comprised three subscales: autonomous motivation, controlled motivation, and amotivation. Nurse experts with doctoral degrees and HF experience assessed 96 items about questionnaire clarity and relevance via Delphi rounds, using a 4-point Likert scale. Items with a content validity index (I-CVI) between .80 to 1.00 were deemed acceptable. The average I-CVI of all items resulted in the scale content validity index average (S-CVI/Ave) with a cutoff point of .90. Results: We invited ten experts, with nine participating. They had an average of 17.1 ± 10.7 years of HF clinical experience and 11.6 ± 7.4 years of research experience. In the initial Delphi round, items scored I-CVI ranging from .44 to 1.00 for anxiety, depression, and fatigue, and .66 to 1.00 for edema, resulting in an S-CVI/Ave of .81. After the first round, 54 items with I-CVI >.80 were retained (56.2%), and 42 items were revised (43.8%). A second Delphi round, with 77.7% of the original experts, showed most items with excellent I-CVI scores (> .80; 84; 87.5%), with only ten items needing clarity revisions (10.4%). The overall CVI of the questionnaire was excellent with a S-CVI/ Ave of .90 after two rounds of validation. Conclusions: The HF-SMM questionnaire demonstrates excellent content validity for assessing motivation in HF self-management. Future studies should incorporate cognitive interviews to understand better patient perceptions about the items.

Risk-Prediction Model of Restenosis after Endovascular Treatment for Peripheral Arterial Disease: A Systematic Review and Meta-analysis.

Peripheral artery disease (PAD) patients after endovascular treatment (EVT) have a relatively high restenosis rate. However, this risk can be mitigated through precise risk assessment and individualized self-management intervention plans. Moreover, the number of predictive models for restenosis risk in PAD patients after EVT is gradually increasing, yet these results of study exhibit certain discrepancies, raising uncertainties regarding the quality and applicability in clinical practice and future research. The objective of this study was to systematically evaluate risk-predictive models for restenosis in patients with PAD after EVT. A systematic review and meta-analysis of predictive model construction and validation using observational studies was undertaken. The China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to January 1, 2024. Two researchers independently conducted literature screening and data extraction, encompassing study design, data sources, outcome definition, sample size, predictive factors, model development, and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used for risk of bias and applicability assessment of the models. A total of 4275 studies were retrieved, ultimately resulting in the inclusion of 7 articles comprising 7 predictive models for restenosis in PAD patients after EVT, with a restenosis incidence ranging from 21.8% to 39.7%. The total sample size of the included models ranged from 137 to 1578 cases, with logistic regression analysis being the most commonly used modeling method. All models were built using R software. Only 2 models underwent external validation, and the reported area under the curve ranged from 0.728 to 0.864. The summary area-under-the-curve statistic was 0.80 (95% confidence interval [CI], 0.74-0.86), with an approximate prediction interval of 0.80 (95% CI, 0.62-0.91) . The number of included predictive factors ranged from 3 to 10, with the most common factors being age, Trans-Atlantic Inter-Society Consensus Ⅱ classification, hypertension, diabetes, high-sensitivity C-reactive protein, and surgical approach. All studies exhibited high risk of bias, primarily attributed to inappropriate sources of data and poor reporting of the analysis domain. Predictive models for restenosis after EVT in PAD patients demonstrate overall good predictive performance but are still in the developmental stage with higher risk of bias. Future studies should follow the TRIPOD statement, focusing on the development of new models with larger samples, rigorous study designs, and multicenter external validation. This systematic review adheres to the PRISMA 2020 statement, offering the most recent systematic assessment of risk prediction models for restenosis following endovascular treatment in peripheral arterial disease.The newly developed PROBAST tool was employed to assess the risk of bias and the applicability of the existing evidence.This review emphasizes the practical utility, limitations of the current evidence, and recommendations for future research, with the goal of providing valuable information for clinicians and patients in their decision-making process, while also supporting the advancement of future research endeavors.

Self-management interventions to patients with cirrhosis: A scoping review.

Self-management in chronic diseases like cirrhosis involves patients providing the necessary knowledge, skills, and confidence to enhance self-efficacy. This scoping review aims to describe the literature on self-management interventions in patients with cirrhosis to create an overview and identify key concepts and gaps in the existing literature. Four databases (CINAHL, Embase, Medline, and Scopus) were searched from November 2022 to September 2024. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Studies published from 2000 onward, including patients with cirrhosis of different etiology and severity, focusing on self-management and/or self-efficacy, and performed in a health care setting, were considered. The search produced 1012 articles, of which 16 were included in the review. These represented studies from 7 countries and a sample of 1.276 patients. The studies differed in study design, sample size, delivery format, self-management interventions designed by the authors, and evaluation. However, all studies described some form of improvement in patient-related and clinical outcomes after the intervention, mainly improved patient knowledge and quality of life. Self-management interventions for patients with cirrhosis improved patient-related outcomes. However, more comprehensive and standardized interventions tailored to patients' needs are needed. These self-management interventions should focus on increasing confidence and self-efficacy and address the different skills required by patients to manage their disease.

Exploring Education Interventions for Stroke Prevention Among Adults and Older Individuals: A Scoping Review.

This investigation aims to conduct a comprehensive review of educational interventions targeting stroke prevention to provide effective preventive measures and optimize resource utilization in adults and the elderly populations. A comprehensive literature search was conducted on PubMed, SCOPUS, and Embase for articles published online or in print until February 22, 2022. Inclusion criteria for studies were limited to the studies that examined stroke education or training interventions aimed at improving knowledge among adults aged 30 years and above, with a particular focus on older adults. A review of 97,848 papers was conducted, resulting in the inclusion of 19 papers. Of these, six were randomized controlled trials (RCTs), six were non-randomized studies, five were campaign studies, one was a cross-sectional study, one was a pilot study, and one was a prospective study. The provided information describes various interventions and educational programs related to stroke awareness, prevention, and management. The intervention subjects were categorized as awareness of warning signs and symptoms of stroke (n = 14), comprehensive awareness campaigns (n = 5), multilevel strategies for stroke education (n = 4), community-based nursing education and rehabilitation program (n = 5), multimedia campaign for 9-1-1 awareness (n = 3), and self-management interventions (n = 1). The categorized interventions, addressing awareness of warning signs and symptoms, comprehensive awareness campaigns, multilevel strategies, community-based nursing education and rehabilitation programs, multimedia campaigns for 9-1-1 awareness, and self-management interventions, collectively enrich our understanding of the multifaceted approaches to stroke education.

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.

Digital Health and Self-Management in Idiopathic Inflammatory Myopathies: A Missed Opportunity?

This paper explored the potential of digital health in idiopathic inflammatory myopathies (IIMs), with a focus on self-management. Digital self-management technology includes tailored treatment plans, symptom tracking, educational resources, enhanced communication, and support for long-term planning. After arguing the importance of digital health in IIMs management, from diagnosis until treatment, our literature review revealed a notable gap in research focusing on the efficacy of digital self-management interventions for individuals with IIMs, with no randomised controlled trials or observational studies addressing this topic. Our review further highlighted the significant unmet need for research in self-management interventions for individuals with IIMs. The absence of studies underscores the necessity for collaborative efforts to address this gap and develop personalised, effective strategies for managing IIMs using digital technology. Individuals with IIMs deserve tailored self-management approaches akin to those available for other rheumatic and musculoskeletal diseases.

The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis.

Chronic diseases significantly impact global morbidity and mortality, affecting millions. Self-management interventions are crucial for improving patient health outcomes. This study explores the effects of self-management interventions on the quality of life (QOL), self-efficacy, depression, and anxiety of patients with chronic diseases. Relevant studies were searched from PubMed, EMBASE, and Web of Science. Two reviewers independently screened the literature, evaluated the risk of bias assessment, and extracted characteristics and outcomes among patients with chronic diseases. For each included study, we calculated the standardized mean difference (SMD) and 95% confidence interval (CI) of the main outcomes. When deemed feasible, the heterogeneity of the study was explored by meta-analysis and subgroup analysis. Thirty-four studies involving a total of 7603 patients with chronic diseases were included. Self-management interventions significantly improved quality of life (Higher-better QOL and Lower-better QOL), self-efficacy, and reduced depression symptoms compared to usual care (95%CI 0.01 to 0.15, p = 0.03; 95%CI -0.49 to -0.08, p = 0.006; 95%CI 0.19 to 0.62, p < 0.001; 95%CI -0.23 to -0.07, p < 0.001). However, no significant effect was found for anxiety (95%CI -0.18 to 0.03, p = 0.18). In the heterogeneity analysis, Lower-better QOL and self-efficacy were all higher than 50% (I2 = 80%, 87%). After the subgroup analysis, the heterogeneity of Lower-better QOL and self-efficacy was less than 50% (I2 = 0%, 16.1%). Subgroup analyses revealed that studies with mean age greater than 60 years old and follow-up times greater than 6 months were more effective in improving patients' Lower-better QOL (p = 0.03, p = 0.004), whereas follow-up times less than 6 months were better at reducing patients' anxiety symptoms (p = 0.03). Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients' quality of life, self-efficacy, and reducing depressive symptoms, but they did not show significant improvements in anxiety symptoms. Overall, self-management interventions for chronic diseases can help patients adapt to the changes brought about by the disease and self-manage diseases to prevent disease progression.

Prediction of mental health risk in adolescents via a smartphone app: a feasibility pilot study

Abstract Background The prevalence of mental health problems in adolescents is a global public health concern. Machine learning (ML) can analyse multidimensional data collected by phone sensors (passive tracking) and symptom self-reporting (active tracking) to model and predict mental health states. However, research in adolescents is lacking. This study investigated the feasibility of using ML to predict mental health in a non-clinical population of adolescents from active and passive data collected through the Mindcraft mobile app. Methods We recruited 103 secondary students (aged 14-18) who first completed the Strengths and Difficulties Questionnaire (SDQ) and then used the Mindcraft app for two weeks. The app integrates sensor data (location, steps, noise, light, battery, app usage) and self-reports. We extracted 85 sensor-based features and 19 from questionnaires to develop a gradient-boosted ensemble ML model. This model identifies students with abnormal SDQ scores and was evaluated using leave-one-out cross-validation. Results All students completed the active questionnaires; 67 also provided passive sensor data. 31 had abnormal SDQ scores. Using passive data, the ML model reached a balanced accuracy of 0.64 and an AUC score of 0.57. Incorporating both data types improved accuracy to 0.67 and AUC to 0.70. Feature importance scores showed step count and questionnaire on racing thoughts and hopefulness as most significant. Conclusions Our findings affirm the potential of integrating passive and active data collection to monitor mental health in real-world settings. Our ML model demonstrated moderate accuracy in predicting adolescents’ mental health risk measured with a behavioural screening questionnaire. This study will guide the development of a ML-driven, personalised mobile intervention for early symptom detection and mental health self-management, which might constitute an innovative and scalable tool for mental health prevention and intervention in adolescents. Key messages • This study shows the feasibility of using active and passive data to predict mental health risk in adolescents. • This study informs the development of a personalised machine learning-driven mobile intervention.

Implementing a chronic disease self-management program in Moldova: a roadmap for sustainability

Abstract Chronic disease self-management programs are evidence-based interventions but achieving their sustainability can be challenging. We propose a roadmap to sustainability that examines the transferability of intervention components and fosters multi-level and multisectoral partnerships. Since 2019, the Swiss Agency for Development and Cooperation’s Healthy Life project, in cooperation with the Ministry of Health of Moldova, has implemented a self-management program in rural communities. At pilot stage, we achieved a 53% increase in participants’ self-efficacy (Palmeirim et al, 2024). To date, the program has reached 1432 beneficiaries in 70 communities. The intervention cost per participant was approximately 74 Euros. Our evidence supported the inclusion of self-management in the national non-communicable disease program 2023-2027. We designed a roadmap to hand over this innovation to Moldovan public health institutions. Firstly, we unpacked the intervention into transferable resources, processes and roles. These included human resources (a network of 140 facilitators), pedagogical resources (culturally adapted facilitator training and self-management workshop content) and key operational processes (coordination, resource management, partnership building, monitoring and evaluation). Then, we convened a national workshop to discuss the transfer of these components to relevant institutions. We emphasized working in a coordinated partnership across institutions for intervention delivery. Finally, we launched a national working group that will work on the operational modalities of this multi-stakeholder partnership. Achieving an enabling policy environment for self-management created favorable conditions and accountability for institutional partnership building. A strategic reflection on our partner ecosystem was key to leverage local and national interests in continuing self-management approaches. Key messages • We have established priorities among transferable intervention components to match country stakeholders’ ability and readiness to sustain innovative approaches. • We are building an institutional partnership across sectors based on complementarity of experience to sustain the delivery of a self-management intervention.

Effects of self-management interventions based on the COM-B model on peri-implant condition in older adults with periodontitis: a randomized controlled trial

ObjectivesThis study evaluated the impact of self-management interventions based on the COM-B model on peri-implant conditions in older adults with periodontitis.Materials and methodsThe patients were randomly divided into two groups: Group 1 (control group) received only an oral health education (OHE) pamphlet. Group 2 (test group) performed a self-management intervention based on the COM-B model. Each patient was examined for the most inflammatory implant. The measurement parameters included self-efficacy, self-management ability, and clinical indicators such as probing depth (PD), bleeding on probing (BOP), modified gingival index (mGI), modified plaque index (mPI), and peri-implant mucositis severity score (PMSS). The data was collected at baseline, 4, 8, and 12 weeks.Results42 patients underwent testing for 3 months. After 12 weeks, the improvement of self-efficacy, self-management ability, and the reduction of BOP, mPI, and PMSS in the test group was significantly higher than in the control group.ConclusionThe study suggests that self-management interventions based on the COM-B model can enhance the self-management ability of older adults with periodontitis and reduce peri-implant inflammation. This method is more effective than distributing OHE pamphlets.Trial registrationThe randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2400082660, Date: 03/04/2024).

Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear. We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions. We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration). We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a -5.78 mm Hg (95% CI -7.97 mm Hg to -3.59 mm Hg; P<.001) reduction in systolic BP and a -3.28 mm Hg (95% CI -4.39 mm Hg to -2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: -6.50 mm Hg, 95% CI -9.00 mm Hg to -3.99 mm Hg vs -1.54 mm Hg, 95% CI -4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: -10.06 mm Hg, 95% CI -16.42 mm Hg to -3.70 mm Hg vs -4.13 mm Hg, 95% CI -5.50 to -2.75 mm Hg; P=.07); intervention duration (3 vs ≥6 months: -8.87 mm Hg, 95% CI -10.90 mm Hg to -6.83 mm Hg vs -5.76 mm Hg, 95% CI -8.74 mm Hg to -2.77 mm Hg; P=.09); and the number of BCTs (≥11 vs <11 BCTs: -9.68 mm Hg, 95% CI -13.49 mm Hg to -5.87 mm Hg vs -2.88 mm Hg, 95% CI -3.90 mm Hg to -1.86 mm Hg; P<.001). The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT.

Health-related quality of life of people with depression: pre-post intervention compared with age-matched general population in Vietnam

BackgroundIn Vietnam, there is a paucity of health-related quality of life (HRQoL) research on people with depression as well as a lack of evidence on supported self-management (SSM) intervention for depression on HRQoL. This study aimed to compare the HRQoL of people with depression and age-matched people in the Vietnamese population, evaluate the effects of Tele-SSM intervention on HRQoL, and examine the association between the changes in HRQoL score and mental health well-being (depression, anxiety, and stress).MethodsThis study was a pre- and post-study involving Vietnamese adults aged 18–64 who had depression symptoms (score ≥ 5 points in the PHQ-9). Participants (N = 58) completed Tele-SSM—a supported self-management intervention incorporating cognitive behavioral therapy and non-violent communication and using a task-shifting approach. To compare with the general population, we conducted a 1-to-1 matching by age with an EQ-5D-5L valuation study with a nationally representative sample of the Vietnamese general population.ResultsHRQoL was significantly impaired in people with depression compared to the age-matched general population. Regarding health profile, participants reported the most difficulties in usual activities, pain/discomfort, and anxiety/depression dimensions. Significant improvements were observed in HRQoL scores post-intervention compared to pre-intervention in both EQ-VAS scores (from 59.84 to 79.48) and utility scores (from 0.79 to 0.90). These results remained lower than the age-matched general population (EQ-VAS score = 83.28, utility score = 0.96). Depression was associated with lower HRQoL while controlling for stress, anxiety symptoms and sociodemographic characteristics.ConclusionsThese results indicate that HRQoL is significantly impaired in people with depression and contribute to providing empirical evidence of Tele-SSM intervention in improving HRQoL. Further randomized controlled trials should be conducted to evaluate the effectiveness and cost-effectiveness of the Tele-SSM intervention.

Effectiveness of a peer-to-peer, self-management intervention for young people with depression and anxiety in Denmark: an observational study and a propensity score-matched comparison.

This study investigated the effectiveness of a 7-weeks peer-to-peer program for young people aged 15 to 25 years with depression or anxiety symptoms in Denmark. A total of 483 participants (72% women) participated in the program and the evaluation. The participants completed questionnaires at baseline, postintervention, and at 5-month follow-up to assess changes in depression symptoms (using Beck's Depression Inventory-II), anxiety symptoms (using Spielbergers State-Trait Anxiety Inventory for Adults) and self-efficacy in controlling or managing the illness (using the personal control subscale from the Illness Perception Questionnaire-Revised). Analyses were done using repeated measures mixed linear regression models. Moreover, a register-based matched comparison group was derived as a comparison to assess changes in being in education and employment at 8-month follow-up. Within the intervention group, both depression and anxiety scores declined across the 5-month follow-up compared to baseline (b = -9.6, 95% CI: -11.2, -8.1 for depression symptoms). The self-efficacy score increased from baseline to post-intervention (b = 1.4, 95% CI: 1.0, 1.8) and this level was maintained at follow-up. More than half of the participants were in education at baseline while 24% received social transfer payments. Compared with matched comparison group, a lower proportion of the intervention group remaining in education (71% vs. 80%). Among participants who were employed at baseline, a higher proportion of the intervention group were enrolled in education (27% vs. 19%) and were unemployed (14% vs. 4%) compared to the matched comparison group. This study supports the effectiveness of a peer-to-peer intervention for depression and anxiety symptoms, and self-efficacy in symptom control. However, mixed effects on education and employment were observed, indicating a negative impact on education among those initially enrolled and a higher proportion of employed participants starting education.

Targeting chronic pain care to rural women veterans: A feasibility pilot.

For rural women veterans, significant barriers exist in accessing high-quality, multicomponent behavioral pain self-management interventions. As such, a telehealth behavioral pain self-management intervention designed specifically for rural-dwelling women veterans with chronic pain was piloted for this study. This mixed methods, single-arm preliminary study examined the feasibility and acceptability of this intervention and completed a responder analysis. Participants completed surveys before and 1-month following the intervention, and they completed a qualitative interview following the intervention. About one quarter (24%) of potentially eligible participants who were sent a letter about the study consented to participate (N = 44). All participants identified as female and were rural dwelling, with mean age of 56 years (range = 34-80), and the majority of the sample (81%) self-identified as White and non-Hispanic or Latino. Average baseline scores on the Pain, Enjoyment of Life, and General Activity three-item scale (PEG-3) measure indicated severe pain and functional interference (MPEG-3 total = 6.88, SD = 1.62). Of the 44 participants who consented, 70% completed the intervention. About half of treatment completers (47%, 14/30) were deemed responders, reporting ≥ 30% reduction on their PEG-3 total scores. On the Global Impression of Change scale, 87% reported improvement. Study completers indicated that the telehealth platform facilitated their engagement and that they perceived the intervention to be beneficial and credible. Qualitative data emphasized themes of connection with other women veterans who experienced chronic pain while perceiving a retained sense of individual identity. These preliminary data support feasibly of this intervention for rural-dwelling women veterans with chronic pain. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

12424 A Feasibility Trial Of A Co-created Digital Self-management Programme For Adults With Polycystic Ovary Syndrome (Hope PCOS)

Abstract Disclosure: C.A. Percy: None. A. Turner: None. L. Aphramor: None. D. Broom: None. C. Clark: None. F. Martin: None. P. Wark: None. Introduction: Polycystic ovary syndrome (PCOS) has significant impact on depression, anxiety, psychological wellbeing and health-related quality of life. We co-created a theory-led, evidence-based, 6-week, digital self-management and positive wellbeing intervention (Hope PCOS), delivered to UK adults. We tested the intervention’s potential to improve mental health and wellbeing outcomes and its acceptability and usability for adults living with PCOS. Methods: This was a mixed methods feasibility randomised controlled trial conducted online, with a pre-post, waitlist-controlled design. Primary outcomes were recruitment, completion (≥ 3 intervention sessions) and follow-up rates. At baseline, participants reported demographic information, PCOS symptoms, depression (Patient Health Questionnaire (PHQ-9)), anxiety ((Generalised Anxiety Disorder Assessment (GAD-7)), polycystic ovary syndrome health-related quality of life (PCOSQ-50), psychological wellbeing (Warwick-Edinburgh Mental Wellbeing Scale, WEMWBS) and self-efficacy (Self-Efficacy to Manage Chronic Disease Scale (SEMCD6)) before randomisation to an intervention group (IG) receiving the intervention immediately or a waitlist control group (CG) receiving the intervention 12 weeks later. PHQ-9, GAD-7, PCOSQ-50, WEMWBS and SEMDC6 were reassessed at 6 and 12 weeks. IG participants reported the usability of the digital intervention (system usability scale (SUS)) and acceptability via qualitative exit interviews. Results: Of 131 eligible, consented participants, 83% (N=109, age M=37.1, SD=8.6 years) completed baseline measures and were randomised to the IG (n=54) or the CG (n=55). Baseline clinical caseness was high for depression (n=77, 70.6%) and anxiety (n=78, 71.6 %). Twenty-one participants (39%) in the IG completed ≥3 intervention sessions. At 6-week follow-up, completion of secondary outcomes was n=32 (59%) for IG and n= 38 (69%) for CG; at 12 weeks, n=31 (57%) for IG and n= 38 (69%) for CG. Twelve IG participants took part in the exit interviews. Exploratory descriptive statistics suggest there were greater improvements in depression, anxiety, psychological wellbeing, self-efficacy and quality of life for the intervention group completers compared to the waitlist control group. SUS data and thematic analysis suggest the intervention was usable, acceptable, relevant and interesting. Participants reported experiences including feeling seen and valued, having the difficulties of lifestyle change acknowledged, and learning valuable lessons, particularly how to monitor and manage emotions, prioritise self-care and complete personal goals. Conclusions: This novel intervention was rated as usable and acceptable, with potential for improving mental health and wellbeing outcomes. More research is needed to identify for whom the intervention is beneficial and on implementation in practice. Presentation: 6/1/2024

Technology-Based Interventions to Promote Diabetes Self-Management Behaviors for Persons Newly Diagnosed with Type 2 Diabetes: A Scoping Review.

Type 2 diabetes (T2D) management is complex and requires daily personal involvement and self-management skills to maintain optimal glycemic levels and improve health outcomes. Engagement in self-management behaviors in the early years of diagnosis can be challenging due to prevailing psychosocial factors present during this critical transition period, coupled with a lack of information, support, and skills. Technology-based diabetes self-management interventions can improve access to needed education and support, and their effectiveness in the general T2D population is well documented. This scoping review synthesized evidence on the use of technology for promoting diabetes self-management behaviors and related outcomes among individuals newly diagnosed with T2D (within the first 12months since diagnosis). Twenty-five studies were included. Technology-based diabetes self-management interventions tailored to those newly diagnosed with T2D have grown exponentially in the past five years. Existing evidence, though limited, showed that technologies such as websites, mobile apps, and continuous glucose monitoring combinedwith other communication features, can facilitate patient education, patient-provider communication, and health data monitoring. However, these technologies less commonly involved social support functions. These technologies have the potential to improve diabetes knowledge and positively impactclinical, behavioral, and psychological outcomes. However, small sample sizes, use of non-experimental designs, and the absence of formative research and theoretical foundations limit the strength ofexisting studies. Technology-based self-management interventions for those newly diagnosed with T2D show promise in improving T2D-related outcomes. Future studies should include larger sample sizes, adopt rigorous study designs, and integrate formative work to enhance relevance, adoption, and impact.

Nutritional Support and Physical Activity Intervention Programs with a Person-Centred Approach in People with Chronic Obstructive Pulmonary Disease: a Scoping Review.

The knowledge is sparse in the literature on intervention programs using nutritional support and physical activity for patients with chronic obstructive pulmonary disease within a person-centred approach. We aimed to explore and map the existing evidence on intervention programs with a person-centred approach, focusing on nutritional support and physical activity for people with COPD. A scoping review was conducted using Arksey & O'Malley's methodological framework. A search in the databases CINAHL and PubMed, and a grey literature search, was conducted in June 2022 and updated in June 2023. We identified studies published between 2012 and 2023. The PRISMA checklist for scoping reviews, supported by The PAGER framework was used for reporting the method. A total of 15 studies were included. The primary interventions comprised behavior of change or self-management, addressing needs assessment, motivation, personal goals, education, and physical activity. Health-related quality of life and hospital stay displayed no clinically significant variances. However, eight studies demonstrated differences in physical function and activity levels. Nutritional outcomes were addressed in one study, and three studies involved relatives. This scoping review addresses a knowledge gap in nutritional support interventions with a person-centred approach. It indicates that there is a need to increase nutritional support and consider the patient's physical and social environmental resources within Behavior of change or Self-management intervention programs for patients with COPD. The review found no clinical effect on health-related quality of life, although there were some effects on physical activity. The results highlight how the interdisciplinary team can include the patients' resources when structuring the management of COPD by applying a person-centred approach.

Does adherence to exacerbation action plans matter? Insights from two COPD self-management studies

IntroductionPatients' adherence is essential for COPD self-management, as beneficial effects can only be expected in adherent patients. We explored associations between patients’ adherence to COPD exacerbation action plans and health outcomes. Materials and methodsPooled COPD self-treatment intervention group data from two RCTs were analysed, only including patients who had ≥1 COPD exacerbation or started ≥1 course of oral corticosteroids over one-year follow-up. Optimal adherence was defined as ‘self-treatment initiated ≤1 day before or after exacerbation start’, suboptimal adherence as ‘self-treatment initiated 2 days before or after exacerbation start or no self-treatment initiated for a short (1–3 days) exacerbation’, and significant delay or no treatment as ‘self-treatment initiated >2 days after exacerbation start or no self-treatment initiated for a longer (>3 days) exacerbation’. Regression models were built for several health outcomes, with the number of COPD exacerbation days/patient/year being the primary outcome. ResultsPatients with significant delay or no treatment (n = 46) had more exacerbation days/patient/year (33.3 (95 % CI 10.9; 55.6)) than optimal adherent patients (n = 38) (23.7 (95 % CI 1.7; 45.7)). The duration per COPD exacerbation was longer for patients with significant delay or no treatment (15.5 days) compared to optimal adherent patients (7.8 days). No differences in health outcomes were observed between optimal and suboptimal adherent patients. ConclusionsBeing adherent to action plans is associated with better health outcomes than significant delayed treatment or no treatment at all. Interestingly, suboptimal adherence demonstrated health benefits comparable to optimal adherence. COPD self-management interventions should prioritise strategies to optimise patients’ adherence to action plans.

Capacity Coaching: A Pilot Randomized Trial of a Self-Management Intervention for Patients on Dialysis

Capacity Coaching: A Pilot Randomized Trial of a Self-Management Intervention for Patients on Dialysis

A Self-led Self-management Intervention Supporting Teens with IBD (ASSIST-IBD): protocol for a feasibility study of a novel digital treatment adherence intervention

IntroductionTreatment non-adherence is common in young people with inflammatory bowel disease (IBD), yet support is lacking. A self-led self-management intervention supporting teens with IBD (ASSIST-IBD) is a new theory-based digital...