Disease Self-management Research Articles

Guidelines on self-management of Gaucher disease

Guidelines on self-management of Gaucher disease

Adherence to exercise after an acute coronary syndrome: a 6-month randomized controlled trial.

Introduction: Exercise training with well-known health benefits is a key element in the self-management of coronary artery disease (CAD). Although current guidelines for patients with CAD recommend daily exercise training, most of the patients do not follow the guidelines. We tested the hypothesis that an exercise training program guided by a novel technology used at home will improve adherence to exercise training. Methods: One to three weeks after percutaneous coronary intervention (PCI), acute coronary syndrome patients (n = 50) were randomized into traditional (age 65 ± 8years) and novel technology-guided (age 60 ± 8years) exercise rehabilitation groups. The novel technology included a tablet computer with a virtual autonomous physiotherapy agent (VAPA group) for every patient at home; it was used to guide exercise training time, volume, and intensity. Traditional rehabilitation was performed by exercise training prescriptions, phone calls, and diaries (control group). The duration of the rehabilitation program was 6months for both groups. Exercise capacity and 24-h heart rate variability were measured at baseline and at the end of the program. Adherence to exercise was measured over 6months as the percentage of realized training. Results: None of the patients dropped out from the VAPA group, while three patients dropped out from the control group. Adherence to exercise was higher in the VAPA group than in the control group for resistance training (141% ± 56% vs. 50% ± 20%, p < 0.0001), and there were no differences between the groups for aerobic training (144% ± 45% vs. 119% ± 65%, p = 0.22). Exercise capacity increased in both the groups (time p < 0.001, time × group interaction p = ns). High-frequency power of R-R intervals (lnHF) increased in the VAPA group but remained unchanged in the control group (natural logarithm of lnHF power from 5.5 ± 0.7 to 5.8 ± 0.9ms2 and from 5.3 ± 0.8 to 5.2 ± 0.7ms2, respectively, time × group interaction p = 0.014). Conclusion: Compared with the use of traditional methods, the use of novel technology at home results in better adherence to exercise, particularly in resistance training, in acute coronary syndrome patients. Second, the VAPA group showed improved cardiac vagal regulation, documented by increased vagally mediated R-R interval fluctuation, compared with the traditional training group (ClinicalTrials.gov identifier: NCT03704025).

PATIENT DECISION MAKING ABOUT UTILIZATION OF TREATMENT AND MANAGEMENT METHODS: TOWARD ENHANCED PROMOTION OF PREVENTIVE SELF-MANAGEMENT FOR ULCERATIVE COLITIS

Abstract BACKGROUND Living with Ulcerative Colitis (UC) is accompanied by physical and psychosocial burdens that significantly detract from quality of life. To accommodate, individuals employ multiple treatment and management methods to mitigate gastrointestinal (GI) disease symptoms, reduce pharmaceutical dependence, and respond to the daily challenges of living with UC. This study examines why and how patients choose to utilize treatment and management methods, with emphasis on patient perspectives and experiences. METHODS Adults living with UC for at least 5 years, who had experienced at least one disease flare, were recruited to participate in individual, semi-structured qualitative interviews (N=21). Verbatim transcripts were thematically analyzed using emergent coding with Nvivo12®. RESULTS Decision making about the use of treatment and management methods was shaped by participants’ sources of information, attitudes toward self-management, and personal motivations. Participants rarely expressed feelings of personal responsibility for the unpredictable course of illness. However, some believed that they could, to varying degrees, take charge of their UC experience. A few individuals described an active approach to managing their illness through self-adjusting treatment methods, health behavior change, and self-advocacy towards satisfaction with treatment options and enhanced patient-provider communication. The poor quality of life associated with the daily burden of living with UC emerged as a primary motive for exploration and utilization of treatment and management methods. Participants drew conclusions about diet’s impact on disease activity by observation of immediate GI symptoms. While most patients aimed to mitigate UC symptoms by taking medications, reducing stress, and avoiding perceived ‘trigger’ foods, participants reported primarily utilizing treatment and management methods as reactive responses to flares instead of as preventive measures against disease activity and disease progression. DISCUSSION Results provide insight into patient decision making and may inform individualized patient care, improve patient-provider communication, and guide interdisciplinary efforts to support self-management among patients with UC. Findings highlight a need for greater focus on promoting preventive self-management lifestyle behaviors to protect against disease activity and progressive impairment. This research supports the promotion of disease prevention and self-management both inside and outside of the clinical setting.

Factors Associated with Veteran Self-Reported Use of Digital Health Devices

BackgroundDigital health devices (DHDs), technologies designed to gather, monitor, and sometimes share data about health-related behaviors or symptoms, can support the prevention or management of chronic conditions. DHDs range in complexity and utility, from tracking lifestyle behaviors (e.g., pedometer) to more sophisticated biometric data collection for disease self-management (e.g., glucometers). Despite these positive health benefits, supporting adoption and sustained use of DHDs remains a challenge.ObjectiveThis analysis examined the prevalence of, and factors associated with, DHD use within the Veterans Health Administration (VHA).DesignNational survey.ParticipantsVeterans who receive VHA care and are active secure messaging users.Main MeasuresDemographics, access to technology, perceptions of using health technologies, and use of lifestyle monitoring and self-management DHDs.ResultsAmong respondents, 87% were current or past users of at least one DHD, and 58% were provided a DHD by VHA. Respondents 65 + years were less likely to use a lifestyle monitoring device (AOR 0.57, 95% CI [0.39, 0.81], P = .002), but more likely to use a self-management device (AOR 1.69, 95% [1.10, 2.59], P = .016). Smartphone owners were more likely to use a lifestyle monitoring device (AOR 2.60, 95% CI [1.42, 4.75], P = .002) and a self-management device (AOR 1.83, 95% CI [1.04, 3.23], P = .037).ConclusionsThe current analysis describes the types of DHDs that are being adopted by Veterans and factors associated with their adoption. Results suggest that various factors influence adoption, including age, access to technology, and health status, and that these relationships may differ based on the functionalities of the device. VHA provision of devices was frequent among device users. Providing Veterans with DHDs and the training needed to use them may be important factors in facilitating device adoption. Taken together, this knowledge can inform future implementation efforts, and next steps to support patient-team decision making about DHD use.

The effect of health coaching on blood pressure control and disease self-management among patients in rural area in China: a randomized controlled trial.

The self-management education for patients with hypertension has not been widely provided in rural areas of China. Our study aimed to examine the effect of health coaching intervention on controlling BP and improving self-management skills among rural resident of ≤6 month-history of hypertension. A total of 102 participants were enrolled in the RCT. The control group received usual health guidance and follow-up management; the experimental group received health coaching and follow up management. The primary outcomes were the difference in changes of BP and mean self-management scores. The secondary outcomes included waist circumference, body mass index (BMI), and medication literacy. Participants in the experimental group showed a significantly greater improvement with respect to systolic BP and diastolic BP respectively (133.85 ± 4.74 mmHg vs 127.96 ± 5.42 mmHg;80.94 ± 5.52 mmHg vs 77.37 ± 4.44 mmHg, P < 0.05) and BMI (24.66 ± 2.19 kg/m2 vs 23.44 ± 2.05 kg/m2, P < 0.05) compared with the control group. A significant difference was also observed between the experimental and control groups in terms of self-management and medication literacy at both 3 and 6 months (P < 0.05). However, there was no significant difference in changes of waist circumferences between the two groups (22.6% vs 38.8%). In conclusion, for patients with diagnosed with hypertension within the last 6 months, health coaching maybe is an effective approach to control blood pressure and improve medication literacy and self-management skills.

Epilepsy self–management mobile health application: A needs assessment in people with epilepsy and caregivers in Viet Nam

ObjectivesThis study aimed to determine (1) the needsof Vietnamese people with epilepsy (PWE) and their caregivers for self-management mobile health applications and (2) the self-management features expected to be included in an application. MethodsThe survey consisted of an anonymous self-administered questionnaire that was distributed to PWE and caregivers from the age of 18 in Vietnam through online platforms and onsite at Nguyen Tri Phuong Hospital and University Medical Center, Ho Chi Minh City, from February 2022 to May 2022. The questionnaire assessed the participants’ attitudes toward epilepsy self-management mobile applications, their willingness to use applications, and their expectations of the contents of an application. ResultsResponses from 103 participants were submitted. Eighty-one participants (78.6%) reported using a smartphone, but only 50.6% of those claimed to know about self-management applications. Most respondents (70.9%) thought the applications would be useful for disease self-management, and 68.9% were willing to use epilepsy self-management applications. In addition, the most expected features to be included in self-management applications were epilepsy information, seizure first aid, connecting with medical professionals, and a seizure diary. ConclusionMost Vietnamese PWE and caregivers had a willingness to use epilepsy self-management applications.The expected features are related to all aspects of self-management, including information, seizure, medication, and safety management.

Content analysis of patient support groups related to myositis on Facebook

IntroductionIdiopathic inflammatory myopathies (IIM) are heterogeneous and complex, and routine consultation can be overwhelming for patients, or sometimes so rushed that patients feel unable to discuss their needs and wishes adequately. As a result, online patient support groups (PSGs) on social media platforms like Facebook may help provide them with information they are seeking, and the support of the patient community who are living with this condition. Our goal is to explore the current landscape of PSGs in IIM to discuss the future of such groups and their role in supporting patient-driven self-management of complex connective tissue diseases.MethodsWe investigated factors that influence engagement in publicly accessible support groups on Facebook for patients with myositis. We analysed posts from myositis-related Facebook groups and pages between July 10, 2022, and October 2022. Data were extracted from each post, including presentation format (text, picture, video or mixed media) and content type (news, personal feelings or information). To gauge the post’s impact, we measured engagement metrics, such as likes, comments, shares and reactions.ResultsNearly three-quarters of the groups were private. Among the open ones, most posts seem to comprise pictures with text. Notably, engagement levels were higher for multimedia posts, with the exception of comments in groups, where engagement was comparatively lower.In terms of content, the majority of posts fell under the ‘personal’ category, followed by ‘information’ and ‘news’ posts, with information posts in groups receiving the most interactions. Moreover, groups exhibited higher total engagement compared to pages when considering all posts cumulatively.ConclusionsOur observations indicate that patients with myositis seek information on the condition online, and the multimedia nature of content presentation significantly influences engagement. These digital forums serve as valuable platforms for fostering connections among diverse individuals, providing a perceived safe space for sharing their personal experiences and varied perspectives, and potentially mitigating social isolation.Key Points• Patient support groups on myositis are a key source of support and information for patients.• Public posts with multimedia content garner the most engagement.• The majority of posts are personal in nature, with a smaller proportion of content providing news or information.

Friends, Family, and Food: Development of a Food Allergy Intervention, F3-App, for Children.

Despite a marked increase in the prevalence of pediatric IgE-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA. Development of the "Friends, Family and Food Application (F3-App)" employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts. Phase 1 (Prototype Development/Pilot Evaluation) involved family input on key themes and educational messages, development of a prototype, and pilot testing. Phase 2 (Full F3-App Development/Open Trial) included refinement and expansion of the prototype per advisory panel and end-user recommendations, followed by an open trial with additional iterative refinement. Acceptability and credibility of the F3-App were rated highly by most participants. Relatively few technical challenges arose with F3-App installation or use. Follow up interviews with children and caregivers suggested that the F3-App was generally well-received, families found the content useful, and that it prompted family discussion about the child's FA management. User input is critical to developing family-friendly software to support management of pediatric chronic conditions. Interactive educational software can be a useful channel for children to practice skills and build confidence in disease self-management and to facilitate family communication regarding the stresses of FA management. ClinicalTrials.gov identifier: NCT05111938.

Symptoms and medical resource utilization of patients with bronchiectasis after SARS-CoV-2 infection.

The impact of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on patients with bronchiectasis in terms of symptoms, self-management and medical resource utilization was unknown. To describe the impact of infection by SARS-CoV-2 on fluctuation of symptoms, self-management and medical resource utilization of patients with bronchiectasis during the pandemic of COVID-19. This was a single-center cross-sectional questionnaire study performed in Peking University Third Hospital. An online questionnaire investigation addressing the impact of SARS-CoV-2 infection on respiratory symptoms, self-management and medical resource utilization was conducted among patients with bronchiectasis during the COVID-19 surge in December 2022 in Beijing, China. Five hundred patients with bronchiectasis, with 285 (57%) females, and a mean () age of 57.9 15.1 years, completed the telephone questionnaire. The reported prevalence of COVID-19 was 81.2% (406/500). Of the 406 COVID-19 patients, 89.2% experienced fever lasting mostly for no more than 3 days, 70.6 and 61.8% reported exacerbated cough and sputum production respectively, and 17.7% reported worsened dyspnea. Notable 37.4% of the patients with COVID-19 experienced symptoms consistent with the definition of an acute exacerbation of bronchiectasis. However, 76.6% (311/406) of the infected patients did not seek medical care but managed at home. Of the patients who visited hospitals, 26.3% (25/95) needed hospitalization and 2.1% (2/95) needed ICU admission. Multi-factors logistic regression analysis showed that younger age (p = 0.012) and not using a bronchodilator agent(p = 0.022) were independently associated with SARS-CoV-2 infection, while a history of exacerbation of bronchiectasis in the past year (p = 0.006) and daily use of expectorants (p = 0.002) were associated with emergency visit and/or hospitalization for patients with bronchiectasis after SARS-CoV-2 infection. During the COVID-19 surge, the infection rate of SARS-CoV-2 in patients with bronchiectasis was high, and most of the patients experienced new-onset or exacerbated respiratory symptoms, but only a minority needed medical visits. Our survey results further underscore the importance of patients' disease awareness and self-management skills during a pandemic like COVID-19.

Knowledge, attitudes, and practices among patients with diabetes mellitus and hyperuricemia toward disease self-management.

This study aimed to assess the knowledge, attitudes and practices (KAP) among patients with diabetes mellitus and hyperuricemia toward disease self-management. This web-based cross-sectional study was conducted between June 2023 and January 2024 at Heilongjiang Provincial Hospital. A self-designed questionnaire was developed to collect demographic information of patients with diabetes mellitus and hyperuricemia, and assess their knowledge, attitudes and practices toward disease self-management. A total of 482 participants were enrolled in this study, among them, 364 (75.52%) were male, 235 (48.76%) were aged between 40 and 59 years, 226 (46.89%) had a body mass index (BMI) ranging from 24 to 28 kg/m2, 337 (69.92%) had received a diagnosis of diabetes for a duration of 2 years or more, while 245 (50.83%) had been diagnosed with hyperuricemia for a similar duration. Their median (range) knowledge, attitude and practice scores were 10.00 (9.00, 11.00) (possible range: 0-12), 38.00 (36.00, 40.00) (possible range: 9-45), and 30.00 (26.00, 34.75) (possible range: 10-50), respectively. The path analysis demonstrated that knowledge had direct effects on attitude (β = 0.508, p < 0.001), and attitude had direct effects on practice (β = 0.448, p < 0.001). Additionally, there was an indirect effect of knowledge on practice mediated through attitude, with a path coefficient of 0.228 (p < 0.001). This study demonstrates that patients with diabetes mellitus and hyperuricemia exhibit relatively proficient responses to certain items within the KAP dimensions. However, it also exposes a certain degree of inadequacy in the KAP level toward disease management. Interventions should focus on improving patients' understanding of their conditions while fostering positive attitudes, ultimately translating into better self-management practices.

Developing a transition workshop for adolescents with sickle cell disease

BackgroundThe transfer from paediatric to adult care presents a significant challenge for adolescents and young adults (AYA) with sickle cell disease (SCD). Disease self-management skills have been recognized as important mediators of poor health outcomes, but transition-related skills such as scheduling appointments and understanding the shift in health care responsibilities remain under taught in the healthcare system. The purpose of this quality improvement (QI) study was to (1) understand the areas of disease self-management that AYA patients felt underprepared for, and (2) design and evaluate an educational program addressing the top unmet skills. MethodsThe Plan-Do-Study-Act (PDSA) model was implemented in a tertiary outpatient clinic between September 2020 and July 2021. Patients were surveyed during regular clinic visits to identify their priorities on disease self-management skills. Based on the results, a virtual workshop was created and administered three separate times. Feedback was collected using an electronic survey. Results‘Navigating the adult health care system’ was the top self-management skill that AYA patients (n = 39) identified needing more support with. The majority of participants (79%, n = 14) reported that the virtual workshop was excellent, with ‘appointment management’ being the most useful topic discussed. Participants also reported feeling more confident (71%) and aware (86%) of how to navigate adult care. ConclusionThis QI study showed that delivering a virtual workshop on transition skills was well received by AYA participants with SCD. The PDSA framework was useful for identifying specific knowledge gaps in transition aged AYA to help improve patient education in a well-established transition program.

The Baseline Self-Efficacy Scores to Manage Chronic Diseases Amongst Nigerian Patients with Non-Communicable Diseases are Sub-Optimal.

Nigeria is one of the developing countries with a major burden of non-communicable diseases (NCDs) without a disease self-management program in its healthcare system. Thus, this study was aimed to assess the baseline self-efficacy levels of Nigerian patients with chronic NCDs at tertiary level hospitals. This is a cross sectional study of 286 NCD patients attending tertiary level clinics from 26 July to 27 October 2023. Patients were interviewed on a 10 Self-Efficacy to Manage Chronic Disease (SEMCD) item scales that were considered suitable for the Nigerian population. The 10 SEMCD questions covered: (i) Exercise regularly scale, (ii) Help from community, family and friends scale, (iii) Communication with Physician scale, (iv) Manage disease scale and (v) Manage symptom self-efficacy domains. Data were analyzed both descriptively and statistically using Student's t-tests and Chi-square tests as appropriate. The results showed that more female (59.4%) than males (40.6%) attended clinics during the study, and the mean age of the patients did not differ between gender (P > .05). About 40% of all the patients manage their NCDs with medications alone, a trend that is similar in male and female patients (P > .05). While all the patients had a relatively lower self-efficacy scores under regular exercise scale (52%-55%) and manage disease symptoms scale (53%-55%), they tended toward higher self-efficacy scores under getting assistance from community, family, and friends (79%-80%) and communication with attending physicians (81%-85%). It is concluded that Nigeria literate NCD patients registered at tertiary level institution routine clinics are less than optimal in disease self-management care. We recommend that this study population will benefit from introduction and implementation of disease self-management program in the healthcare system.

A Systematic Review of Telehealth Applications in Endocrinology.

The prevalence of telehealth has witnessed a significant increase in various medical domains, especially in endocrinology. Telehealth brings about considerable advantages for both patients and health care professionals. However, despite these positive aspects, the growing prominence of telehealth is accompanied by certain challenges. This systematic review aims to assess the role of telehealth in endocrinology, including its applications, effectiveness, challenges, and implications for patient care. This study involved a thorough search using comprehensive techniques across databases such as PubMed/Medline, Embase, and Scopus. The studies were selected for a tailored adaptation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to enhance the clarity of our systematic review's reporting. This systematic review explores global telemedicine applications in endocrinology. Addressing various endocrine conditions, interventions utilize technology tools such as smartphones and applications, offering multifaceted utility from education and data gathering to screening and treatment. Notably, these interventions demonstrate adaptability during the COVID-19 pandemic. Positive outcomes include enhanced patient education, disease self-management, reduced complications, and improved glycemic control. However, drawbacks include the need for technical proficiency, perceived lower care quality, and potential privacy risks. These nuanced findings contribute to the discourse on telemedicine efficacy and limitations. In conclusion, telehealth holds significant potential in transforming endocrine care. While there are challenges to its implementation, the benefits it offers underscore its value as a health care delivery model.

Development of a multi-level/multi-modal intervention for health care transition preparation

AimsHealth care transition (HCT) to adult care and young adult disease self-management is a multi-step process involving three major stakeholders – the adolescent, the caregiver, and the provider. Preparation gaps exist within each of these stakeholder groups. This paper presents the development of the Intervention to Promote Autonomy and Competence in Transition-aged Youth (IPACT), a multi-level (adolescent, caregiver, provider), multi-modal (interactive skill building sessions, educational materials, videos) intervention to address gaps in all three stakeholder groups simultaneously and help support achieving the three core elements of HCT planning. MethodsEight processes were utilized to develop the IPACT intervention, including reliance on existing literature and materials, stakeholder feedback at multiple points during development, and regular support and guidance from service liaisons within each of four tertiary-care clinics targeted for this intervention within a large, urban children’s hospital. ConclusionsIPACT includes the conceptual schema, logic model, intervention curriculum components, and implementation timeline. IPACT could be used by programs to simultaneously address gaps in stakeholder HCT planning knowledge and skills.

Development of a transition program for emerging adults with type 1 diabetes: A quality improvement initiative

BackgroundEmerging adults with type 1 diabetes (T1D) struggle with glycemic management that can be exacerbated by a disorganized transition process. Substantial gaps in care have been noted during this transition period and have been shown to lead to suboptimal health care utilization, worsening glycemic management, increased incidence of serious complications, and mental health challenges. A formal transition program can help prevent gaps in care, improve disease self-management skills, decrease disease burden, and reduce diabetes complications. PurposeThere is an increased focus within the pediatric community to formally prepare young adults with T1D as they transition to the adult health care setting. The purpose of the quality improvement initiative was to develop a transition program for adolescents with T1D in a pediatric endocrinology clinic within an academic medical center. Methods/interventionsThe Institute for Healthcare Improvement Model for Improvement was used to guide this project. Got Transition's® Six Core Elements of Health Care Transition were adapted to the unique needs of the pediatric endocrinology setting by incorporating diabetes-specific transition guidelines recommended by the American Diabetes Association (ADA). A new program was designed to target patients between the ages of 16–18 offering structured transition visits focused on enhancing knowledge and skills related to the management of T1D and improving the transfer of care process between pediatric and adult providers. Key elements of the program were integrated into the electronic health record. A focus group with clinical partners was used to evaluate the acceptability and practicality of the program. ResultsTransition activity within the clinic increased from 12/32–28/32 on the Current Assessment of Healthcare Transition Activities tool. Four themes were identified from clinical partner feedback supporting the acceptability and practicality of program design. ConclusionsThe integration of the Got Transition® framework and the ADA recommendations supports clinicians in meeting the unique needs of adolescents with T1D. Incorporating the transition activities into the electronic health record facilitated integration into the workflow of the clinic providers. This initiative can serve as a model to expand transition activities across pediatric specialty care settings.

PERCEPÇÕES DO USO DE TECNOLOGIA MHEALTH POR PACIENTES EM TRATAMENTO DIALÍTICO

ABSTRACT Objective: To understand the perceptions of mobile health technology use in adherence to the treatment of patients with chronic kidney disease under hemodialysis. Method: This is a descriptive study, with a qualitative approach, carried out in a reference hemodialysis clinic in the city of Juazeiro, Bahia, Brazil. Patients with chronic kidney disease under hemodialysis who used the Renal Health application between February and October 2022 were included in the study. The data was analyzed using the content analysis method. Results: A total of 12 patients were interviewed, the majority of whom were male, with an average age of 35.3 (±9.7) years and an average of 2.7 (±1.5) years of hemodialysis. After analyzing the content, two thematic categories emerged: “Support from mHealth technology in treatment management” and “Suggestions for improving the application”, in which patients describe how the application is practical, favors the storage of information related to treatment, such as weight, water intake and medication taking times. In addition to generating graphs of the exams carried out monthly, it provides strategies that can promote disease self-management and consequently better adherence to treatment. Conclusion: The Renal Health application proved to be a useful tool capable of enhancing knowledge about chronic kidney disease and helping patients better manage their diet, fluid control and taking prescribed medications.

Association of chronic disease self-management with health locus of control study on diabetic patients

Aims: It was aimed at determining the relationship between chronic disease self-management and health locus of control in diabetic patients. Methods: Data were collected by the face-to-face survey method from diabetic patients over the age of 18 who were receiving inpatient treatment in a public hospital. Results: According to the research results; The total score average of the participants from the chronic disease self-management scale was moderate (mean: 64.11 Min: 21-Max: 105), w but treatment compliance (mean:15.81 Min:5-Max:25) ) was found to be at a medium level. The participants' internal locus of control score (mean: 25.08, Min: 9-Max: 36) was found to be higher than other sub-dimensions. As a result of the correlation analyses carried out; statistically significant relationships were obtained between chronic disease self-management total and sub-dimensions and health locus of control sub-dimensions. Conclusion: Statistically significant relationships were obtained between the chronic disease self-management total and sub-dimensions and the health locus of control sub-dimensions. It can be said that the participants have more internal locus of control beliefs.

Wearable Devices for Supporting Chronic Disease Self-Management: A Scoping Review (Preprint)

Wearable Devices for Supporting Chronic Disease Self-Management: A Scoping Review (Preprint)

Healthy Aging in Algoma: Tests of Change Program

Introduction: In Algoma District, Ontario, Canada, approximately 25% of the population is 65 years of age and older. The Ontario Provincial Geriatrics Leadership Office (2020) predicts that by 2040 this number will increase to 32% and that 29% of older adults will be living with frailty. In February of 2022, Tests of Change (ToC) Program work commenced to bring an integrated care approach to healthy aging in Algoma. Healthcare member organizations of the Algoma Ontario Health Team (AOHT) and community patient, family, and caregiver advisors identified older adults living with frailty as the target population. A driver diagram of change ideas was conceptualized to support improving care for the identified population. To enact the recommended changes, three priority projects - Outpatient Geriatric Rehabilitation Capacity, Coordinated Access to Geriatric Services and Early Frailty Identification - complement each other with the common purpose of improving early frailty intervention and increasing access to the most appropriate care.&#x0D; Aims: The ToC Program entails:&#x0D; Embedding a frailty screening tool into electronic medical records for use in primary care;&#x0D; Initiating coordinated access to geriatric services leveraging eReferral and a common platform for electronic referral management; and&#x0D; Designing an outpatient geriatric rehabilitation program.&#x0D; This Program aims to advance the following elements:&#x0D; Design upstream engagement strategies (e.g., screening, prevention, disease self-management) for the target population;&#x0D; Increase patient access to the appropriate level of care; and&#x0D; Transform care coordination, transitions and recovery at home.&#x0D; Highlights: The AOHT has engaged partners from across the continuum of care who provide services for frail older adults. Partners include: community support services, home and community care support services, primary care, acute care, specialized geriatric services, and patient advisors. These critical partners assume leadership roles in program design, implementation and evaluation.&#x0D; Conclusions: Early frailty identification can improve quality of life, increase intervention success, and delay the need for specialist care. This program is predicated on the establishment of foundational processes enabled by digital tools to identify frailty early, streamline referrals for access to the most appropriate geriatric services, and provide patients with the opportunity to fully participate in interventions such as outpatient geriatric rehabilitation to increase their ability to live independently in the community. By taking an integrated collaborative approach to program planning and execution, overall patient outcomes will be improved.&#x0D; Transferability: The WHO Guidelines on Integrated Care for Older People (ICOPE) recommend advancing integrated care through community collaboration, a patient centered approach and supportive leadership. In 2019, the Ontario Health Team (OHT) model was introduced provincially as a way for healthcare providers to partner to deliver coordinated, integrated care. Of significance, several of the 54 approved OHTs have identified older adults living with frailty as a target population. Globally, as older adults are living longer lives, it is anticipated that there will be proportionally more older adults living with frailty. Through collaboration and sharing of the ToC program results, program scalability can be achieved at the OHT level and support the global knowledge base on efforts to strengthen integrated care for older adults.

IA model for the creation of automatic and personalized health literacy plans for home care services and protocol for its validation

Background: Health Literacy (HL) is considered a social determinant of health with a direct and significant impact on health-related quality of life, especially in groups of elderly, polymedicated or chronically ill persons. According to the WHO, HL implies achieving a level of knowledge, personal skills and confidence that allows the adoption of measures to improve health through a change in lifestyle. It is a concept that combines elements of health and education. HL is the result of health education. In fact, a poor understanding of health recommendations or instructions is related to poor disease self-management and limited use of preventive resources. Furthermore, a low level of HL translates into an increase in (a) avoidable hospitalizations, (b) healthcare costs and (c) mortality rates. Artificial intelligence (AI) can help create personalized HL plans for each patient automatically. Moreover, thanks to digital education platforms these plans can be delivered and monitored remotely and digitally, reducing the resource of professional hours. The application of AI in health literacy is especially interesting in home health services, where the resources of professionals are scarce and care falls mainly on the family and the patient him/herself.&#x0D; Aim: The aim of this study is to develop an IA model for the creation of automatic and personalized HL plans for home care settings that can be consumed by families through a digital tool. The protocol for validation of the HL plans created by the model is also presented.&#x0D; Method: At the beginning, (1) a comprehensive geriatric assessment is performed that identifies the needs and capabilities of the care ecosystem (patient-caregiver) in a model of comprehensive person-centered care in the home care setting. (2) After analysis of the data collected in the assessment using validated diagnostic algorithms the IA model automatically generates an individualized training itinerary HL plan adapted to each user profile. (3) Using nursing indicators defined in the NNN taxonomy (NANDA, NOC, NIC) we measure at the beginning and at the end of the HL plan: (a) the knowledge acquired; (b) the change in behavior/behavior and (c) objective results of the health status.&#x0D; Main Results: We present an AI model for automated and scalable HL plan creation for home care settings. This model has the potential to improve the HL of the 65+ population (chronicity, complexity, multi-pathology, dependency, frailty, pre-frailty or autonomy) and their informal caregiving ecosystem (non-professional caregivers) in the home setting, especially if long-term care is present. The learning programs created for the HL plan were carried out under a rigorous protocol based on criteria of accessibility and scientific evidence.&#x0D; Conclusions: Thanks to the protocol, it will be possible to validate the impact of the HL plans created by the IA model on both the patient and the caregiver. The IA model is currently in the process of validation but shows promising results in reducing the time spent on direct intervention by professionals and improving the population's accessibility to HL plans thanks to the IA model.