Chronic Disease Self-management Research Articles

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.

Self-Efficacy, Patient Activation, and the Burden of Inflammatory Bowel Disease on Patients' Daily Lives.

The effective management of inflammatory bowel disease (IBD) requires complex self-management behaviors. Both patient activation (the degree to which patients are willing and able to engage in care) and self-efficacy (one's confidence in performing certain behaviors) are thought to play an important role in chronic disease self-management, but patient activation is a broad concept that can be more difficult to precisely target than self-efficacy. We aimed to describe the relationship between patient activation, self-efficacy, and the burden of IBD on patients' daily lives. Patients with IBD were recruited from a single center to complete a survey including the Patient Activation Measure (PAM-13®), the IBD Self-Efficacy Scale (IBD-SES), and an IBD-specific patient-reported outcome measure. Using multivariable linear regression, we examined the relationship between IBD burden, self-efficacy, and patient activation, adjusting a priori for age, gender, IBD type, IBD medications, active corticosteroid use, anxiety, and depression. We performed a post-hoc mediation analysis to examine self-efficacy as a potential mediator in the relationship between patient activation and the burden of IBD on patient's daily lives. A total of 132 patients with IBD completed the survey (59% Crohn's disease, 41% ulcerative colitis, 52% female). Higher levels of patient activation and higher levels of self-efficacy were each associated with lower IBD burden (patient activation: ß = -1.9, p < 0.001, self-efficacy: ß = -2.6, p < 0.001). Post hoc mediation analysis confirmed that the relationship between patient activation and daily IBD burden was mediated by self-efficacy (Average Causal Mediation Effect = -1.00, p < 0.001, proportion mediated = 0.62, p < 0.001). The relationship between patient activation and IBD burden is highly mediated by self-efficacy, suggesting that self-efficacy could be a more precise target for intervention. Future studies could focus on targeting self-efficacy to build individuals' confidence in IBD self-management and testing of IBD-tailored self-management programs to ultimately improve disease outcomes.

Biosensor applications in the monitoring of elderly patients

Nurse-based patient monitoring is prone to errors due to manual measurements and documentation, leading to potential inaccuracies in care. The use of biosensors offers a promising solution by enabling real-time and continuous monitoring of patient health. Categorizing patient care reports as critical or non-critical using mobile recording systems based on biosensor data can help prevent errors and improve care. The use of biosensors can significantly reduce morbidity and mortality, especially after emergencies and accidents. These devices improve the quality of care and increase the satisfaction of older people, their families and healthcare professionals. Wearable biosensors make it easier for older people to monitor their health, which can help reduce hospital admissions. Chronic diseases such as cardiovascular disease, cancer, diabetes, dementia and stroke pose challenges to healthcare delivery and interpretation of results. Integrating biosensors into health monitoring and measurement is an innovative approach to managing these chronic conditions more effectively. To improve self-management of chronic diseases in older people, it is essential to educate healthcare professionals and promote research in this area. As a result, the use of biosensors to monitor the daily activities and health parameters of elderly patients is expanding, highlighting the importance of multidisciplinary research in biotechnology, chemistry, engineering and nursing.

An application for mobile devices as a decision support for the treatment and prevention of bovine fasciolosis - A survey among organic dairy farms in Bavaria

Based on health applications used in human medicine for the self-management of chronic diseases, the aim of this study was to evaluate a mobile app in veterinary medicine using the example of a decision-making aid for the control and prevention of bovine fasciolosis on dairy cattle farms. The study was carried out on 37 organic dairy cattle farms in Bavaria. The farms were divided into two groups: one group received a mobile app (n=17) as a decision-making aid, while the other group received a printed brochure (n=20) with identical content. At the beginning of the study, all participants were questioned by telephone concerning their farm, among other things. After using the respective tool, the participants were again interviewed by telephone. At the beginning of the study, the majority of participants were aware of the options for drainage (n=28; 75.7%) and fencing off wet areas (n=36; 97.3%). 37.8% (n=14) stated that they were familiar with a pasture rotation system. After using the respective aid, the majority of participants described the tool as helpful (94.1% app; 80% brochure). Many participants (app group: n=10 (58.8%); brochure group: n=16 (80%)) stated that they wanted to change their approach based on the new knowledge gained, e. g. introducing a pasture rotation system (app group: n=9 (52.9%); brochure group: n=13 (65.0%)). Both study groups enjoyed working with the tool they used. They viewed the knowledge imparted by the mobile app or brochure as helpful and useful. Most participants expressed a desire to continue using these tools in animal health management on farms in the future. The use of tools such as mobile apps may improve veterinary advice, e. g. in the management of parasitoses in cattle herds.

Factors influencing patients’ engagement with ChatGPT for accessing health-related information

ABSTRACT This study aims to investigate the factors influencing patients’ engagement with ChatGPT for accessing health-related information. A quasi-experimental design with a mixed-methods approach including both quantitative online survey and qualitative interviews was adopted in this study for data collection and analysis. A total of 139 and 24 outpatients were recruited for survey and interviews, respectively. Twenty-eight influencing factors were identified from both survey and interview analysis that may affect positively or negatively on patients’ engagement on ChatGPT. Survey results revealed user-centric factors, including perceived usefulness (mean score rating = 3.59), followed by trustworthiness (Mean score rating = 3.53) to be major influencing factors, while interview findings revealed ChatGPT-related factors such as information quality, ethical concerns, and technical limitations as the major influencing factors. ChatGPT has exponentially generated users’ interest in its features and functionalities, but there are still some concerns which may limit their engagement. Areas of future research include ChatGPT and patient satisfaction; ChatGPT for public health awareness; and ChatGPT for self-management of chronic diseases.

Health Literacy Levels of Women Attending a Perinatology Outpatient Clinic for High-Risk Pregnancy Follow-Up.

Health literacy, defined as the ability to obtain, understand, evaluate, and apply health information with knowledge, motivation, and skills, is crucial for maintaining and improving quality of life. Despite the availability of health information, limited health literacy is linked to health disparities, inadequate self-management of chronic diseases, and poorer health outcomes. The purpose of this study is to assess the health literacy of pregnant women who visit the Perinatology Outpatient Clinic for follow-up care. It seeks to identify gaps in knowledge and understanding that may impede effective healthcare delivery and inform targeted health education and public awareness programs to enhance health literacy. This prospective survey study included 210 pregnant women aged 18 to 40 years attending the Perinatology Outpatient Clinic at Giresun Obstetrics and Gynecology Training and Research Hospital, Turkey. Participants completed a questionnaire on health literacy, sociodemographics, and basic health status via Google Forms (Google Inc., Mountain View, CA, USA). Statistical analysis was performed using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA), employing tests such as Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, Student's t-test, ANOVA, Spearman, and Pearson correlation, and multivariate linear regression analysis. The mean age of participants was 29.97±5.44 years, with a mean health literacy score of 29.89±7.05. Education level and living place significantly influenced health literacy scores, with higher scores among those with higher education and urban living (p = 0.014 and p = 0.038, respectively). Economic status also significantly impacted health literacy, with lower scores among those with poor economic status (p<0.001). Health literacy scores were higher among those receiving health information from healthcare professionals (p = 0.006) and lower among those finding medical information from doctors insufficient (p = 0.008). Health literacy is significantly influenced by education level, living place, and economic status. The study emphasizes the necessity of focused health education initiatives, especially for individuals with lower educational attainment and those residing in rural regions. Improving health literacy via efficient communication from medical professionals can benefit expectant mothers and their unborn children by lowering medical expenses and improving health outcomes.

Outcomes of a Self-Management Program for People with Non-Communicable Diseases in the Context of COVID-19.

To evaluate the effectiveness of the online version of the Chronic Disease Self-Management Program (CDSMP) on physical activity and depressive symptoms in individuals with non-communicable diseases (NCDs) in Mexico and Peru during the COVID-19 pandemic. Quasi-experimental study with a non-probability sample of 114 people with NCDs, recruited by invitation in Mexico and by convenience in Peru. The participants were assigned to intervention (n = 85) and control (n = 29) groups. The Personal Health Questionnaire (PHQ-8) and the Physical Activity Scale were used to assess the outcomes. Measurements were taken before and after the intervention. The CDSMP comprises six sessions that take place once per week and last 2.5 h each. The intervention group showed a significant reduction in depressive symptoms and an increase in physical activity (PA) at the end of the program. In contrast, the control group showed no significant improvement in depression and presented a significant decrease in PA.

A microfluidic chip with integrated plasma separation for sample-to-answer detection of multiple chronic disease biomarkers in whole blood

Point-of-care testing of multiple chronic disease biomarkers is crucial for timely intervention and management of chronic diseases. Here, a “sample-to-answer” microfluidic chip was developed for simultaneous detection of multiple chronic disease biomarkers in whole blood by integrating a plasma separation module. The whole detection process is very convenient, i.e., just add whole blood and get the results. The chip successfully achieved the simultaneous detection of total cholesterol, triglycerides, uric acid, and glucose in undiluted whole blood within 21 min, including 6 min for plasma separation and 15 min for enzymatic chromogenic reactions. Moreover, the sensitivity levels of on-chip detection of chronic disease biomarkers can also meet clinically relevant thresholds. The chip is easy to use and has significant potential to improve home self-management of chronic diseases and enhance healthcare outcomes.

Understanding barriers and facilitators to integrated HIV and hypertension care in South Africa

BackgroundThe burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions.MethodsUsing a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups.ResultsData from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic’s logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients’ knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care.ConclusionsThe convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.

Preferences for Food Vouchers Among Adults with Low Incomes

ABSTRACT There is growing interest in understanding the optimal design of food voucher programs to impchange the word “All foods” in the Table to “SNAP-eligible” to be consistent with the language used in Table 2 and Figure 1rove diet quality and support chronic disease self-management. We examined preferences for voucher program design among adults with low incomes who participated in a randomized trial. Participants preferred vouchers eligible for all foods over those restricted to fruits and vegetables (p = .001) and a monthly over weekly redemption schedule (p = .003). Preferences differed significantly by voucher assignment (pinteraction < 0.0001 for both), with those assigned to the fruit and vegetable voucher more likely to prefer that voucher. Flexibility was identified as a key driver of preference.

Improving Health and Reducing Chronic Disease Disparities with Latinx Communities: Evaluating the Role of Documented Community-Based Intervention Participation.

Limited evidence exists on the impact of participation in community-based chronic disease self-management and prevention programs on health disparities. The purpose of this research was to determine the effects of participation in the Healthy Here Wellness Referral System on existing disparities in glycated hemoglobin (HbA1c), systolic blood pressure (BP), and diastolic BP among Hispanic/Latinx adults compared with non-Hispanic White adults. We merged administrative clinical and referral data from 2018 through 2022 for adult patients in six focus ZIP codes in New Mexico resulting in a sample of 1331 patients and used regression models to examine predictors of intervention participation as well as propensity-adjusted impacts of participation on HbA1c and BP outcomes. Non-Hispanic White patients who were referred to community-based programming but did not participate saw statistically significant increases in HbA1c. Hispanic/Latinx patients saw statistically significant decreases in HbA1c with referral alone, with no added benefit from program participation. The impact of participation differed statistically significantly (t(683) = 3.55, p < .001) between these two groups for HbA1c levels, as well as for systolic (t(958) = 2.11, p = .04) and diastolic BP outcomes (t(958) = 2.96, p = .003). Results of this study support the promise of using centralized referral systems to co-produce health improvement in community settings. Mixed findings highlight the need for further uptake of theory-informed measurement in evaluations seeking to understand heterogeneous program impacts by race and ethnicity.

“Veteran to Veteran, There's Automatically a Trust”: A Qualitative Study of Veterans’ Experiences in a Peer Health-Coaching Program for Hypertension

IntroductionVeteran peer Coaches Optimizing and Advancing Cardiac Health (VetCOACH) was a randomized controlled trial to test the effectiveness of a peer support intervention to reduce blood pressure among Veterans with hypertension and one or more cardiovascular risks. We studied participant perceptions of the intervention, including barriers and facilitators to participation, factors promoting behavior change, and disease self-management practices. MethodsWe enrolled participants at their exit visit for the VetCOACH study. Participants received primary care at the Veterans Administration health care system and had multiple cardiovascular disease risks, including a diagnosis of hypertension. We conducted a qualitative content analysis of semi-structured interviews about their experience with the VetCOACH intervention. ResultsInterview participants (n=29) were 60 years of age on average (SD 8.6), 71% male, and 55% White. They had mean systolic blood pressure of 138 mmHg (SD 18) at baseline. We identified themes across three major categories, which follow the general progression of the intervention: participation, relationship-building, and behavior change. Scheduling flexibility, shared identity and experiences with the coach, acquisition of new knowledge and skills, and goal-setting were important determinants of participants’ experiences in the program. In the participation category, the themes were scheduling, visit modality, life circumstances, and staffing. In the relationship category, the themes were the coach's professional role, shared identity and experiences, and social support. In the behavior change category, the themes were memory, attention, decision-processes; goal-setting; skills and knowledge; and environmental context and resources. We report differences across patients varying by blood pressure reduction following the intervention and number of coaching visits. ConclusionsParticipants generally reported positive experiences in a peer support intervention for Veterans with hypertension. Participant perceptions provide important insights to the intervention design and implementation. These findings may inform future implementation of peer support among Veterans in hypertension and chronic disease self-management more generally.

Potential profiling of self-management skills in older co-morbid patients

BackgroundUnder the general trend of global aging, geriatric comorbidity is increasingly common, which may have some impact on the quality of life of the older people. Self-management can effectively improve patient compliance, subjective initiative, and improve patient quality of life. However, the present situation of self-management in different old people is different. Therefore, this study classifies older co-morbid patients through potential profiling analysis, understands the category characteristics of self-management level of older co-morbid patients, and discusses the influencing factors of self-management level of different categories of older co-morbid patients, which can provide reference for personalized intervention programs for different comorbidity characteristics of elderly people in the future. MethodThrough a cross-sectional study, 616 cases of older co-morbid patients in three districts of Zhengzhou City, Henan Province, were selected as survey subjects by using the whole cluster sampling method. The General Information Questionnaire, Chronic Disease Self-Management Scale, Health Literacy Scale, Electronic Health Literacy Scale, Collaborative Social Support Scale, and Health Empowerment Scale were used to conduct the survey.ResultsThe result of LPA shows that the self-management characteristics of older co-morbid patients should be classified into 3 categories: good self-management (19.4%), medium self-management(27.9%), and low self-management (52.7%). The results of multivariate logistic regression analyses show that literacy, religiosity, health literacy, e-health literacy, appreciative social support, and health empowerment are influential factors for self-management among older co-morbid patients (p < 0.05).ConclusionThere is obvious heterogeneity in the self-management level of older co-morbid patients. It is recommended that healthcare professionals give targeted interventions for their weaknesses according to the self-management characteristics of different categories of patients in order to enhance the self-management level of this population and improve their quality of life.

“An excellent servant but a terrible master”: Understanding the value of wearables for self-management in people with cystic fibrosis and their healthcare providers – A qualitative study

BackgroundWearables hold potential to improve chronic disease self-management in conditions like cystic fibrosis (CF) through remote monitoring, early detection of illness and motivation. Little is known about the acceptability and sustainability of integrating wearables into routine care from the perspectives of people with CF (pwCF) and their treating clinicians. MethodsA cross-sectional qualitative study involving semi-structured interviews with adult pwCF and focus groups comprising members of a CF multidisciplinary team (MDT) were conducted at a specialist CF centre in Australia. A phenomenological orientation underpinned the study. Inductive thematic analysis was performed using the Framework method. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. ResultsNine pwCF and eight members of a CF MDT, representing six clinical disciplines, participated in the study. Eight themes were inductively generated from the data, of which four were identified from each group. PwCF valued wearables for providing real-time data to motivate healthy behaviours and support shared goal-setting with healthcare providers. Wearables did not influence adherence to CF-specific self-management practices and had some hardware limitations. Members of the CF MDT recognised potential benefits of remote monitoring and shared goal-setting, but advised caution regarding data accuracy, generating patient anxiety in certain personality traits, and lack of evidence supporting use in CF self-management. ConclusionsPerspectives on integrating wearables into CF care were cautiously optimistic, with emerging risks related to patient anxiety and lack of evidence moderating acceptance.

Implementing PDSA Cycles to Expand Reach of Self-Management Education in the Post-COVID Era

ABSTRACT Background COVID-19 reduced participation in our region’s evidence-based chronic disease self-management program (SMP), despite having expanded offerings to include diverse delivery modes (e.g. virtual, mailed toolkit, phone-based group support). Purpose The purpose was to test various approaches of disseminating the mailed toolkit (an independent study version of the SMP) to expand reach of the program. Methods We ran three process improvement (PDSA) cycles. We used electronic health record data, a participant survey, and implementer feedback to guide our decision-making process throughout the iterations. Results Toolkits reached populations that had not previously been exposed to SMPs: individuals with type 2 diabetes who did not attend diabetes education in the past year; individuals being discharged from acute care with an admitting diagnosis related to a chronic disease; and individuals referred by their provider to the program. Discussion Toolkit utilization will remain low for those who are not ready to make a behavior change. Running PDSA cycles provided the necessary information for our team to make decisions about future dissemination of the mailed toolkits. Translation to Health Education Practice Engaging in PDSA cycles can be a helpful tool for health educators when considering how to expand reach or engage new populations of interest.

Assessment of Patient Awareness Regarding Chronic Kidney Disease Management in Santhal Parganas

Background: Chronic kidney disease (CKD) is a global health challenge, and effective self-management is crucial for optimal outcomes. Assessing the prevailing knowledge about CKD in patients can help strategies information education communication program to better manage the disease. This study evaluated the current knowledge of self-management of CKD among patients suffering from CKD in Santhal Parganas of Jharkhand state in India. Materials and Methods: This cross-sectional survey was conducted in a tertiary care teaching hospital situated in Deoghar, Jharkhand, India from June to December 2023. Patients suffering from CKD were enrolled for this study from the Outpatient Department. The Chronic Kidney Disease Self-Management Knowledge Tool (CKD-SMKT) was used to measure patients’ knowledge through face-to-face interviews conducted by a trained local surveyor. Results: A total of 228 patients with a mean age of 52.63±10.65 years (men 136 [59.65%], women 92 [40.35%]) participated in the survey. All the patients (100%) gained knowledge about CKD from doctors, followed by other patients (63.6%) and relatives (41.23%). On average, 53.61% did not have proper knowledge about overall kidney disease. Correct knowledge about maintaining kidney health was among 38.1% of patients with 36.59% unsure about their knowledge and 25.31% declaring their lack of knowledge. Conclusion: A low level of knowledge about kidney health was found among the patients suffering from CKD in Santhal Parganas, a region with a tribal population with a low literacy rate. The identified knowledge gap emphasizes the need for a tailored educational program for CKD patients by doctors and patients relative.

Key stakeholders' perspectives on the development of an early dietary phosphate self-management strategy for children and young people with chronic kidney disease stages 1-3: A modified Delphi consensus process.

An early dietary phosphate intervention (EPI) can provide vital medical benefits supporting self-management of chronic kidney disease (CKD) in childhood. To utilise expert consensus to provide early modelling for an EPI to guide clinical practice across a paediatric renal network. Forty-eight statements across six domains were constructed following a systematic review and semi-structured interviews with children and young people (CYP), parents and healthcare professionals (HCP). A three-round online Delphi survey with parents and paediatric renal multi-disciplinary healthcare experts was undertaken. Twenty-one experts agreed on 56 statements over three Delphi rounds. Statements were accepted in all six domains: definition of an EPI (2), rationale (12), intended users (3), delivery (14) (when [1], where [3], who [2], how [8]), other considerations (16) and potential concerns (9). Consensus was reached on a definition and a set of guiding principles, providing some early modelling for implementation and future research on the development of an EPI strategy for CYP with CKD.

Effectiveness of Trained Community Lay Workers on Glycemic Control, Knowledge, and Self-Efficacy Among Agricultural Workers with Diabetes in the Texas Panhandle

Systemic health barriers, economic challenges, and lack of follow-up care exacerbate self-management of chronic diseases like diabetes among Hispanic agricultural workers. The primary objective of this pilot project was to determine the benefit of using community coaches to decrease A1C levels and increase diabetes knowledge among agricultural workers with diagnosed diabetes in the Texas Panhandle. A longitudinal study design with two phases was used to create, deliver, and evaluate a diabetes coaching program. Phase 1 was the development of the program and community coaches training (n = 4). In Phase 2, the coaches then delivered the program over 12 weeks to thirteen clients. Phase 1: All coaches were Hispanic females, 28.3 (SD 3.8) years of age, half had at most a high school education level and the other half had a vocational certification (n = 4). Mean DKQ-24 score was 54.2% (SD = 29.7) at baseline and 75.0% (SD = 31.4) after training (t (4) = 4.6, P < 0.05). We observed a very large difference between mean baseline and exit DKQ-24 scores relative to the pooled standard deviation, resulting in an effect size estimate of 0.59 indicative of a medium to large learning effect. Phase 2: Clients were Hispanic Spanish-speaking, predominantly female (55%), 44.4 (SD 6.8) years of age with at most a high school level of education (88.9%) and occupations varied from dairy farm worker (33.3%), meat processing worker (33.3%), and other agriculture or manufacturing position (33.3%). The mean SKILLD score was 40.0% (SD = 28.7) at baseline, increasing to 72.2% (SD = 25.4) at 12 weeks upon completion of the coaching program (t (9) = 2.956, P < 0.05). We observed a very large difference between mean baseline and exit SKILLD scores relative to the pooled standard deviation, resulting in an effect size estimate of 1.13 indicative of a large learning effect. The mean A1C levels at baseline screening was 8.3% (SD = 3.0) and 7.6% (SD = 3.0) at exit screening, representing a 0.7% decrease (p = 0.4730). No statistically significant differences were observed between depression (p = 0.786) or anxiety (p = 1.000) measures at baseline compared to exit. Training and coaching programs for hard-to-reach agricultural and meat processing workers must be culturally, linguistically, and literacy appropriate for both coaches and clients. The program must be feasible and sustainable, focus on empowering community members, capitalize on technological advances and persisting new-normals from the COVID-19 pandemic as well as dismantle common systemic barriers to health and understanding lived-experiences of agricultural working populations in rural regions.

A Mobile App for Chronic Disease Self-Management for Individuals with Low Health Literacy: A Multisite Randomized Controlled Clinical Trial

The purpose of this study was to evaluate the effects of a mobile app designed to improve chronic disease self-management in patients aged 40 years and older with low health literacy and who had at least one chronic health condition, and to assess the impact of delivering information at different levels of reading difficulty. A randomized controlled trial was completed at two sites. Individuals aged 40 years and older screened for low health literacy who had at least one chronic health condition were randomly assigned to a tailored information multimedia app with text at one of three grade levels. Four primary outcomes were assessed: patient activation, chronic disease self-efficacy, health-related quality of life, and medication adherence. All groups showed overall increases in activation, self-efficacy, and health-related quality of life, but no change in medication adherence. No between-group differences were observed. The mobile app may have been effective in increasing participants’ levels of several psychosocial variables, but this interpretation can only be advanced tentatively in light of the lack of control-experimental group differences. Reading difficulty level was not significantly related to outcomes.

A mobile app providing individually-tailored psychoeducation about sleep for older adults with chronic health conditions and low health literacy.

This paper reports on a study of a mobile app that provides tailored information about sleep to individuals aged 40 and older who have chronic health conditions and low health literacy. The sleep module was a part of a multitopic app focused on chronic disease self-management. Participants were randomly assigned to receive sleep psychoeducation at reading levels equivalent to 3rd, 6th or 8th grade. The primary outcome measure was the Pittsburgh Sleep Quality Index (PSQI), which was completed at baseline, after the intervention, and again three months later. Outcomes were assessed using repeated measures mixed effects models. Most participants were Black, Indigenous, or Other Persons of Color (BIPOC; 87%); they had average reading level at the 7th grade. Health literacy, socioeconomic status, and number of health conditions were related to the PSQI. The PSQI score decreased over the course of the three study visits for all groups, consistent with a small to medium effect size (d = 0.40). No effect of treatment group was observed. Participants were positive about the usefulness and helpfulness of the app. Results suggest that a brief tailored information intervention may be beneficial for individuals aged 40 and older who have low health literacy and chronic health conditions. Further development of the intervention may enhance its clinical effectiveness.