Self-management Interventions Research Articles

Effect of an in-hospital medication self-management intervention (SelfMED) on medication adherence in polypharmacy patients postdischarge: protocol of a pre–post intervention study

IntroductionHealthcare providers usually manage medication for patients during hospitalisation, although patients are expected to self-manage their medication after discharge. A lack of self-management competencies is found to be associated with...

Illness perceptions in relation to self-management behaviour among elderly patients with COPD: A cross-sectional study.

The purpose of this study was to investigate the status of self-management behaviour and illness perceptions and to examine illness perceptions in relation to self-management behaviour in elderly patients with chronic obstructive pulmonary disease (COPD). A cross-sectional study was conducted, and 152 elderly COPD patients were recruited via the convenience sampling method. The COPD Self-Management Scale and the Revised Illness Perception Questionnaire for COPD patients were used to examine self-management behaviour and illness perceptions. Pearson correlation analysis, univariate analysis and hierarchical linear regression analysis were used to explore illness perceptions in relation to self-management behaviour. The mean overall score for self-management behaviour was 2.90 ± 0.39. Among the subscales of self-management behaviour, information management had the lowest score of 2.20 ± 0.76. Patients' demographic and clinical characteristics, including educational level, smoking status, type of primary caregiver, home oxygen therapy and COPD duration, were found to be significant determinants of self-management behaviour. After controlling for these variables, several illness perception subscales, including treatment control, personal control, coherence, timeline cyclical and identity, were significantly correlated with self-management behaviour. This study confirmed that elderly COPD patients' self-management behaviour was unsatisfactory and that illness perceptions were significant determinants of self-management behaviour. The findings may contribute to the development of self-management interventions for elderly COPD patients.

Digital interventions for self-management of prediabetes: A scoping review.

Rates of prediabetes, which can lead to type 2 diabetes, are increasing worldwide. Interventions for prediabetes mainly focus on lifestyle changes to diet and exercise. While these interventions are effective, they are often delivered face-to-face, which may pose a barrier to those with limited access to healthcare. Given the evidence for digital interventions addressing other noncommunicable diseases, these may also be effective for prediabetes self-management. The aim of this scoping review was to assess the breadth of evidence around digital interventions for prediabetes self-management. We developed a targeted search strategy and relevant studies were identified through searches conducted in four bibliographic databases (Medline, Embase, PsycInfo, and Scopus). Published studies were eligible if they included a digital intervention to support adults aged 18+ with prediabetes self-management. Titles and abstracts were first screened for relevance by one researcher. Full texts of selected records were assessed against the review criteria independently by two researchers for inclusion in the final analysis. Twenty-nine studies were included, of which nine were randomised controlled trials. Most efficacy studies reported significant changes in at least one primary and/or secondary outcome, including participants' glycaemic control, weight loss and/or physical activity levels. About one-third of studies reported mixed outcomes or early significant outcomes that were not sustained at long-term follow-up. Interventions varied in length, digital modalities, and complexity. Delivery formats included text messages, mobile apps, virtually accessible dietitians/health coaches, online peer groups, and web-based platforms. Approximately half of studies assessed participant engagement/acceptability outcomes. Whilst the evidence here suggests that digital interventions to support prediabetes self-management are acceptable and have the potential to reduce one's risk of progression to type 2 diabetes, more research is needed to understand which interventions, and which components specifically, have the greatest reach to diverse populations, are most effective at promoting user engagement, and are most effective in the longer term.

Long-Term Effect of Home Blood Pressure Self-Monitoring Plus Medication Self-Titration for Patients With Hypertension

Patient empowerment through pharmacologic self-management is a common strategy for some chronic diseases such as diabetes, but it is rarely used for controlling blood pressure (BP). Several trials have shown its potential for reducing BP in the short term, but evidence in the longer term is scarce. To evaluate the longer-term effectiveness of BP self-monitoring plus self-titration of antihypertensive medication vs usual care for patients with poorly controlled hypertension, with passive follow-up and primary-care nursing involvement. The ADAMPA (Impact of Self-Monitoring of Blood Pressure and Self-Titration of Medication in the Control of Hypertension) study was a randomized, unblinded clinical trial with 2 parallel arms conducted in Valencia, Spain. Included participants were patients 40 years or older, with systolic BP (SBP) over 145 mm Hg and/or diastolic BP (DBP) over 90 mm Hg, recruited from July 21, 2017, to June 30, 2018 (study completion, August 25, 2020). Statistical analysis was conducted on an intention-to-treat basis from August 2022 to February 2024. Participants were randomized 1:1 to usual care vs an individualized, prearranged plan based on BP self-monitoring plus medication self-titration. The main outome was the adjusted mean difference (AMD) in SBP between groups at 24 months of follow-up. Secondary outcomes were the AMD in DBP between groups at 24 months of follow-up, proportion of patients reaching the BP target (SBP <140 mm Hg and DBP <90 mm Hg), change in behaviors, quality of life, health service use, and adverse events. Among 312 patients included in main trial, data on BP measurements at 24 months were available for 219 patients (111 in the intervention group and 108 in the control group). The mean (SD) age was 64.3 (10.1) years, and 120 patients (54.8%) were female; the mean (SD) SBP was 155.6 (13.1) mm Hg, and the mean (SD) diastolic BP was 90.8 (7.7) mm Hg. The median follow-up was 23.8 months (IQR, 19.8-24.5 months). The AMD in SBP at the end of follow-up was -3.4 mm Hg (95% CI, -4.7 to -2.1 mm Hg; P < .001), and the AMD in DBP was -2.5 mm Hg (95% CI, -3.5 to -1.6 mm Hg; P < .001). Subgroup analysis for the main outcome showed consistent results. Sensitivity analyses confirmed the robustness of the main findings. No differences were observed between groups in behaviors, quality of life, use of health services, or adverse events. In this secondary analysis of a randomized clinical trial, BP self-monitoring plus self-titration of antihypertensive medication based on an individualized prearranged plan used in primary care reduced BP in the longer term with passive follow-up compared with usual care, without increasing health care use or adverse events. These results suggest that simple, inexpensive, and easy-to-implement self-management interventions have the potential to improve the long-term control of hypertension in routine clinical practice. ClinicalTrials.gov Identifier: NCT03242785.

Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing.

Globally, cancer predominates in adults aged older than 60 years, and 70% of older adults have ≥1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. This app has the potential to support the complex health care needs of older adults with cancer, creating a "home base" for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation.

Peer Ambassador Perspectives in a Culturally Tailored Self-Management Intervention for African Americans with Type 2 Diabetes: A Qualitative Study

Objective: Diabetes disproportionately affects African Americans, leading to higher morbidity and mortality. This study explores the experiences of African American adults who successfully self-manage their type 2 diabetes (called Peer Ambassadors) and provided phone-based peer support in a 6-month culturally tailored diabetes self-management program for African Americans guided by the information–motivation–behavioral skills model. Design: A group discussion using a semi-structured discussion guide was conducted. Qualitative content analysis was used to identify the facilitators and barriers to completing the role of a Peer Ambassador and to develop strategies for overcoming possible challenges in the future. Setting: Key informant discussions were conducted in a community location to gain insights into Ambassadors’ motivations and challenges in delivering peer support. Participants: Three Peer Ambassadors completed ethics training and peer mentor training and received a phone call guide before providing support to their peers. Results: There were four core themes related to Peer Ambassador experiences: (1) Motivation to be a Peer Ambassador, (2) program elements that supported Peer Ambassador role, (3) key elements of achieving engagement, and (4) challenges related to being a Peer Ambassador. Conclusions: This study showed Peer Ambassadors in a culturally tailored peer supported self-management program found fulfillment in sharing experiences and supporting peers. They highly valued educational group sessions for knowledge updates and sustaining their health-related goals, suggesting the potential benefits of recognizing milestones or providing advanced training for future program sustainability. Findings suggest the importance of recruiting motivated patients and providing effective facilitation for peer support roles, including addressing barriers such as time commitment and lack of socialization opportunities.

A Meta-Analysis of Self-Management Interventions in Teaching Daily Living Skills to Autistic Individuals.

The current study aimed to conduct a systematic review and meta-analysis of self-management interventions for teaching daily living skills to autistic individuals. This study accessed the corresponding studies by doing a search in six databases. 14 articles and one dissertation met the inclusion criteria. The included studies were first analyzed descriptively and coded according to quality indicators using What Works Clearinghouse (WWC) standards. Second, the effect sizes of the included studies were calculated using two different effect size measures (i.e., Tau-U and performance-criteria-based effect size values [PCES]). Third, these analyses were also conducted for generalization and maintenance data. Of 15 studies included in this review, nine met the WWC standards with and without reservations. Tau-U analyses were conducted for 14 studies, whereas PCES values were calculated for only eight studies with mastery criteria. The findings indicated that the self-management interventions had a .93 CI95 (.80, 1) overall effect size for Tau-U with a very large effect. On the other hand, the overall effect size for the PCES values indicated a moderate effect with .99. The weighted effect sizes in generalization and maintenance phases were very large for Tau-U; however, moderate to high effects for PCES. Although self-management interventions showed diversity, one of the domains of daily living skills (i.e., community living skills) has not been studied in the field. Notably, among the studiesin our review, the last ones are from 2019. Detailed findings from descriptive analyses and two different effect size calculations are discussed, and recommendations for future studies are given.

The social and organisational factors shaping acceptability of a self-management education and exercise intervention for people with hip or knee osteoarthritis in Greenland

ABSTRACT This study aimed to explore the experiences and perspectives of people with osteoarthritis attending the “Osteoarthritis School” (OA School) in Nuuk, Greenland to generate insights and lessons that can inform the development of self-management education and exercise interventions for people with other lifestyle conditions in a Greenland context. We conducted a qualitative interpretive description (ID) study based on ten semi-structured interviews with people with hip or knee osteoarthritis. Interviews were audio-recorded, transcribed, and coded. Using ID, we identified three themes: 1) perceptions and experiences of how the OA School intervention was organised (time and place); 2) perspectives and experiences of the education and exercise components (social factors, motivation, and education); and 3) significant change stories (physical and mental improvements and increased knowledge of OA). Social and organisational factors, such as working out with peers and the time and place of the intervention, influenced the participants’ acceptance of the OA School intervention. Knowledge from this study will help us gain insight into what to address when developing future self-management education and exercise interventions in the Greenlandic healthcare system.

Outcomes and Characteristics of Interdisciplinary Self-Management Interventions for Older Adults Living with Chronic Pain: Insights from a Scoping Review

Introduction: Up to 50% of community-dwelling older adults report living with some chronic pain that interferes with their daily functioning and leads to disabilities. Hence, it is crucial to provide these individuals with strategies to effectively manage pain. An interdisciplinary approach is warranted considering the numerous factors contributing to pain among older adults. Although several studies have been conducted on various interdisciplinary pain self-management programs, little effort has been made to synthesize knowledge about such programs for older adults. Objective: The objective of this review was to synthesize the characteristics and effects of interdisciplinary chronic pain self-management interventions targeting community-dwelling older adults. Methods: A scoping review was conducted following the steps recommended by Arksey and O’Malley (2005) and Levac et al. (2010). Keyword searches were performed in MEDLINE, CINAHL, EMBASE, and the Cochrane Library. Results: Sixty-six articles were included. Most interventions were based on a cognitive-behavioral group approach and used a combination of modalities, including education and training on the use of self-management strategies. The professionals most frequently involved in group interventions were psychologists, physiotherapists, and occupational therapists. Several benefits of these programs have been reported concerning pain intensity, independence in daily functioning, mental health, and quality of life. Conclusions: Interdisciplinary chronic pain self-management programs appear promising in guiding clinical and rehabilitation interventions for older adults living with chronic pain.

Abstract PO2-19-04: Trial in Progress: The REJOIN Trial to Use Exercise and Education to Relieve Joint Pain in Older Breast Cancer Survivors Taking Aromatase Inhibitors

Abstract Background: Physical activity (PA) is a recommended part of breast cancer survivorship. PA promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially in reducing joint pain associated with Aromatase Inhibitors (AIs). The purpose of the study is to test if a self-management intervention (including education and exercise instruction) improve joint pain management better than standard care. Trial Design: This two-armed randomized controlled pilot trial (NCT03955627) includes insufficiently active BCS, 60 years and older, diagnosed with stage I-III hormone-sensitive breast cancer, who have completed primary cancer treatment and are within 6 months of initiating AIs. We adapted an evidence-based PA program for older adults (Fit and Strong!) that includes bi-weekly, supervised exercise sessions plus education (90 minutes total). The 16-week, evidence-based intervention program includes: 8-weeks of supervised sessions delivered remotely plus 8-weeks of self-guided home sessions with periodic phone coaching. We are conducting select geriatric assessments (e.g., cognitive assessment, polypharmacy) plus measurements of exercise (both self-reported and objectively measured by accelerometer), joint pain (brief pain inventory), and AI adherence (confirmed by self-report and prescription records) assessed four times (baseline, 4, 6 and 12 months). Eligibility Inclusion criteria: • Female, aged ≥ 60 years at enrollment  • Planning to initiate (or are &amp;lt; 24 weeks from initiating) AIs  • Diagnosed stages I-III breast cancer  • ER+ tumor (at least 5% of cells)  • Completed surgery, radiation and/or chemotherapy  • Independent ambulator (verified by treating clinician/staff)  • Physician approval to start an exercise program • Insufficiently active (less than 150 minutes per week of moderate intensity activity or less than two sessions per week of strength training)  • Able to complete surveys and forms/understand English  • Agree to random assignment to treatment or control group  • Can commit to 8 weeks, bi-weekly classes offered by Zoom video and 8 Weeks of at-home exercise.  • Must have internet access or data plan to support video conferencing software  • Minimum cognitive impairment (verified by cognitive screening questions administered by phone) Specific Aims: The primary aim is to test the efficacy of a self-management intervention (exercise plus education) on AI-associated arthralgia. Hypothesis: Participants in the treatment group will report less pain than the control group. –A secondary aim is to test the effect of the pilot intervention on adherence to AIs. Hypothesis: Participants in the treatment group will report better AI Adherence than controls. Statistical Methods: We will use the Wilcoxon-Mann-Whitney t-test to assess the effect size from the start to the end of the trial, assuming a power calculation of 80%, a two-sided alpha of 10%, and a pooled standard deviation of one between the outcomes of the two groups (usual care and treatment) being compared. Present Accrual and Target Accrual REJOIN enrolled 12 participants in 2022, but two withdrew after randomization. We now have data on 10 participants with a target accrual of 24 overall. The original 12 were accrued at Penn State College of Medicine. We subsequently opened a second site at Wake Forest University and are recruiting the remaining participants. Contact information: For more information about REJOIN, please contact the study director, Dr. Shirley Bluethmann at sblueth@wakehealth.edu or the REJOIN project manager, Angela Grubb, at agrubb@wakehealth.edu Citation Format: Shirley Bluethmann, Peri Newman, Cristina Truica, Nancy Olsen, Heidi Klepin. Trial in Progress: The REJOIN Trial to Use Exercise and Education to Relieve Joint Pain in Older Breast Cancer Survivors Taking Aromatase Inhibitors [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-19-04.

Effectiveness of Applying Green Heart, a Smartphone-Based Self-management Intervention to Control Smoking: A Randomized Clinical Trial.

Cardiovascular diseases (CVDs) pose a significant global health concern and are the most common cause of death and disability, necessitating preventive interventions targeting modifiable risk factors. Recently, mobile-health technology has been developed to improve the delivery of cardiovascular prevention by risk factor modification. The "Green Heart" mobile application (app) was designed to aid in risk factor control among coronary artery disease (CAD) patients. This parallel-group, single-blinded randomized controlled trial enrolled 1590 CAD patients, including 668 current smokers, randomly assigned to control (paper-based education) and intervention (application-based) groups. The app encompassed three modules targeting smoking cessation, dyslipidemia control, and blood pressure management. This study evaluated the impact of the smoking cessation module on behavioral change among current smokers. Green Heart assesses nicotine dependence, offering personalized quit plans, educational content, motivational messages, and automated progress tracking. The odds of smoking behavior changes during the 24-week follow-up underwent assessment. The intention-to-treat analysis highlighted significantly elevated rates of smoking cessation and reductions in the intervention group versus the control group. Adherence to the app (per-treatment analysis) also demonstrated significantly more favorable smoking behavior changes among the application users. Logistic regression emphasized higher odds of quitting and reduction in smoking in the application group, showing an odds ratio of 2.14 (95% CI: 1.16-3.97) compared to those not using the app (P=0.015). Our results confirmed that complete adherence to the app for at least 24 weeks was linked to alterations in cigarette smoking behavior among CAD patients. Trial Registration Number: IRCT20221016056204N1.

A multicenter randomized controlled feasibility trial of a digital self-management intervention for adults with epilepsy.

Self-management interventions may enhance health-related quality of life (HRQoL) in epilepsy. However, several barriers often impair their implementation in the real world. Digital interventions may help to overcome some of these barriers. Considering this, the Helpilepsy Plus Prototype was developed as a prototype smartphone-delivered self-care treatment program for adults with epilepsy. The 12-week Helpilepsy Plus Prototype was evaluated through a randomized controlled feasibility trial with a waiting-list control (WLC) group. Outcome measurement at baseline and at 12 weeks assessed adherence to the prototype intervention and changes in epilepsy-related outcomes. The primary endpoint was patient autonomy measured with EASE, and secondary endpoints included HRQoL measured with QOLIE-31, health literacy measured with HLQ, anxiety, and depression symptoms measured with HADS. Semi-structured interviews were conducted with a heterogeneous sample of participants to assess user-friendliness and usefulness. The prototype program was delivered through the Neuroventis Platform (Neuroventis, BV, Overijse, Belgium), a certified medical device (under EU/MDD Class I, and EU/MDR grace period). Ninety-two patients were included (46 in the intervention group, 46 in WLC). Most participants (63%, 58/92 women, median age 30 years) had pharmacoresistant epilepsy (61%, 56/92). Only 22% of participants (10/46) in the intervention group completed at least half of all intervention sessions. No significant differences between the intervention group and WLC were observed. Although there was a larger proportion of patients in the intervention group with meaningful improvements in HRQoL compared to WLC (19/46 versus 11/46), the difference was not significant (p = 0.119). Qualitative feedback showed that participants would appreciate more personalization, such as adaptation of the content to their current epilepsy knowledge level, a more interactive interface, shorter text sections, and interaction through reminders and notifications. Digital interventions should allow sufficient scope for personalization and interaction to increase patient engagement and enable benefits from self-care apps. Feedback loops allow the participatory development of tailored interventions. In this study, we investigated the effectiveness of an app-based self-help intervention. Study participants were either randomly assigned to a group that had access to the app or a group that received access to the app after the end of the study. Although a larger proportion of participants in the intervention group showed a relevant improvement in quality of life, the difference between the two groups was not statistically significant. Less than one-fifth of participants in the intervention group attended at least half of all intervention sessions; patient feedback showed that patients required more personalization and interactive options.

자폐 범주성 장애 청소년 및 성인의 자기관리 중재 문헌 분석

This study analyzed domestic and international research on self-management interventions for adolescents and adults with ASD, aiming sought to explore their practices and implications. A total of 21 domestic and international articles published between 2013 and 2023 were selected to analyze research trends and intervention contents, and the quality of each study was analyzed according to qualitative indicators. The results showed that 12 studies included adolescents, nine studies included participants in early adulthood, and only one study included middle-aged adults over 40 years old. Self-monitoring was the most common self-management subcomponent (19 studies). Thirteen studies used self-monitoring alone, while seven studies used it in combination with other self-management subcomponents. The most common dependent variables were social communication and occupational skills (5 studies). One study met all 22 quality indicators, and six out of 21 studies met 90% or more of the total score. Based on these findings, the study suggests implications for the field of self-management interventions for adolescents and adults with ASD and provides directions for future research.

Goal setting in people with low back pain attending an education and exercise program (GLA:D Back) and the impact of demographic factors

BackgroundIndividual goal setting is a fundamental element in self-management supportive interventions, serving to guide actions and enhance motivation for engagement. Despite this, little is known about the goals people with back pain have and to what extent these differ across genders, age groups and geographical location. This study aimed to elucidate this by first describing individual goals set by Danish and Canadian participants in a self-management intervention for people with back pain using the ICF framework; then, determining what proportion of these goals met criteria for being specific, measurable, acceptable, and time bound, and finally, by investigating differences between countries, sexes, and age groups.MethodsIn a cross-sectional study conducted August 2018 to June 2020, 394 Danish and 133 Canadian (Alberta Province) participants defined their individual goals of participating in a self-management programme involving patient education and supervised exercises. The goals were linked to the ICF framework. Distribution of goals was compared between countries, sexes, and age groups.ResultsGoals most often related to the ICF component of ‘Activity and Participation’. The most prevalent goals were “Walking” (DK: 20%; CA: 15%) and “Maintaining a body position” (DK: 17%; CA: 22%). Only few goals differed between populations, age and sex. All elements of SMART goal setting were recorded for 88% of Danish and 94% of Alberta participants.ConclusionsPeople with low back pain attending a self-management programme established goals according to the SMART criteria and focused primarily on activity. Goals were similar across countries and showed few differences across sex and age groups. The high number of different goals points to the need for individualised person-centred care.

P169 Optimising self-management in axial spondyloarthritis: a qualitative exploration of patient perspectives

Abstract Background/Aims In the UK, people living with axial spondyloarthritis (axSpA) will see their rheumatology team once a year, or less during routine clinical practice. Providing patients with the knowledge, tools and resources to confidently self-manage their condition is therefore an important component of patient care. The 2022 NICE Impact Arthritis report indicates that education and non-pharmacological treatment is lacking, making long-term self-management difficult for patients. Development of effective self-management interventions requires a deep understanding of the psychosocial context of people living with axSpA and the challenges they face when managing the practical, physical and psychological impacts of axSpA. This study therefore aimed to collect rich qualitative data from people living with axSpA to understand their experiences living with and managing their condition. Methods Online surveys were designed in alignment with guidance from Braun et al., (2021), regarding online surveys as a qualitative research tool. Open-ended questions were prioritised to collect rich qualitative data. Surveys were distributed via patient organisations and Twitter. Responses were collected via the Jisc online surveys platform from July 2022-January 2023. Results were interpreted using inductive reflexive thematic analysis. Results Data were collected from 30 axSpA participants, with varying durations of diagnosis (&amp;lt;1 year to &amp;gt; 20 years). 70% of respondents were female, and all participants were aged 25-84 years. Over half (63.3%) had experienced symptoms for ≥10 years before diagnosis. Three themes were generated from the qualitative data. Theme 1) Personalised, flexible approach: AxSpA is a heterogenous, fluctuating, unpredictable condition, thus requiring a personalised, flexible approach to self-management. Optimal self-management requires a deep understanding and acceptance of one’s own condition and symptoms, to effectively self-regulate emotions and behaviour and communicate changing needs in response to fluctuating symptoms. Theme 2) Making the invisible, visible: people living with axSpA often have no visible disability, and can struggle to feel seen and believed, especially if experiencing diagnostic delay and lacking education about axSpA. Feeling supported, believed and understood is critical for disease acceptance and feeling confident and able to engage with positive health behaviours and communicate needs, versus isolation, inner conflict, guilt and suffering through a “personal world of pain”. Theme 3) Coping with fatigue and pain: fatigue and pain are the most challenging aspects of the condition to manage, due to their unpredictability and impact on emotional resilience, autonomy, and motivation or ability to perform self-care behaviours. Conclusion Optimal self-management in axSpA requires early diagnosis, education and reassurance from healthcare professionals, including guidance for communicating with friends, family and colleagues about axSpA, and signposting to patient organisations/communities. Self-management interventions should target fatigue, pain and disease acceptance, and support patients to gain a deep understanding of their own condition to identify personalised, flexible self-care strategies that work for them. Disclosure R. Barnett: None. C. Clarke: None. R. Sengupta: Honoraria; RS has received honoraria from Abbvie, Biogen, BMS, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this abstract. P. Rouse: None.

563 Self-management Interventions and Outcome Measures for Individuals with Chronic Traumatic Injury: A Scoping Review

563 Self-management Interventions and Outcome Measures for Individuals with Chronic Traumatic Injury: A Scoping Review

Effectiveness of behavior change and self-management theoretically-informed telehealth interventions for stroke secondary prevention: An overview of systematic reviews

Effectiveness of behavior change and self-management theoretically-informed telehealth interventions for stroke secondary prevention: An overview of systematic reviews

Trajectories of self-management and independence in youth with spina bifida: Family-related predictors of growth.

The purpose of this study was to assess family-related predictors of self-management trajectories in youth with spina bifida (SB). Participants with SB completed the Adolescent/Young Adult Self-Management and Independence Scale (AMIS II) interview across four time points. Family functioning, family-related stress, and perceived family support were assessed by multiple reporters and multiple methods. Growth in AMIS II total self-management and the AMIS II subscales (Condition and Independent Living) were estimated using linear mixed effect models as a function of family factors, after controlling for socio-demographic, condition-related, and neuropsychological variables that had been found to be significant predictors of self-management in prior studies. Model fit and parsimony were assessed using Akaike's information criterion (AIC). This diverse community sample included 99 respondents aged 18-27 years old. About half were female (52.5%) and White (52.5%); 15.2% were Black, and 32.3% were Hispanic/Latino. Observed family cohesion at baseline was associated with all self-management scales at age 18 (all p < 0.05). Growth in self-management was associated with parent-reported number of family stress events. For growth in total self-management, the best model included age, race/ethnicity, family income, shunt status, lesion level, neuropsychological function, observed family cohesion, and an age-by-number of family stress events interaction effect. The study findings suggested that family factors were important predictors of self-management trajectories, even after controlling for socio-demographic, condition-related, and neuropsychological covariates. Risk and protective factors identified in families of youth with SB can inform family-focused interventions for self-management.

Peer-Led Symptom Management Intervention to Enhance Resilience in People with Systemic Sclerosis: Mediation Analysis from a Randomized Clinical Trial.

Facilitated self-management interventions have the potential to enhance resilience and well-being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12-week online peer-led symptom management intervention. We conducted a secondary data analysis from a randomized control trial comparing a peer health coached intervention to a waitlist control. Participants completed the Connor-Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12. One hundred and seventy-three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (p < .001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of -1.41 (95% Confidence Interval [CI], -2.41 to -0.41), pain interference of -0.86 (95% CI, -1.65 to -0.08), and depressive symptoms of -1.99 (95% CI, -3.16 to -0.81). For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions.

Fine-grained effect sizes.

To make transparent individuals' responses to intervention over time in the systematic review of single-case experimental designs, we developed a method of estimating and graphing fine-grained effect sizes. Fine-grained effect sizes are both case- and time-specific and thus provide more nuanced information than effect size estimates that average effects across time, across cases, or both. We demonstrate the method for estimating fine-grained effect sizes under three different baseline stability assumptions: outcome stability, level stability, and trend stability. We then use the method to graph individual effect trajectories from three single-case experimental design studies that examined the impact of self-management interventions on students identified with autism. We conclude by discussing limitations associated with estimating and graphing fine-grained effect sizes and directions for further development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).